Dr. Nadia Alam speaks out against planned changes to the Breast Screening and Assessment Clinic as Mike Foligno, whose wife died from breast cancer, steps up to offer help from the Foligno Foundation

It’s a bad idea for Health Sciences North to restructure a clinic where women are screened and assessed for breast cancer and quickly scheduled for surgical consultation, says the president of the Ontario Medical Association.

Dr. Nadia Alam, a family physician from Georgetown, blames the provincial government, not necessarily HSN administrators, for planned changes to the Breast Screening and Assessment Service at the hospital. Alam visited Sudbury this week to speak at the annual general meeting of the Sudbury and District Medical Society.

For years, the BSAS has offered women a one-stop centre at which they could be screened for breast abnormalities with mammography or ultrasound, have breast diagnostic test results assessed, undergo biopsies and consult with surgeons about a course of treatment should they test positive for breast cancer.

While women will continue to be screened and assessed for breast abnormalities at the service, they will be referred to see surgeons in their private offices, a move many fear will lengthen the wait to have a consultation.

Alam said a similar direct access program to the one now operating at HSN is offered at Halton Health Services in her region. That centre offers more efficient provision of care around breast screening and treatment than a fragmented system “and it’s really made a difference in my community.

“I love this program, as a family doctor,” said Alam. “It’s one less thing off my mind.”

Referring patients to surgeons’ offices makes their wait longer and “weighs” on patients’ minds, she said.

Doctors she spoke with during her Sudbury visit said they were “devastated” by the restructuring of the program, said Alam. “They were really upset about it” because they don’t want to delay care to women with breast cancer.

A program like HSN’s Breast Screening and Assessment Service “gets rid of layers of administration between a patient trying to access not just diagnosis but quick treatment,” said Alam.

She understands Ontario hospital administrators are “stuck” making tough decisions to balance budgets deep in the red after years of under-funding by the province. But those decisions are affecting patient care, Alam warned.

Sudbury surgeon Dr. Rachel Paradis spoke out last week saying the restructuring of the Breast Screening and Assessment Service would result in longer waits for women to see surgeons and poorer health outcomes.

Meeting Thursday on clinic changes

Paradis and other breast surgeons will meet Thursday with David McNeil, senior vice-president of patient experience and digital transformation at HSN, and Mark Hartman, the hospital’s vice-president of cancer services and clinical support. The purpose of the meeting is to discuss how to co-ordinate hospital and private services so women are still seen in a timely manner.

McNeil stressed that breast screening with mammograms and ultrasounds, assessment and even biopsies will still be done at the service located at the Sudbury Outpatient Centre at the old Memorial Hospital site. Where the process will change is when patients with abnormal test results are directed back into the community for follow-up.

HSN is keeping resources for “navigation,” said McNeil, “because we know the risk of falling through the cracks.” But HSN will not be running private clinics for doctors.

When people get positive results for other types of cancer, they consult with surgeons in their offices, not in the hospital, McNeil pointed out.

But Alam said a direct access program such as the one at HSN “cuts wait times to zero. It’s amazing. It’s so helpful. My mom had breast cancer so I sort of lived through it with her and I’ve seen what the wait does for patients.”

Before the Breast Screening and Assessment Service was established at HSN, results of abnormal breast tests were referred to family physicians, and patients had to wait days or longer for appointments. More delays followed when family doctors referred patients to breast surgeons for consultation.

McNeil said HSN officials will discuss with surgeons how to avoid the “horror stories about the six-month delay” before they see breast patients. The hospital will work with doctors to create a “co-ordinating mechanism to make sure people don’t fall through the cracks.

“You know, we’re not careless … we’re not going to put patients at risk, believe me,” said McNeil. “I’ve been subject to those types of things as a patient … we’re not putting patients at risk and we need to work with our physicians so we don’t do that.”

McNeil insisted the clinic isn’t “disappearing” but it will be restructured so it is more efficient yet results in the same health outcomes for patients.

“I don’t want the message out there that the clinic’s disappearing. Breast screening is staying,” said McNeil.

Women come forward

Dozens of women have spoken out about their belief the Breast Screening and Assessment Service, as it now exists, saved their lives. Ann Lamont said she was grateful for the care she received after being diagnosed with breast cancer.

“I have been through this and am so thankful for the quick way everything was handled and am a firm believer (of) this program. I really wish more women and men would start speaking up about these cutbacks,” she said.

Elaine Sauriol said she benefited from early assessment and surgery for breast cancer. Within three weeks of being diagnosed, she was scheduled for a lumpectomy. Early detection prevented her from having to undergo chemotherapy.

“Had I waited for surgery, I would not have been so lucky,” she said.

She did have to have radiation therapy, but its long-term effects weren’t as severe as they would have been from chemotherapy.

“The cost on the health care system was a lot less because of early detection and surgery,” she pointed out.

She said she understands costs have to be trimmed at HSN, “but surely there are other places to cut.” It “boggles the mind” that HSN would cut a program “that has proven time and time again its efficiency,” she said.

Foligno Foundation wants to help

Mike Foligno is president and chief executive officer of the Janis Foligno Foundation, which was established in memory of his wife, who died of breast cancer in July 2009. Foligno said he is interested in discussing how the foundation could help preserve “this important program (that is) working and providing first-class care for women in our community.”

The Janis Foligno Foundation is committed to finding a cure for cancer and helping people battling it have “a brighter future.”

Foligno is looking at ways the foundation might help offset the cost of the Breast Screening and Assessment Service, perhaps starting a drive to help fund the program.

HSN bills the BSAS as a comprehensive consolidation of breast-related services, including digital mammography, ultrasound, MRI, surgical services, education and support services. It provides timely and co-ordinated access to Ontario Breast Screening Program mammography, breast assessment along with diagnostic services to patients of all ages, it says on HSN’s website.

Carol Mulligan is an award-winning reporter and one of Greater Sudbury’s most experienced journalists.

