03/20/2024
What happens in Nova Scotia in the next week or so can have implications for women's health Canada wide. A bill for supplementary screening for women with dense breasts was recently introduced by opposition member, MLA Rafah DiCostanzo. She is a breast cancer patient herself and her diagnosis was delayed due to dense tissue and the lack of additional screening.
Will the bill get past the debate at the second reading this March?
Dalhousie University law professor, Jodi Lazare, has written an OP-ED that speaks to the inequitable situation in Nova Scotia. How can doctors referrals be rejected? How can women with and without breast cancer who have dense tissue be continuously denied the screening they need to find cancer early.
Please read Jodi's commentary. It is relevant to all of us and if you live in Nova Scotia, please write to your MLA. You can customize the advocacy letter/template in our footer as you like. Your voice is needed. Time is of the essence with the second reading expected near the end of March.
Thank you.
Nova Scotians Deserve Early Breast Cancer Detection:
Jodi Lazare, an associate professor at the Schulich School of Law at Dalhousie University, provided the following opinion article.
I am a breast cancer survivor. So it should come as no surprise that I was thrilled to learn of the introduction and first reading of the proposed Find It Early Act in Province House last week.
The act would provide access to additional diagnostic screening for women with dense breasts in Nova Scotia. This kind of supplemental screening is currently denied to Nova Scotians, despite clear evidence that for many, mammograms alone are not enough to detect cancer before it has grown and spread.
Nova Scotia, despite accepted wisdom about our ageing and resource-strapped health-care system, has historically been a leader with respect to breast cancer screening. It was one of the first provinces where women could self-refer for screening mammograms at age 40 (some other provinces require people with no demonstrated risk to wait until 45 or 50, despite the increasing frequency of diagnosis below that age). The province also provides patients with their breast density after their first mammogram. Beyond these developments, however, Nova Scotia flounders.
Later diagnosis
Breast density is a measure of glandular tissue in breasts. The more glandular the tissue, the denser the breast, the harder it is to see cancer on a traditional screening mammogram. Breast density is scored on a scale of A to D, with D being the most dense. The organization Dense Breasts Canada, which Liberal MLA — and breast cancer survivor — Rafah DiCostanzo worked closely with in drafting the bill, reports that mammograms miss approximately 40 percent of cancers in density C and D breasts.
Not only, then, does dense tissue increase the risk of developing breast cancer, it also makes cancer harder to detect, resulting in later diagnosis, at a more advanced stage, requiring longer, harsher, and more expensive treatment. In some patients, it might mean a diagnosis of stage 4, or metastatic cancer, for which there is no cure.
This is a tough pill to swallow for the 43 per cent of women who have dense breasts. It is particularly terrifying for women like me, with a higher chance of another breast cancer diagnosis than the general population, and with no access to supplemental screening, despite already having had cancer, and even with a referral from my family doctor. Nova Scotia is the only province where I would be denied the screening I need.
Access to Screening:
The Find it Early Act would help. The act would recognize that people with dense breasts should have access to supplemental screening — by ultrasound or MRI —even in the absence of a suspicious mammogram. Its adoption would, in other words, mean that more cancers are caught earlier, sparing women the excruciating experiences of full or partial mastectomy, lymph node removal (with the associated lifelong risk of lymphedema), harsh chemotherapy (for many women, losing their hair is worse than losing their breast), radiation therapy, immunotherapy, and endocrine therapy, all of which I have received and none of which I would wish on my worst enemy.
Put simply, cancer has changed my life, and every day I worry I will have to do it all again because a mammogram alone might fail to detect a recurrence in my dense breasts.
This is not a political issue. Cancer doesn’t care if you’re liberal or conservative, rich or poor, or even what your gender is, although it’s clear who breast cancer affects the most. This is a question of access to health care and equality for the43 percent of people whose cancers risk going undetected until they have grown and spread.
The current situation puts patients with dense breasts at a serious disadvantage, placing them at risk of a delayed and advanced, life-altering diagnosis. In legal terms, this kind of disadvantage at the hands of the government might mean that people are subject to discrimination pursuant to the constitutional guarantee of the right to equality.
Dated statistics
Opponents of the act will argue that the evidence does not support the cost of supplemental screening. Indeed, current evidence suggests that earlier detection does not reduce mortality rates.
The problem with that argument is two-fold. First, the data is old and current studies are showing that supplemental screening to find cancer when it is small prevents growth and spread. Growth and spread inform cancer staging, where stage 1 cancer has close to a 100 percent five-year survival rate, which plummets to 22 per cent at stage 4. Logic dictates that early detection of early-stage cancer will save lives.
Second, mortality is, quite frankly, not only cruel, but an offensive measure of success. Between initial diagnosis and death, there are years of suffering, on the part of patients and their families, brought on by costly treatments, which cost far more, in the aggregate, than the tools needed for early detection.
Not to mention the cost in terms of the quality of life of advanced-stage cancer patients. Do we, as a society, care so little about our family members, friends, and neighbors, that we are willing to rely on dated statistics instead of trying to prevent the immense pain and suffering that follows a breast cancer diagnosis —suffering that can often be prevented by early detection?
Support Legislation:
With all of this in mind, it’s hard to understand why a similar opposition bill tabled last fall never made it past first reading; because it was not debated, we can't know precisely why it
failed to become law. This time around, Health Minister Michelle Thompson says the government has no definite plans to move the bill along, but that she is open to learning more.
There is a common trope about breast cancer: that it is a “good cancer” to have, that it is treatable, and that lots of money goes into breast cancer research.
I’m here to tell you that breast cancer is no joke. That the research dollars are probably proportionate to the frequency of diagnoses. That the long-term impacts of treatment, both physical and mental, are in many cases debilitating, even when the actual cancer is a distant memory. Cancer is a scourge on society, and breast cancer in particular affects huge swaths of our population — and mostly women, whose health concerns have for too long been secondary to other legislative and regulatory priorities.
Nobody ever thinks it will happen to them. I certainly never imagined how my life would change overnight at the age of 40.
Contact your MLA. Write to the government (Dense Breasts Canada has a template available here
https://densebreastscanada.ca/wp-content/uploads/2023/11/Nova-Scotia-Advocacy-NOv-2023.docx ). Ask them to support this bill. It might save your life, or your mother’s, or sister’s, or brother’s. It might save mine. If nothing else, it would certainly help me sleep at night.
