Relocating blood sampling for fast-track genetic testing reduces time to surgery in breast cancer: a quality improvement study
Fanny Gränse Weström, Alva von Gerber, Annika Gazi Bergqvist, Claudia Symanzic, Mikaela Langen, Nushin Mirzaei, Linda AdwallAbstract
Introduction
Timely completion of preoperative genetic testing is essential for selected breast cancer patients, as results may influence surgical planning and time to definitive treatment. At Stockholm South General Hospital, Stockholm, blood sampling for fast-track genetic testing was previously performed at the oncology clinic several days after the initial surgical consultation, introducing an avoidable delay. In November 2024, blood sampling was relocated to the breast surgery clinic and performed during the first surgical visit. This study aimed to examine whether relocating blood sampling affected genetic turnaround time and time to surgery.
Methods
This quality improvement study included patients undergoing primary breast cancer surgery with preoperative fast-track genetic testing. The pre-implementation cohort (March 2023–January 2024) followed the oncology-based pathway, and the post-implementation cohort (November 2024–October 2025) followed the updated surgery-based pathway. Primary outcomes were time from test initiation to genetic result and time from initial surgical consultation to surgery.
Results
Ninety-five patients were included, 37 pre-change and 58 post-change. Pathogenic variants were identified in 12.6% of patients. Following implementation, median time to genetic result decreased from 19 days (IQR 16–21) to 15 days (IQR 14–16). Median time to surgery decreased from 36 days (IQR 28–45) to 25 days (IQR 22–29).
Discussion
Relocating blood sampling to the surgical clinic eliminated a process-related delay in the preoperative pathway. This single workflow adjustment yielded faster genetic turnaround and a clinically meaningful reduction in time to surgery, highlighting how small structural changes can enhance efficiency in breast cancer care.