When Shira Farber turned 40 she asked her family physician about starting routine mammograms. With no family history of breast cancer, and given her age, she said her doctor advised her that there was no rush.
“I was really sort of discouraged from starting mammograms. The doctor leaned on the guidelines that were established … so that we didn’t need to start until 50,” she recalled.
At age 47, Farber found a lump in her breast. Six weeks later, she went for her first mammogram.
“At that point, it was already in advanced stage of cancer,” she said.
Following the mammogram, Farber was referred to Princess Margaret Hospital in Toronto for a biopsy.
“They found three large tumours in my breast. I needed to have very aggressive chemotherapy. I lost all of my hair. I was very, very, very sick. I developed cardiac issues, either as a result of the chemotherapy or the radiation … then I had a full mastectomy. I also had a sentinel node removal, so they took out 36 nodes. I now have lymphedema.”
Farber is now pushing for earlier, routine breast cancer screening for all Canadian women.
She is not alone in this fight.
“In some provinces, like British Columbia, Nova Scotia, P.E.I., they will include women in the screening programs in their 40s, and they will actually invite them to return on a regular basis every one or two years,” explained Dr. Jane Seely, head of breast imaging at The Ottawa Hospital and professor at University of Ottawa’s faculty of medicine.
“But in provinces like Quebec and Ontario, which are the most populated provinces, women can only get a screening mammogram if they get a referral from their family physicians.”
Seely identified two problems with that approach.
Not all Canadian women have a family physician to access a referral for a mammogram and those who do have a doctor are often told there is no need, she said.
“I understand from many of my patients, they sometimes received a bit of resistance because of this misunderstanding about when physicians can order imaging. So they can always order it. So the real question is, should routine screening be moved to a younger age?” said Dr. Andrea Covelli, surgical oncologist at Sinai Health System and University Health Network in Toronto.
“I see a very high number of women, less than 50, coming in with breast cancer and those are usually self-detected masses, meaning they’ve discovered them themselves. They’ve had either nipple changes or something that they can feel. And at that time, they are often quite large, more aggressive cancers. And had those women been screened, could we have diagnosed it at an earlier stage?”
In August, Seely co-authored a study that found starting annual screening for breast cancer before the age of 50 results in a lower proportion of advanced-stage breast cancer diagnoses.
“In the provinces like British Columbia, Nova Scotia, that screen women in their 40s, we had lower rates of breast cancer that had spread that was metastatic at diagnosis than in the provinces that did not, like Ontario,” said Seely. “So we’ve started to really show that impact of screening, but there’s a long lag in this dissemination of information and so we really need more advocacy to change this on a federal and a provincial level.”
She also pointed to another issue with the current guidelines in provinces like Ontario that will only do routine annual screening on younger women with a history of breast cancer.
“Eighty per cent of women who get breast cancer have no family history … so we can’t restrict it to just women with a family history,” she said.
Also, Seely noted that earlier screening can quite simply save lives.
“Women who get breast cancer in their 40s are more likely to die of breast cancer than any other cause…. By screening a woman in her 40s, her risk of dying is reduced by 44 per cent,” she said.
Finally, both Seely and Covelli said earlier screening and earlier detection of breast cancer means the treatment a woman would undergo is much less aggressive.
“They’re more likely not to need to have their breast removed. They’re more likely not to need chemotherapy or more aggressive intensive therapy. So they’re better able to go back to the workforce to be back to normal, productive lives,” said Seely.
Covelli says “breast cancer kind of comes in different flavours.”
“And so some breast cancers always, or very routinely, get chemotherapy and breast cancers that are estrogen-positive, if they are quite small, then sometimes we are able to omit chemotherapy in those patients,” said Covelli.
On Wednesday, Farber was invited by MP Ya’ara Saks for York Centre in Toronto to Parliament Hill to call for a review of current breast screening standards in Canada.
“If I had lived in British Columbia, I would have started my screening at the age of 40 and things would have gone very differently for me. Not to say that I wouldn’t still have had cancer, but they would have been able to detect it very early and my outcome probably would have been very different,” said Farber.
“As Canadians, we have a right to universal health care. That is a right that we have. And the idea that the type and quality of treatment that you receive differs by postal code to postal code is really unjust.”
While Farber has completed her cancer treatment, the journey, she said, will be lifelong.
“It leaves permanent scars. It changes your body in terrible, horrible ways and you constantly live with the fear of it coming back. That’s the reality for one in eight women.”