B.C. patients worry as breast cancer screening wait times climb

Over the course of her life, Marliese Dawson, now 51, has seen five family mem‐ bers get diagnosed with breast cancer.

So since her mid-30s, Dawson has been diligent about undergoing breast cancer screening. Because she has dense breasts, which puts her at heightened risk, she undergoes alternating di‐ agnostic mammograms and screening ultrasounds every six months on the advice of her family doctor and radiol‐ ogist.

But her most recent at‐ tempt to book an appoint‐ ment left Dawson concerned that a backlog of breast imaging appointments in B.C. will delay the screenings she's undergone for years.

First, her diagnostic mam‐ mogram was delayed from October to December due to a lack of available appoint‐ ments. When she called to book her screening ultra‐ sound for June, she was told they could only book four months in advance. And when she called in the begin‐ ning of March, she was told the earliest available slot was December - a full year after her last screening.

"I was already behind there. So it seems like it's get‐ ting further and further," she said.

"I'd obviously like to keep on my schedule because the radiologist has recom‐ mended this as the best way to keep me safe. And I'm not able to do that."

Dawson isn't alone in her concerns. The B.C. Radiologi‐ cal Society and doctors who refer patients across the province say delays in book‐ ing and processing breast imaging are worsening, leav‐ ing patients navigating a complex system that is in‐ creasingly understaffed and underfunded.

WATCH | Current breast imaging wait times in B.C. are 'very difficult': physici‐ an:

Brenda Farnquist, presi‐ dent of the Society and a practising radiologist at Kelowna General Hospital, said financial concerns, staff shortages and a growing de‐ mand for screening are push‐ ing wait times for breast imaging in B.C.

"It's very anxiety-provok‐ ing. Can you imagine know‐ ing you have a palpable ab‐ normality in your breast and you can't get an imaging study? We know this is hap‐ pening," she said.

"Patients are just besides themselves, and some of the places providing these ser‐ vices don't even have the hu‐ man resources to deal with all the phone calls they get."

Struggles to find ap‐ pointments

Checking for breast can‐ cer can involve a number of different screening and diag‐ nostic exams. The B.C. Can‐ cer agency offers regular screening mammograms for women without breast con‐ cerns. Women whose mam‐ mograms show a lump or other abnormality can be sent for a diagnostic mam‐ mogram.

Women like Dawson, whose breasts show high density, putting them at in‐ creased risk for breast can‐ cer, can be sent for a screen‐ ing ultrasound, though only one clinic in Vancouver cur‐ rently offers that service.

Dedeshya Holowenko, a physician at Westcoast Wom‐ en's Clinic in Vancouver, said her clinic has bumped up against increasingly long de‐ lays as staff work to book pa‐ tients in for critical follow-up screenings.

"I've had patients where I've done an exam, found a lump, and looking for a diag‐ nostic mammogram having to phone three or four differ‐ ent locations to get a reason‐ able time because the first appointment that we're given is six months later, and this is with a palpable lump," she said.

"Any woman who has been told that their mammo‐ gram is abnormal goes through a spiral of the worst case scenario, and it's hard to think about anything else."

B.C.'s Ministry of Health did not respond to a CBC News request for informa‐ tion about how long it cur‐ rently takes to book a screen‐ ing or diagnostic appoint‐ ment.

But Farnquist said she's heard of wait times spanning six months for some appoint‐ ments, and patients in rural parts of the province can face even lengthier waits.

'It's not just for me, it's for everybody'

Holowenko said the delays in the current system are multilayered, and not limited to breast cancer screening.

Because B.C.'s screening and diagnostic programs aren't synced, the onus in en‐ suring screenings are booked and managed falls to patien‐ ts and their doctors - an issue aggravated by a severe short‐ age of family doctors in B.C. Temporary shutdowns during the COVID-19 pandemic worsened pre-existing back‐ logs.

Farnquist said a critical shortage of medical imaging technologists and radiolo‐ gists that practice breast imaging is also contributing to the issue. Publicly funded community imaging clinics are also under financial stress, she said.

"It's becoming very diffi‐ cult for some of these clinics to even keep updated equip‐ ment. So some are even choosing to not replace the mammography equipment they have once it breaks down, because it's just not worth it," she said.

Starting in 2018, B.C. be‐ gan providing breast density information with screening mammogram results, making it the first Canadian province to do so. The change allows patients and their doctors to more easily assess their risk level, but has also increased the number of patients seek‐ ing additional screening.

Holowenko and Farnquist say while it's good news that more women are seeking fur‐ ther screening, it's also in‐ creased the demand for breast ultrasounds in a sys‐ tem already struggling to keep up.

"Prior to that, breast ultra‐ sound time was only for a di‐ agnostic on a palpable lump. So when you start adding the numbers of women that have breast density into the equation, it's just adding more demand," said Holowenko.

Dawson said because of her family history, she's long since learned to manage the anxiety around her personal risk, and feels that for years, B.C.'s health-care system has helped her manage her case. But she worries that wait times could only continue to grow.

"The receptionist said to me, call back at the begin‐ ning of May to see if we can get you in for any cancella‐ tions. So I'm hopeful that that's what's going to happen," she said.

"But I'm upset that the system is like this because it's it's not just for me, it's for everybody."