Patients are experiencing delays accessing breast ultrasounds in Quebec

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Despite having multiple referrals from her family doctor — including one flagged as urgent — a Montreal woman has been going around in circles for months trying to book an appointment for a breast ultrasound in the city.

Repeated attempts with at least five clinics since July have gotten Sofia nowhere. Reasons appear to vary, but ultimately stem from a backlog that the Association des radiologistes du Québec said is causing delays in clinics across the province.

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“There’s a clogging situation going on in many disciplines, and unfortunately in breast ultrasounds I think it’s even more acute,” said Dr. Grégoire Bernèche, the association president.

Sofia, who asked to keep her real name private to avoid worrying friends and family, had gone to see her doctor for a lump under her arm in July following a routine mammogram in March.

“She wrote a (referral) for a breast ultrasound, and I sent it off,” Sofia said, adding that she received automated replies saying the clinics were busy and would get back to her.

“And then there was nothing,” she said.

Sofia’s doctor eventually followed up, expressed surprise that she hadn’t been seen yet and wrote a new referral, this time saying it was urgent.

When Sofia finally got answers, some clinics said they weren’t taking new patients, others said their wait-lists spanned months, and some suggested going back to the clinic where she did her mammogram. She said that clinic, meanwhile, told her they don’t do followup ultrasounds unless the mammogram had been flagged as abnormal.

“I’ve reached out now four or five times since July to all of those RAMQ imaging centres,” Sofia said. “One of the women that I spoke to … said, and I can quote her: ‘I don’t know why doctors are still writing prescriptions for these.’

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“And it’s like, because there’s cause for concern, maybe?”

Meanwhile, another one of the clinics Sofia spoke to, Radimed Westmount Square, told her there was a minimum one-year wait. Its director, Suzanne Roy, said in an interview it’s not that long — but that since 2022, according to guidelines from the Quebec health ministry, radiologists are responsible for complementary exams following mammograms. That means the clinic doesn’t have the capacity to take on patients from elsewhere, Roy explained.

“It’s impossible,” she said. “It hurts my heart. We sometimes have people who come to us in tears, but I don’t have the space. If I had more technologists I could open Saturdays and evenings, but I don’t have any.”

A patient who needs additional testing following a mammogram should be seen within 10 days, according to government guidelines, which Roy said the clinic is able to respect, but just barely.

“That’s why we can’t do patients from elsewhere,” she said.

Meanwhile, Bernèche said there’s no specific guideline for patients with referrals for breast ultrasounds outside of the breast cancer screening program. He considers a delay of two to four weeks reasonable in the case of a patient being referred by a doctor following a breast exam, but said it depends on the situation and the patient’s medical history.

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“It’s not one-size-fits-all when you’re outside the program,” he said.

Delays for breast ultrasounds following mammograms, meanwhile, vary from less than week to more than 12 weeks at clinics in Montreal, according to 2024 survey data from the Institut national de santé publique du Québec.

Bernèche said those numbers “are not pretty” and called the situation one of the main access problems in radiology today.

“It’s really deplorable,” he said. “It’s something that we find very unpleasant.”

He considers the delays especially of concern because of the possibility that Quebec will widen the eligibility of its screening program from ages 50-74 to 40-74.

“As radiologists, we are strongly encouraging the fact that (this change is) coming, it’s just that we do not know how to absorb the caseload that will go with it,” Bernèche said. “I think it’s just the beginning of the storm.”

Kimberly Carson, the CEO of Breast Cancer Canada, said she has been hearing of delays with breast ultrasound appointments across the country but that it’s unclear where exactly they’re coming from. The group has been trying to do surveys and research on cases like Sofia’s “to see where the lag is.”

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“It’s not clear that it’s the same in every province or the same in every rural or urban centre, if that makes sense,” Carson said.

Bernèche, for his part, said over the past decade, requests for scans — ultrasounds, MRIs and CTs — have increased by about 50 per cent in Quebec, in part due to what he described as an “over-reliance on imaging” when they’re not necessarily medically indicated. Patients are also surviving longer, thus needing more scans.

“The main problem would be that among the increase in exams, there is some degree of irrelevant exams that as an association, we really aim to solve,” he said.

Meanwhile, the number of radiologists in Quebec has only increased by 11 per cent over that same period, Bernèche said.

“There’s a mismatch between what we can anticipate in the demand and how long it is to academically train (radiologists),” he said. 

Asked if it’s aware of delays in accessing breast ultrasounds and if anything is being done to rectify the situation, Quebec’s health ministry said if necessary, it “supports establishments in order to find strategies that will improve access to breast cancer screening and investigation examinations.”

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It referenced its guidelines surrounding the trajectory of patients being screened for breast cancers, saying “service co-ordination centres in each region are responsible for ensuring followup with the designated screening centres in their territory.”

It said it meets with them to remind them of and support them in their role.

The ministry did not respond to questions about Sofia’s situation specifically.

Sofia’s mammogram in March was done at one of Biron’s imaging clinics. Asked about her case, a spokesperson for Biron said on Friday that patients who receive prescriptions for secondary exams after mammograms can make an appointment and are given the option of returning to their original clinic or another one to ensure prompt followup.

“Each person is unique and has a right to receive the care for which they have a medical prescription,” senior communications adviser Stéphanie Côté said in an email, adding that Sofia could contact them again if she believes she was given incorrect information.

After communicating with Côté directly, Sofia was told the clinic would call her. But when they did, they said they couldn’t offer an ultrasound or put her on a waitlist, instead suggesting a diagnostic mammogram. Out of options, she decided to take it.

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“Any other time that I’ve needed an ultrasound or an X-Ray, it’s absolutely no problem,” Sofia said back in September. “And there is still no problem … you can walk into some of these clinics and get an X-Ray within 20 minutes. And everybody that I’ve spoken to, all of the agents at all of these clinics have said, ‘No, it is specifically breast ultrasounds where the backlog is.’”

Bernèche said he feels there are two solutions to the backlog: increasing reliance on ultrasound technologists and 3D mammograms.

While other types of ultrasounds are commonly performed by technologists and then reviewed by specialists, the practice is less common for breast ultrasounds in Quebec, especially compared to other provinces and the United States, Bernèche said.

“That would probably help radiologists and the workload a lot and … it would probably unclog the system,” he said. “I’m not saying technologists should do all the ultrasounds … but I really do think there’s something with better autonomy for technologists in breast ultrasounds.”

But he expects 3D mammography to play the biggest role in unclogging the system, since it provides better images than 2D mammography, thus reducing the need for referrals for breast ultrasounds to begin with. He said the technology is used in most clinics across Quebec already, but that it hasn’t been around long enough for the effects to be felt.

“The studies that are done all around the western world, they decrease the number of breast recalls by up to 30 per cent,” he said. “Which means if I read 100 mammograms … probably my average is I will have to recall seven to eight patients for an ultrasound. But with 3D mammograms, this should go between four to five recalls for 100 mammograms.

“And not only that, but 3D mammograms also help us detect more cancers.” 

kthomas@postmedia.com

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