Breasts… tissue of life, and… ?

Jennifer is 42. Single mom. 2 kids. Pays attention to her health. Had a full medical in October. Including a breast exam. Because of her age, her doctor gave her a referral slip for the breast screening clinic. She booked her appointment… nearest date was end of March…five months later. By January, during her regular self exam she found a lump the size of a golfball.

Heart in her throat, Jennifer made a doctor’s appointment, explaining what she’d found. Both nurse and doctor expressed surprise. Jennifer had had a full breast exam. Her doctor booked an emergency mammogram for a few days hence. She had the mammogram and an ultrasound and a biopsy the same day. The ultrasound identifed four more growths. These did not appear in the mammogram. All in the same appointment, Jennifer was told they were benign.
But before any of the tests occurred, Jennifer was called in for a breast exam with Nurse Judy. “It was the best part of the whole experience. I learned from her that I wasn’t self-assessing in the right way. She gave me an incredible amount of knowledge plus she eased my mind. She explained the difference between first degree or high risk (mother or sister) and a lesser risk like cancer in a more removed relative,” says Jennifer.

“She did the exam and showed me how to properly do a full breast exam; that’s when I realized I wasn’t doing it right. I hadn’t had good instruction.

“I believe this is a 100% necessary service.”

This week, March 2, six weeks after her RVH day, Jennifer received a letter from RVH Breast Clinic saying the mammogram found nothing.

and so…

You get your letter… time for your biannual breast screening. Please call and book your appointment. It’s a letter most women don’t ignore. After all, what a fabulous service offered at our own hospital.

For women, especially those over 50, checking for cysts, growths, unfamiliar masses… it’s anxiety coupled with confidence if you’re on your way to the RVH breast screening area. Comfy sofas, great reading material, and all of us lined up like bookends in those lookalike flowered gowns. It’s a place of polite comfort where women are united briefly by their anatomy.

And whether we’re greeted and cared for by Margot, Brenda, Lynda, Donna, Margaret or Judy, we’re cared for by a woman who’s a nurse and who has an expertise in breasts of every shape, size, and density.

Breasts… giver of life to our babies… cause of death for many of us later on.

While the treatment of breast cancer continues to enjoy increased success, the numbers of deaths are still high enough to strike fear in the soul of any woman who hears the phrase… ‘we’d like you to come in for an ultra sound’ or ‘just come up to xxth floor for a minute,’ it remains a very real threat.

So, last week when Royal Victoria Hospital announced that it’s purchased new software that will provide more timely diagnosis for high risk women in the region, it seemed like a good thiing. However, reading between the lines leaves lots of concern.

The software, attached to MRI technology, is not part of an ordinary mammogram. What’s a high risk woman? The article and the press release doesn’t say.

As a low-risk woman who has a family doctor and pays attention to regular screening, I’m likely not ever to see the inside of an MRI. But my concern centres around the fact that right now every woman who goes in for breast screening, regardless of ‘risk’, gets a mammogram AND a breast exam by an expert who does at least 20 of those exams every day. Those nurses (there are six of them, full or part time doing this at RVH now) know what they’re looking for. And because they see EVERYONE, unless a woman refuses, it’s a universal opportunity for every woman regardless of age, doctor affiliation, risk history, culture or language barrier. It catches everybody. On average, the breast screening clinic (and breast exam component) sees about 60 women every day.

RVH feels, though, that the mammogram is the best test, and test enough to indicate if there’s a reason to go further… to the newly hopped-up MRI. Bryn Pressnail, Clinical Director of RVH Cancer Care Program says that RVH is following guidelines identifed through Cancer Care Ontario, citing a 2002 study that identifed mammograms as the most reliable test for breast irregularities. It is his hope that women without family doctors will continue to get referred through after hours clinics.

“If a woman is over 50 and doesn’t have a doctor, she can call and book a breast screening appointment on her own volition.” says Suzanne Legue, Senior Director, Corporate Communications at RVH.. Women under 50 who can’t get to a family doctor can go to an after hours clinic and get referred for a mammogram. Legue also ays it’s important for women to know their own breasts and continue to do breast self exam.

But the reality is the breast exam portion of the Ontario Breast Screening service is no longer going to be available. It ends in three weeks, at the end of March.

So, it’s really two issues… we have wonderful new software but it’ll only be available to women identified as high risk. We have the mammogram, which Cancer Care Ontario says is still the reliable test for breast irregularities. Not in Jennifer’s case.

It’s a move to technology, it’s a move to reduce budgets; it’s a move to looking at statistical analysis and designing service around it. It’s a move away from the human element. We won’t have those nurses whose touch, whose practiced hand might identify that element that moves a woman from low to higher risk.

This is not to undervalue the power behind a computerized device with incredible capabilities. But there’s strong pull for the human factor, too. In a community where there are so many commuting women, sole support women with kids and no doctors, I just wonder… and hope.