Re-imagining breast care: Cost-effective innovations for Canadian healthcare

With an anticipated increase in breast screening volume, provincial healthcare systems and health leaders must identify innovative technologies and care pathways that can alleviate the burden of an already resource-constrained healthcare system. The solution explored here utilizes vacuum-assisted technology that is clinically equivalent and a more cost-effective alternative care pathway, as successfully demonstrated in many other countries. This article reviews the clinical efficacy of Vacuum-Assisted Biopsy (VAB) and Vacuum-Assisted Excision (VAE) and calculates the potential Canadian direct cost savings by implementing VAE for the management of benign and high-risk breast lesions in place of Surgical Diagnostic Excision (SDE): calculated to be $1,607,769 to $11,341,107 (2025 CAD) annually in Canada, or $2,208 (2025 CAD) per-patient procedural savings from avoiding SDEs. Additional non-quantifiable patient benefits are also explored: avoiding unnecessary surgery; preventing the associated anxiety and time off work; and greater patient autonomy over their diagnosis journey, helping maintain their quality of life. Finally, barriers to adoption are identified, and an Implementation Leadership Action Plan is proposed, to help support the successful integration of this practice shift. The plan includes procedural reimbursement and policy changes, and multidisciplinary engagement targeting radiology, surgery, and pathology stakeholders.