In less than two years, the Breast Care Centre at St. Joseph’s Hospital has significantly cut wait times for patients facing breast cancer while also doubling the number of patients being assessed at the centre.
Since 2010, when the centre was created, the wait from the time of diagnosis to breast cancer surgery has dropped from 16 weeks to 10 weeks, with work ongoing to further reduce wait times.
"This is a tremendous achievement and a direct result of bringing together our dynamic interdisciplinary breast care team of surgeons, radiologists, medical radiation technologists, nurse navigators, advanced practice nurses, social workers, and others in one specially-designed location to focus on the best in breast care," says Karen Perkin, Vice President, Acute and Ambulatory, Professional Practice/ Chief Nurse Executive. "Much work has been done by this team and with our care partners to improve access for patients and smooth the care journey."
Those efforts include:
- A one-number central referral process. A nurse practitioner reviews all new referrals, triages them and books the appropriate appointments to streamline access to care and reduce wait times for women most in need.
- Same day imaging and biopsy so that patients with an abnormal mammogram screening receive the necessary imaging and breast biopsy in one day.
- Expanded hours for breast imaging to accommodate more patients each day. Currently about 110 patients receive breast imaging daily at the centre.
- Onsite radiation oncology consultation to enhance convenience for breast patients, who are now able have their initial meeting with a radiation oncologist during their visit to St. Joseph’s. (Chemotherapy and radiation therapy remains at London Health Sciences Centre.)
- A multidisciplinary approach, including nurse navigators and advanced practice nurses who help coordinate care from the time an abnormality is detected throughout the care journey.
St. Joseph’s Breast Care Centre, which officially opened in May 2012, is the primary location for breast imaging, diagnostic and surgery services in London. The purpose of amalgamating these services at St. Joseph’s was to improve access and coordination of care, education and support for those requiring breast care. Currently, about 23,000 mammograms, 7,200 breast ultrasounds, 700 breast MRI scans, and 50 MRI-guided breast biopsies are performed each year at the Breast Care Centre, along with about 850 breast surgical procedures.
Forging New Ground in Breast Care
With a strong focus on research, clinicians at St. Joseph’s Breast Care Centre are striving to improve care for the patients they see. Among them are three radiologists whose landmark study may lead to a significant drop in unnecessary mammograms worldwide for women with a suspicious lump in their breast.
Currently, when a lump is discovered by a woman or her physician within one year of negative mammogram, both a repeat mammogram and an ultrasound are performed. This is the traditional approach around the world although there are no set standards, explains radiologist Dr. Anat Kornecki, Breast Imaging Medical Director and Associate Scientist at Lawson Health Research Institute.
But in studying the cases of about 600 women between 2005 and 2012, Dr. Kornecki and colleagues Dr. Ilanit Ben-Nachum, clinical fellow and Lawson trainee, and Dr. Stephanie Leung, radiology resident and Lawson trainee, found that ultrasound was better than repeat mammograms to assess an abnormality found within one year of a negative mammogram. It’s the first study to compare ultrasound to mammogram in such cases.
"What this means is that we don’t have to start with a mammogram when a woman comes in with a lump within in a year of a negative mammogram," says Dr. Kornecki. "We can start with ultrasound and only add in mammogram if, based on the ultrasound, there is a need to do so."
For patients, this means reduced exposure to unnecessary radiation, less discomfort by avoiding a mammogram, and better use of their time. Eliminating a repeat mammogram is also cost effective and reduces disruptions in routine mammogram screening for women.
"The hope is that the findings eventually influence practice worldwide and result in a significant drop in unnecessary mammograms," says Dr. Kornecki.
Towering Show of Support
In addition to its unique integrated approach to care, there is something else novel about St. Joseph’s Breast Care Centre. It can be found perched outside St. Joseph’s Hospital and looming large – a giant pink construction crane. It will remain a fixture at the corner of Richmond and Grosvenor streets for the next year as a show of support for St. Joseph’s role in breast care from EllisDon, which is building the hospital’s new addition at that corner.
"We’ve been working on the redevelopment of St. Joseph’s Hospital for years and enjoy an excellent partnership with St. Joseph’s," explains Brian Waltham, Senior Vice President, Area Manager, EllisDon. "We wanted to do something unique to show our support for the organization and what could be more unique than a pink crane?"
The crane’s grand arrival came just days before St. Joseph’s Health Care Foundation’s inaugural Bust a Move for Breast Health event on April 6, which raised more than $1 million for the centre. More than 400 people took part in this group fitness extravaganza, including several teams of staff from across St. Joseph’s.