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Breast Cancer Control in Canada

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Breast Cancer Control in Canada SYSTEM PERFORMANCE REPORTS Breast Cancer Control in Canada A SYSTEM PERFORMANCE SPECIAL FOCUS REPORT SEPTEMBER 2012 Breast Cancer Control in Canada A SYSTEM PERFORMANCE SPECIAL FOCUS REPORT SEPTEMBER 2012 This document has been made possible through a financial contribution from Health Canada, through the Canadian Partnership Against Cancer. The views expressed herein represent the views of the Canadian Partnership Against Cancer. The contents of this publication may be reproduced in whole or in part, provided the intended use is for non-commercial purposes and full acknowledgement is given to the Canadian Partnership Against Cancer. Suggested citation: Canadian Partnership Against Cancer (2012). Breast Cancer Control in Canada: A System Performance Special Focus Report. Toronto, Canadian Partnership Against Cancer. The Canadian Partnership Against Cancer 1 University Avenue, Suite 300 Toronto, Ontario, Canada M5J 2P1 Tel: 416.915.9222 Toll-free: 1.877.360.1665 www.partnershipagainstcancer.ca Aussi offert en français sous le titre : Lutte contre le cancer du sein au Canada : Rapport thématique spécial sur le rendement du système A SYSTEM PERFORMANCE SPECIAL FOCUS REPORT Canadian Partnership Against Cancer ii The production of this report was made possible through Editorial Panel for Breast Cancer Control in Canada: the dedicated efforts of the members of the pan-Canadian A System Performance Special Focus Report System Performance Steering Committee and Technical Dr. Kelly Dabbs Working Group for System Performance (see Appendix I Clinical Professor, Division of General Surgery, University of Alberta for a list of members) and the considerable data collection Dr. Elizabeth Eisenhauer efforts of staff from the 10 provincial cancer agencies Head, Department of Oncology, Queen’s University and programs. Dr. Christine Friedenreich Senior Research Scientist/Epidemiologist; AI-HS Health Senior The Partnership would also like to acknowledge Statistics Scholar; Adjunct Professor and ACF Weekend to End Women’s Canada, in particular the Health Statistics Division, for Cancers Breast Cancer Chair, Faculties of Medicine and Kinesiology, University of Calgary providing access to data, vetting output, and providing estimates of incidence, mortality and survival; the Canadian Dr. Eva Grunfeld Giblon Professor, Department of Family and Community Medicine, Breast Cancer Screening Initiative; and the Canadian University of Toronto; Clinician Scientist, Ontario Institute for Institute for Health Information for providing data and Cancer Research analysis for mastectomy and breast conserving surgery Dr. Verna Mai utilization in Canada. Expert Lead, Screening, Canadian Partnership Against Cancer; Assistant Professor, Department of Public Health Sciences, The report was prepared by the System Performance University of Toronto and Surveillance team at the Canadian Partnership Dr. Steven Narod Against Cancer. The team includes Dr. Heather Bryant, Senior Scientist and Director, Familial Breast Cancer Research Unit, Vice-President, Cancer Programs, Clinical and Population Women’s College Research Institute; Professor, Dalla Lana School of Public Health, University of Toronto; Tier 1 Canada Research Chair in Health; Rami Rahal, Director; Julie Klein-Geltink, Program Breast Cancer Manager; Carolyn Sandoval and Tonia Forte, Research Dr. Geoff Porter Associates; Sandy Chan, Summer Student; Gina Lockwood, Gibran and Jamile Ramia Chair in Surgical Oncology Research, Manager, Analytics, and Senior Biostatistician; and analysts Dalhousie University Sharon Fung, Dan He, Jin Niu, and Julie Xu. Dr. Kathy Pritchard Professor, Medicine and Public Health Sciences, University of This report was overseen by an Editorial Panel that Toronto; Professor, Department of Oncology – Division of Medical provided guidance on content and clinical interpretation Oncology, and Co-Director, Ontario Clinical Oncology Group, of findings. McMaster University; Head, Clinical Trials and Epidemiology, Odette Cancer Centre Dr. Sandip SenGupta Professor and Deputy Head, Department of Pathology and Molecular Medicine, Queen’s University Dr. Scott Tyldesley Radiation Oncologist, BC Cancer Agency, Vancouver Clinic; Clinical Associate Professor, University of British Columbia; Michael Smith Foundation for Health Research Scholar Dr. Nancy Wadden Chair, Mammography Accreditation Program, Canadian Association of Radiologists; Medical Director, Breast Screening Program for Newfoundland and Labrador Dr. Martin Yaffe Senior Scientist, Physical Sciences, Odette Cancer Research Program, Sunnybrook Research Institute; Professor, Departments of Radiology and Medical Biophysics, University of Toronto; Director, Smarter Imaging Program, Ontario Institute for Cancer Research A SYSTEM PERFORMANCE SPECIAL FOCUS REPORT iii Breast Cancer Control in Canada About the Partnership and System Performance Measurement The Canadian Partnership Against Cancer (the Partnership) is an independent organization funded by the federal government to accelerate action on cancer control for all Canadians. Bringing together cancer experts, government representatives, the Canadian Cancer Society and cancer patients, survivors and their families to implement the first pan-Canadian cancer control strategy, the vision is to be a driving force to achieve a focused approach that will help prevent cancer, enhance the quality of life of those affected by cancer, lessen the likelihood of dying from cancer, and increase the efficiency of cancer control in Canada. In support of this vision, one of the five-year mandate (2012 to 2017) and has Partnership’s key mandates is to measure and developed a multi-faceted plan for advancing report on the quality of cancer control across the understanding of cancer system performance the country. The Partnership has identified in Canada and ultimately stimulating efforts to System Performance Analysis and Reporting as increase the effectiveness and efficiency of the one of its core enabling functions for its new cancer control system. Table of Contents 1 About this Report 3 Breast Cancer Patient Experience, Survivorship and End-of-Life Care 59 Screening for distress 61 Breast Cancer Burden and Outcomes 5 Place of death 65 Age-standardized incidence 7 Conclusion 68 Age-standardized mortality 8 Relative survival 10 Breast cancer subtypes 12 Breast Cancer Prevention 69 Conclusion 14 Overweight and obesity 72 Physical activity 75 Alcohol consumption 77 Breast Cancer Screening 15 Chemo-prevention (discussion only) 83 Screening program participation 17 Conclusion 84 Breast screening rates (mammography) – CCHS and program-based 19 Conclusion 26 Breast Cancer Research 85 Research investment 87 Breast Cancer Diagnosis 27 Clinical trial enrolment 88 Wait times: abnormal breast screening Conclusion 91 result to resolution 29 Capture of stage data 33 Conclusions 92 Stage distribution 36 ER/PR and HER2 testing 38 Appendices Conclusion 42 Appendix I: Members of the System Performance Steering Committee and Technical Working Group 96 Breast Cancer Treatment 43 Appendix II: Attributes of provincial/territorial Mastectomy and breast conserving surgery 46 breast screening programs 98 Appendix III: Radiation therapy wait times: Stage distribution (%) – ready-to-treat to treatment 50 excluding stage not available 100 Appendix IV: Radiation therapy utilization 52 Description of staging data collection methodologies 101 Adjuvant radiation therapy for Appendix V: Stage I and II breast cancer 54 Research priorities identified by the Canadian Breast Cancer Research Alliance 102 Chemotherapy utilization 57 Conclusion 58 Glossary of Terms 104 References 108 A SYSTEM PERFORMANCE SPECIAL FOCUS REPORT 2 Breast Cancer Control in Canada About this Report About this Report 3 About this Report Considerable advances in breast cancer control, including improvements in screening and early detection, as well as diagnosis and treatment, have led to a reduction in the mortality rate for women diagnosed with breast cancer. In spite of these important successes, breast cancer remains the most common cancer diagnosed and the second- leading cause of cancer death among Canadian women. Breast cancer places a substantial burden on individual women and has a considerable impact on the delivery of health care in Canada. This report presents and discusses a broad range indicator results where pan-Canadian data of system performance measures assessing currently exist and signal opportunities for Canadian breast cancer control across the future measurement. The indicator results are continuum. Previous system performance reports compared by province and by territory (where have featured colorectal cancer (in 2010) and data are available) and across a number of relevant lung cancer (in 2011). The decision to produce demographic and socio-economic groupings. a system performance report on breast cancer The measures are designed to identify potential in 2012 was influenced by a number of factors gaps and to inform improvements in breast including: the heavy burden the disease places cancer control across the country. on Canadian women, the availability of data for The primary target audience for this measurement (e.g., population-level staging, report includes: diagnosis and treatment wait times, surgical rates, etc.), and the broad scope and range of • provincial cancer authorities as they identify disease control modalities (chemo-prevention, opportunities for advancing policy, planning, organized screening, genetic testing, hormone funding,
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