Breast cancer screening delays may have harmed patients - Inquiry

An official inquiry has found breast cancer screening delays of up to nine months in the Wellington region may have harmed 10 women.

But it has stopped short of saying they definitely did suffer harm.

The report of the year-long investigation is due out from Te Whatu Ora later today.

A copy obtained by RNZ shows the failures were due in part to lack of resources.

It shows almost two-thirds of women, or 8100, enrolled by Breast Screen Central from 2017-2021 waited longer than the target of 60 days to be seen.

Most delays were around three months long, but some much longer.

The "complex" enrolment process had "multiple potential points of failure", the report said.

The expert review team concluded that for 10 women, "earlier screening may have resulted in their cancer being at a less advanced stage at the time of diagnosis or requiring less intensive treatment".

The "harm could not be defined but that these individuals had not received the full benefit of the screening programme", their 25-page report said.

"The review team also acknowledged that these delays may have had psychological and emotional impacts for many individuals that are not easily quantifiable."

The report refers to the likelihood harm was done just once, where it states: "For all those identified with possible high potential of having experienced harm, adverse/reportable event notifications were entered into the reporting system used by Hutt Hospital."

The nub of the problems the inquiry has found were:

• Lack of resources to provide the required number of screenings, with constraints made worse by Covid-19
• Poor communication with some women
• Gaps in monitoring nationally, so the problems were not picked up
• No process for quickly referring on women who said at the time they enrolled that they had symptoms
• Complex enrolment

Gaps in the national monitoring of breast cancer screening resulted in "a missed opportunity" to fix the long delays in the Wellington region, the report said.

While the National Screening Unit did some regular monitoring, there had "never" been monitoring of the target to offer more than 90 percent of women an appointment within 60 working days.

"This gap in monitoring meant that BSC's [BreastScreen Central] inability to meet demand and their increased waiting times for new enrolments, when compared to other lead providers nationally, was not recognised and acted upon until July 2021."

It added there had also "never been coordinated monitoring of the capacity within the screening system through measures such as staffing hours or available appointment numbers".

Health authorities had alerted the women, and apologised to them when they launched the inquiry a year ago.

At that time, they said, "The factors leading up to this pre-date the Covid-19 pandemic."

They had also thought they had only 6000 women who waited too long, and had only 52 cases where delays might have affected people's chances or treatment, though it turned out to be 59.

Today's report in a flowchart shows that out of 13,000 women enrolled, only 4900 got an appointment on time, and 8100 did not.

Seven were not offered an appointment at all.

Of those 8100, 59 were eventually diagnosed with breast cancer, and the reviewers narrowed down those with more advanced cancer to 25.

"All 59 people were contacted by phone to apologise for the delay."

For 15 of those, the delay was "unlikely" to have made a difference, leaving 10 cases they looked at more closely, the report shows.

"The review team were not able to quantify this impact at an individual level."

The 10 women had follow-up calls to apologise, explain the review and allow them to talk, plus a letter about support and avenues to lodge a complaint.

Recommendations

In its series of recommendations, the report said more work was going on to recruit and retain medical imaging technicians, and wanted a national perspective brought to this. It was another symptom of national workforce shortages in health.

It said the central region service took action, when it realised waiting times were too long, to increase appointment slots, took on another provider to do 555 more screens over three months and brought in Saturday clinics.

"As a result of these actions, by March 2022, Breast Screen Central had no new enrolments waiting beyond the 60 working day target."

It was planning services in a new way but that rebalancing had actually increased the interval between screenings to more than two years "highlighting the ongoing capacity constraints".

An alert system to managers about delays, and to monitor them, was recommended, as was standardised communications to clients.

Te Whatu Ora will also today put out a review into improving breast screening nationwide.