Knowledge to Action

Improving local therapy for young women with breast cancer across Canada

Background
Young women with breast cancer are known to have a worse prognosis than older women with this disease. Treatment delay, which has been associated with a more advanced stage at presentation and in some studies with an increased risk of cancer recurrence, may be one factor influencing outcomes. Alternate surgical treatments may also have varying survival outcomes. The equivalence of breast conserving therapy and mastectomy has been established through numerous randomized trials; however, these studies have not been specific to young women. Furthermore, the variation in the mastectomy rate across Canada and the high rate of re-excision in young patients indicates that there are gaps in the pre-operative selection of patients suitable for breast conserving treatment. Improved pre-operative assessments will translate into an improved selection of women for breast conserving treatment, potentially limiting the number of unnecessary reoperations.  In order to improve patient outcomes, we must develop a better understanding and initiate steps to address modifiable mechanisms of this disease.

What is the goal of this sub-project?
The main goal of this sub-project is to understand the frequency, predictors and impact of treatment delay for young women diagnosed with breast cancer. The investigators are also planning on evaluating the impact of breast conserving treatment on the survival of young women, and optimizing multi-disciplinary local therapy of primary breast cancer care for young women.

What is the design of this sub-project?
This study will consist of three smaller studies.

  1. Study I will be evaluate three components of time to evaluate (i) time from first symptoms to presentation to a health care provider (HCP), (ii) time from presentation to a HCP to diagnosis, and (iii) time from diagnosis to treatment.
  2. Study II will focus on developing a retrospective cohort of over 3,000 previously diagnosed young women with breast cancer from across Canada. This cohort will be comprised of merged data from two existing retrospective provincial cohorts (Ontario, British Columbia) and retrospective data collected via chart abstraction from Alberta, Manitoba and Quebec.
  3. Study III will use the “knowledge to action cycle” conceptual framework to enhance the coordination and optimization of multidisciplinary care for young women with breast cancer  at each RUBY participating site.

Why is this important?
Successful completion of this study will (i) provide targets for interventions to reduce treatment delay relevant to the Canadian healthcare system, (ii) provide sufficient evidence to determine the safety of breast conserving treatment in young women with breast cancer, (iii) lead to improved multi-disciplinary surgical care for young women with breast cancer, and (iv) set a national standard for surgical quality initiatives in breast cancer, for both patient and process-level outcomes across Canada.

Who are the other investigators on this project?

  • Dr. Marco Simunovic (Co-Principal Investigator), Juravinski Cancer Clinic
  • Dr. Scott Tyldesley (Co-Principal Investigator), British Columbia Cancer Agency
  • Dr. Steven Latosinsky (Co-Investigator), St. Joseph’s Health Care London
  • Dr. Pamela Hebbard (Co-Investigator), Winnipeg Regional Health Authority
  • Dr. Erin Kennedy (Co-Investigator), Mount Sinai Hospital
  • Dr. Rinku Sutradhar (Co-Investigator), Institute for Clinical Evaluative Sciences
  • Dr. Jeffrey Cao (Co-Investigator), London Health Sciences Centre
  • Dr. Julie Lemieux (Co-Investigator), Centre hospitalier affilié universitaire de Québec
  • Dr. Marcy Winget (Co-Investigator), Alberta Cancer Foundation
  • Dr. Carol Russell (Collaborator), Alberta Health Services

Fully affiliated with

A member of

Council of Academic Hospitals of Ontario (CAHO)