Access to surgery following centralization of breast cancer surgical consultations

Am J Surg. 2020 May;219(5):831-835. doi: 10.1016/j.amjsurg.2020.01.050. Epub 2020 Jan 31.


Introduction: Timely access to breast cancer surgery is imperative for patient outcome. Building upon our previous model, 5 breast surgeons centralized all breast surgical referrals using principles of centralized intake and nurse navigator triage. The goal of this study was to investigate whether centralization can further improve access to surgery.

Methods: This study was designed as a before-after series, comparing wait times for breast cancer surgery prior to centralization and after. Primary outcome was wait time from diagnosis to surgery, and secondary outcomes included median wait time, days required for 90% case completion, number of available operating days, and number of patients who underwent breast reconstruction and neoadjuvant therapy.

Results: Overall, centralization of breast cancer surgical referrals reduced wait time from 47 to 41 days. The median wait time and time required for 90% of case completion was reduced, despite a 7% reduction in operating room availability. Fewer patients underwent neoadjuvant therapy and more patients underwent breast reconstruction following centralization.

Conclusion: Centralization of surgical referrals for breast cancer patients improved access to surgery.

Keywords: Access to surgery; Breast cancer; Clinical research; General oncology; Health systems; Surgical oncology.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / surgery*
  • British Columbia
  • Female
  • Health Services Accessibility*
  • Humans
  • Mammaplasty
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data
  • Referral and Consultation*
  • Retrospective Studies
  • Time-to-Treatment*
  • Waiting Lists