A Sudbury surgeon, who operates on women with breast abnormalities, is speaking out about Health Sciences North’s plan to close its Breast Screening Assessment Clinic, saying it will hurt women and result in poorer health outcomes.
Dr. Rachelle Paradis says ending the program will result in longer wait times to see surgeons for women who have had abnormal mammograms, ultrasounds and other diagnostic tests. The breast assessment clinic, which has been operating for 18 years, is a one-step centre for women with breast issues. They can have mammograms and other diagnostic tests there, and if there’s an abnormality, they are triaged, directed to have biopsies and quickly referred to a surgeon.
Paradis recognizes HSN has significant financial restraints and is obligated by the Health ministry to meet budget requirements. So far, hospital administrators have achieved savings by downsizing the number of managers and other employees, and finding efficiencies that don’t affect clinical care. But ending this program will directly hurt patients, mostly women, the surgeon said.
HSN’s David McNeil, senior vice-president in charge of patient experience and digital transformation, insists the program is not being eliminated, but rather is being trimmed to help address the $11.1-million deficit HSN has to correct.
The biggest change in the program is that surgical consultation for patients will no longer be done at the breast assessment clinic at the former Memorial Hospital site. It will now be done in the offices of surgeons who are juggling patients requiring any number of surgical procedures as well as breast operations.
McNeil stressed that HSN’s breast screening program is not being cut, but changes are being made to the services available to women at the clinic. He also points out HSN has shorter waits than the provincial average from when a patient is seen by a surgeon and surgery is discussed, to when operations are performed. HSN’s average wait time in that area is 22 days versus 30 days provincially.
But Paradis and other critics of the move to downsize the breast assessment program say that is not where wait-times will increase for women. Higher wait-times will occur between the time a mammogram or other diagnostic procedure indicates an abnormality and the time the patient is seen by a surgeon.
With the clinic operating the way it does now, surgeons can quickly recommend biopsies and nursing staff can arrange for those to be done before patients see a surgeon, often in a very short time.
Cutting the program will turn the clock back 18 years to when the Breast Screening Assessment Clinic began as a pilot project, said Paradis. At that time, it was taking 180 days on average for women to be seen by a surgeon.
“That’s what precipitated the development of the breast clinic,” she said this week. The goal of the clinic was to shorten the time between an abnormality being identified “and things being done.”
But McNeil said a nurse will continue to help patients navigate the system, directing them after an abnormality is detected.
Appointments for other surgical procedures are booked months in advance, said Paradis, so surgeons may not be able to accommodate the volume of patients who will be directed to them without expanding their offices and hiring more staff.
The program, as it is operating now, costs about $270,000 annually. In a meeting with Mark Hartman, vice-president of cancer services and clinical support, to discuss whether the breast assessment clinic’s budget could be cut to $70,000 and still function in some way, Paradis said the suggestion was not accepted.
Carolyn Jackson is a retired registered nurse who was in on the ground floor of developing the breast screening assessment clinic, and managed it for several years. The period of the highest anxiety for women fearing breast cancer occurs after they have been told they have a breast abnormality and when they see a surgeon, said Jackson.
Before the program began, women were waiting up to six months for a diagnosis and it was causing them tremendous stress. In some cases, women couldn’t work or even take care of their families because they were paralysed with fear about what they would hear when they visited a surgeon.
“The outcomes were very poor and more women died of the disease,” said Jackson.
Since breast assessment clinics were opened in many Ontario cities, there have been improvements in mortality rates due to breast cancer, she said.
“We’ve closed that window from the time of (screening) to diagnosis and treatment,” said Jackson, “and by closing that window, women are living longer and the stats prove that.”
Jackson said the breast screening assessment clinic was never funded, but relied on the hospital’s largesse for money. It opened under the guidance of Dr. Robert Corringham, who was recruited from the United Kingdom to be chief executive officer of what was then the cancer centre.
“Right away, it changed outcomes, right away,” said Jackson. “And women were getting a diagnosis in less than 30 days.”
But the program has been “on slippery ground” for years and there have been attempts to fold it before, but those advocating for it to remain open were successful.
Still, says Jackson, “you can’t run a Cadillac on a Chevy budget. The (Health) ministry has always expected Sudbury to do that.”
She is concerned about the wait women will have between an abnormality being found and the time it will take to see a surgeon, especially those patients who don’t have a family doctor, as they may have to be referred to a surgeon.
Paradis said she and two other surgeons are trying to buy time to respond to the plan to cut the program. All three feel strongly that closing it is a mistake. McNeil said he and Hartman will meet soon with surgeons to discuss restructuring the clinic.
In the meantime, McNeil wished to provide some “surety” to the community that the breast screening program won’t be affected and that there will be someone to help patients navigate the system if tests show a breast abnormality.
Cutting services is one of the difficult decisions hospital administrators have to make as they work to balance hospital budgets, he said. HSN personnel will monitor the time from when a patient sees a surgeon to surgery. He agreed it would also be important to monitor the length of time it takes between detecting an abnormality and the visit with a surgeon.
Nickel Belt MPP France Gélinas is the New Democrats’ Health critic. She said women have already contacted her constituency office, alarmed that the breast screening assessment clinic is being closed.
The current system of grouping breast health services together at the breast screening assessment clinic at the old Memorial Hospital site is “more humane” than a process in which women may get news they have a breast abnormality and then have to wait to discuss where they go next.
The stress of having to navigate the system on top of the stress of being told you have a breast abnormality will be tremendous for many women, she said.
Gélinas said she does not consider the closing of the breast screening assessment clinic a done deal.
“I don’t intend to give up” on trying to save it, she said.
(If you have had an experience at HSN’s breast screening assessment clinic and would like to talk about it, contact Carol Mulligan at firstname.lastname@example.org.)
Carol Mulligan is an award-winning reporter and one of Greater Sudbury’s most experienced journalists.