Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont.
CMAJ Open. 2022 Apr 5;10(2):E313-E330. doi: 10.9778/cmajo.20210254. Print 2022 Apr-Jun.
In Ontario, patients with breast cancer typically receive their diagnoses through the Ontario Breast Screening Program (OBSP) after an abnormal screen, through screening initiated by a primary care provider or other referring physician, or through follow-up of symptoms by patients' primary care providers. We sought to explore the association of the route to diagnosis (screening within or outside the OBSP or via symptomatic presentation) with use of OBSP-affiliated breast assessment sites (O-BAS), wait times until diagnosis or treatment, health care use and overall survival for patients with breast cancer.
In this retrospective cohort study, we used the Ontario Cancer Registry to identify adults (aged 18-105 yr) who received a diagnosis of breast cancer from 2013 to 2017. We excluded patients if they were not Ontario residents or had missing age or sex, or who died before diagnosis. We used logistic regression to evaluate factors associated with categorical variables (whether patients were or were not referred to an OBAS, whether patients were screened or symptomatic) and Cox proportional hazards regression to identify factors associated with all-cause mortality.
Of 51 460 patients with breast cancer, 42 598 (83%) received their diagnoses at an O-BAS. Patients whose cancer was first detected through the OBSP were more likely than symptomatic patients to be given a diagnosis at an O-BAS (adjusted odds ratio 1.68, 95% confidence interval [CI] 1.57 to 1.80). Patients screened by the OBSP were given their diagnoses 1 month earlier than symptomatic patients, but diagnosis at an O-BAS did not affect the time until either diagnosis or treatment. Patients referred to an O-BAS had significantly better overall survival than those who were not referred (adjusted hazard ratio 0.73, 95% CI 0.66 to 0.80).
Patients screened through the OBSP were given their diagnoses earlier than symptomatic patients and were more likely to be referred to an O-BAS, which was associated with better survival. Our findings suggest that individuals with signs and symptoms of breast cancer would benefit from similar referral processes, oversight and standards to those used by the OBSP.
在安大略省，乳腺癌患者通常在异常筛查后通过安大略省乳腺癌筛查计划（OBSP）、初级保健提供者或其他转诊医生发起的筛查或患者初级保健提供者对症状的随访获得诊断。我们旨在探讨诊断途径（OBSP 内或外筛查或通过症状表现）与使用 OBSP 附属乳房评估点（O-BAS）、诊断或治疗前的等待时间、医疗保健使用和乳腺癌患者总体生存率之间的关系。
在这项回顾性队列研究中，我们使用安大略省癌症登记处确定了 2013 年至 2017 年间被诊断患有乳腺癌的成年人（年龄 18-105 岁）。如果患者不是安大略省居民或年龄或性别缺失，或在诊断前死亡，则将其排除在外。我们使用逻辑回归评估与分类变量相关的因素（患者是否转诊至 O-BAS，患者是否筛查或症状性），并使用 Cox 比例风险回归识别与全因死亡率相关的因素。
在 51460 名乳腺癌患者中，42598 名（83%）在 O-BAS 获得诊断。通过 OBSP 首次发现癌症的患者比症状性患者更有可能在 O-BAS 获得诊断（调整后的优势比 1.68，95%置信区间[CI] 1.57 至 1.80）。通过 OBSP 筛查的患者比症状性患者提前 1 个月获得诊断，但在 O-BAS 获得诊断并不影响诊断或治疗的时间。转诊至 O-BAS 的患者总体生存率明显优于未转诊的患者（调整后的风险比 0.73，95%CI 0.66 至 0.80）。
通过 OBSP 筛查的患者比症状性患者更早获得诊断，并且更有可能被转诊至 O-BAS，这与更好的生存相关。我们的研究结果表明，有乳腺癌症状和体征的个体将受益于与 OBSP 相同的转诊流程、监督和标准。
