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Breast-cancer patients in Ontario are looking for a more integrated system of care that won't add to the already stressful job of fighting the deadly disease, a study released yesterday says.

The report on the three-year study, funded by the Ontario chapter of the Canadian Breast Cancer Foundation and other organizations, says a more co-ordinated system would include providing more information to patients upon diagnosis and improved care after treatment, among other recommendations.

It also suggests that women 40 to 49 be included in the province's breast screening program, which currently targets women 50 to 79.

That recommendation is key, said Nancy Noble, a 47-year-old cancer survivor from London, Ont.

"Women under 50 are really comfortable with technological change and would line up," the mother of two said. "I mean, I have friends I know who would pay to have one done if it was accessible to them."

However, earlier scientific studies have questioned the merits of introducing breast screening programs for all women 40 to 49. In particular, there is less evidence that screening mammography significantly reduces mortality in those under 50, compared with screening in older age groups.

The new study drew its findings from interviews and consultations with former patients, their personal-care providers and health-care professionals, as well as a telephone survey of 802 Ontario women not diagnosed with cancer.

Most former patients experienced a "difficult path" through treatment, from experiencing booking errors to finding themselves a "go-between" among professionals, the report found. Only a small minority reported that their care had lived up to expectations.

"Currently, there is no co-ordinated system of care," said Sharon Wood, executive director of the foundation's Ontario chapter.

"Women were surprised, because they expected a co-ordinated system of care and didn't find it."

Ms. Noble said she found it difficult to navigate her way through the health-care system when she was first diagnosed with the disease in 2004.

She underwent chemotherapy treatments on Friday afternoons, only to find that when the extreme side-effects of the treatment kicked in, the cancer centre she relied on for her care was closed for the weekend.

When things didn't work, like pain medication, it could take days before the problem could be rectified, she added. She once had to wait two days to obtain a much-needed drug, because it wasn't available in her city.

Ultimately, it's up to the patient to manage their own treatment, even as they're fighting the deadly disease, Ms. Noble said.

"Once you get onto the treadmill, you realize very quickly that you are your own advocate," she said. "And when you're as sick as you are, to have that added burden and stress to do something like that is just daunting."

The report also suggests that support-care services be more integrated; that patients be made aware of other cancer costs not covered under the public system, such as certain drugs, prosthetics and daycare for children during treatments; and that knowledge and the capacity of health-care providers be increased, along with information about the disease, including its causes and risk factors.

An estimated 22,200 women in Canada were diagnosed with breast cancer in 2006 and 5,300 died from the disease, according to the Canadian Cancer Society and the National Cancer Institute of Canada.