Ticking time bomb: Women in B.C. wait up to 3 years to have preventive mastectomy

Open graph image for Lennox Cosmetic Surgery

By Thandi Fletcher, The Province May 21, 2013

Women in B.C. considering the headline-making decision Angelina Jolie made to have her healthy breasts removed to reduce her risk of breast cancer won’t get the same treatment, say Vancouver plastic surgeons.

Women in this province are waiting too long – as much as three years – to get the same potentially life-saving surgery, say the doctors.

Some patients wait so long they end up getting breast cancer before their surgery date, said Dr. Sheina Macadam. For others, the possibility they could be diagnosed during the multi-year wait is distressing, said Dr. Peter Lennox.

“They sort of feel like they have this ticking time bomb,” said Lennox.

Jolie wrote in a recent New York Times Op-Ed that she had a preventive mastectomy and immediate breast reconstruction after genetic tests revealed she carries a defective BRCA-1 gene.

Inheriting a faulty BRCA-1 or BRCA-2 gene sharply increases a person’s risk of developing breast and ovarian cancers.

A preventive mastectomy, the surgical removal of both healthy breasts, can reduce the risk of breast cancer in high-risk women by about 90 per cent, according to the Canadian Cancer Society.

Vicky Crompton of North Vancouver has the defective BRCA-2 gene. But unlike Jolie, after getting her diagnosis the 50-year-old nurse had to wait two years for the same surgery Jolie was able to schedule for herself in a matter of months.

Although she doesn’t consider herself an anxious person, Crompton, who had her surgery last November, said the wait was emotionally draining. It was especially difficult as Crompton received the results of her genetic test after already being diagnosed with an aggressive form of breast cancer. She had a partial mastectomy after that diagnosis and spent months going through chemotherapy and radiation.

“You can’t move on because it’s lingering over you,” she said.

Women in B.C. can get tested for the BRCA gene through the B.C. Cancer Agency’s Hereditary Cancer Program. The test, which costs about $3,000, is covered by MSP, but the eligibility criteria is strict. Patients wait about three months for the results.

About 27 per cent of women who test positive at the clinic opt for the radical choice to have a preventive mastectomy, said the program’s medical director, Dr. Barb McGillivray. These women can have reconstructive surgery – rebuilding their breasts using implants or tissue from another part of their body – but once they choose to have the surgery, many don’t realize how long they will wait.

About 20 women in B.C. undergo preventive mastectomies every year, McGillivray estimated. But many more are on the wait list to get the surgery, said Macadam.

Part of the problem is that women seeking these mastectomies, who don’t yet have breast cancer, aren’t considered priority cases.

Immediate reconstruction requires general surgeons, who perform the mastectomy, and plastic surgeons, who do the reconstruction, to co-ordinate operating time. But only a few plastic surgeons in Vancouver perform the procedure and there is limited operating-room time allocated for it.

Surgeons’ wait lists are swamped with more urgent cases: women who have already been diagnosed with breast cancer and are seeking reconstruction at the same time as their mastectomy. Also on the wait lists are patients who have already undergone mastectomies and want reconstruction, although without active cancer they aren’t considered a priority and also face multi-year waits.

The number of patients with active breast cancer requiring a mastectomy with immediate reconstruction is so overwhelming that Lennox said he was forced to stop accepting new delayed breast-reconstruction cases.

Lennox said the only way women seeking preventive mastectomies get bumped up the list is when they’re diagnosed with breast cancer. At that point, women often face a much more aggressive treatment plan than if they had undergone preventive surgery.

Waiting is often “the hardest part” of the journey, added Lennox. “For some people it’s a very difficult decision to make,” he said, “but once they make the decision, they want to get on with it.”

In Macadam’s practice, women wait about a year for a consultation and another two to three years for surgery, which she described as “too long.”

“I think the longer a patient waits, the more distressing it is,” she said. “They’re worried and they want to get the surgery done so that they don’t have to worry about developing a new breast cancer.”

While she couldn’t say how many women develop breast cancer while waiting for surgery, Macadam said it does happen. She’s gathering data on the problem to lobby the B.C. government for more operating-room time.

“What we need is another breast-reconstruction surgeon and then we need more (operating-room) time for that surgeon,” said Macadam.

But her research is currently at a standstill. Two years ago, Macadam submitted a proposal to the cancer agency to review all BRCA-positive patients in B.C. to determine how long they wait for surgery and how many develop cancer while waiting. Today, she’s still awaiting approval to gain access to the patient charts. McGillivray wouldn’t comment on the matter.

If Macadam is successful, she said her study could be finished within three months.

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