Maychai Brown

The long period of time it takes to diagnose breast cancer is a recognized problem in Quebec and elsewhere. Often women experience weeks of agonized waiting between the discovery of that unusual hard spot in their breast before learning whether it is benign or malignant. Although the Canadian Breast Cancer Screening Initiative declared, in 1999, that a wait time of seven weeks between screening and biopsy was medically acceptable, common sense says that seven weeks of anxiety takes its toll on a woman’s well-being.

What would it take to telescope weeks of waiting into just 24 hours? Dr. David McCready, a surgeon at The Princess Margaret Hospital in Toronto, envisioned a one-stop centre where clinical exams, mammograms, ultra-sounds, and biopsies could be performed and evaluated on the same day, drastically reducing the average 33-day wait period in Ontario. The stumbling block for a 24-hour diagnosis was the time it took to prepare tissue samples for a pathologist. Dr. McCready found the solution in a piece of equipment from Japan, the X-Press Rapid Tissue Processor, which prepares slides from cores of biopsied tissue within a few hours.

Four years ago, and with a donation of $1 million from Toronto’s ‘Week-end to End Breast Cancer,’ Dr. McCready created a pilot project at the Princess Margaret Hospital, to test his concept. Purchase of the $280,000 US tissue processor enabled pathologists to examine tissue and provide diagnoses of both the type and stage of breast cancer within hours of the biopsy. The one-day-a-week clinic for referred patients was so successful that it was expanded to two days a week.

According to a spokeswoman for the clinic, most patients receive their diagnosis within one day. In the remaining cases, there is a delay either because further stains may be needed for a tissue sample, or a surgical excision will be needed rather than the quicker core biopsy.

Even though the majority of patients leave with a diagnosis of breast cancer, they are relieved to walk out the door at the end of the day with a solid treatment plan in hand. The patients may then choose to return to the Princess Margaret to start the process or go to another hospital closer to home.

In May 2009, husband and wife philanthropists Emmanuelle Gattuso and Allan Slaight donated $12.5 million, enabling the clinic – renamed The Gattuso Rapid Diagnostic Centre – to open three days a week. With the increase in clinic hours it is necessary to employ a team of four pathologists, one of whom must be available to examine slides.

What would it take to telescope the weeks of waiting into just 24 hours?

Dr. McCready plans to expand the clinic to a full-time centre by 2013, with the capacity to receive 3,000 referrals a year. Another $12.5 million will be needed to cover the costs of opening full-time and Allan Slaight has volunteered to match any donation given to the Princess Margaret Foundation for the clinic. This expansion will require hiring additional radiologists.

Although women have been happy with the speedy diagnosis obtained at the clinic, some have found it difficult to absorb new information in such a short time. The clinic addresses this by using specially trained Advance Practice Nurses (APNs) to walk patients through the tests and to answer their questions. One of the goals of the clinic is “to offer a caring and supportive environment throughout the diagnostic process” according to clinic coordinator Bridgette Lord, APN.