More than 300,000 Ontarians are waiting for breast cancer screening as the pandemic continues to stress the province’s health care system, the most recent data from Ontario Health shows.
“There are a number of challenges that were are facing right now when we are trying to get patients to surgery for breast cancer. The first is simply getting a timely diagnosis,” says Dr. Timothy Hanna, an oncologist and clinician at Kingston Health Sciences Centre.
There was a 97 per cent drop in screening mammograms at the beginning of the pandemic, according to numbers provided to CityNews by Ontario Health. There were just 4,020 mammograms conducted through the Ontario Breast Screening Program (OBSP) between March 15 and May 30, 2020, compared to 156,287 tests the same time a year prior.
At the end of the first wave, healthcare providers were allowed to re-start routine screenings, but screening levels never caught up to prior years.
“In 2020, there were 400,318 screening mammograms completed through the OBSP. In comparison, there were 706,363 screening mammograms completed through the OBSP in 2019,” a spokesperson for Ontario Health tells CityNews. “There is a backlog of over 300,000 mammograms as of December 2020, reflecting the screening that could not be undertaken from March to December 2020 due to COVID-19.”
The agency says screenings are still being impacted in the third wave, and may be scaled back depending on the state of local healthcare resources.
“We recognize that this is a very difficult time and particularly distressing for people waiting to receive the cancer screening they need,” the health agency adds.
One in every eight women is likely to develop breast cancer in her lifetime, according to the Breast Cancer Society of Canada. Last year, the society estimates that 25 per cent of all women’s cancer diagnoses were for breast cancer, and 13 per cent of all women’s cancer deaths were due to breast cancer.
The delays in diagnosis continue all the way to surgery, Hanna says. Appointments for pre-operative diagnostic tests and consultations with anesthesiologists are taking longer as specialists are being pulled into the fight against the pandemic.
“We only have so many healthcare providers: nurses, anesthetists, surgeons, OR rooms, etcetera, in order to do even these surgeries,” he says.
Even getting a patient a recovery bed is a challenge.
“We are seeing very high levels of ICU cases of COVID-19 on top of the usual case volumes,” he says. “There could be strains on the system that limit the number of women who have breast cancer who are able to undergo those surgeries, if they do require intensive care unit capacity.”
The staffing and beds issue isn’t just in hotspots, Hanna says, but also in communities across the province which are taking COVID-19 patients transferred from overloaded hospitals in other regions.
“For example, here at Queen’s at the Kingston Health Sciences Centre,” he notes, “we see [resource] redeployments even here that can certainly affect our capacity to take care of other patients.”
The issue isn’t limited to breast cancer. In Ontario, there was an immediate 60 per cent drop in all cancer surgeries at the beginning of the pandemic. While that number recovered somewhat by June 2020, there were still nearly 36,000 fewer cancer surgeries performed in the province in that time, found a study by a Sunnybrook Hospital researcher. Also, more surgeries were considered urgent.
There is a backlog of more than 257,000 surgeries of all types in the province, with thousands added every week, further choking the healthcare system. The Ontario government has budgeted $300 million in 2021-2022 to help clear the province’s surgical backlog, part of a $600-million multi-year investment. The funding will help hospitals keep operating rooms open late, and it will also give healthcare providers the cash to tackle the backlog in MRI and CT scans. The province is also planning a centralized surgical waitlist to help match patients with surgeons who have shorter wait times.
Ontario Health says it is possible to clear the backlog of breast cancer screenings. In February – before the onset of Ontario’s third wave – Sunnybrook Hospital announced it had cleared its own backlog and was encouraging people to book appointments. At the same time it estimated that hundreds of people around the province have been going about their daily lives with undiagnosed breast cancer.
The third wave, which public health officials say they hope is Ontario’s last, will play a deciding factor in whether many of these people are ultimately able to access screening, says Ontario Health.
“We will be able to catch up over time, but it will depend on how long COVID-19 impacts the health care system.”