With a broader age catchment for breast cancer screening, British Columbia in Canada has diagnosed women who would be missed in the Irish system, reports Eithne Donnellan, Health Correspondent
WHEN JUDY Caldwell was diagnosed with breast cancer at 46 years of age, she was shell-shocked. As she puts it, she was boring - she didn't smoke or drink, she nursed her two children, was on a low-fat diet, ate broccoli, checked her breasts regularly, and there was absolutely no history of the disease in her family.
The diagnosis, when it came, was therefore like "a pie in the face". And it was only made because she availed of the free breast cancer screening programme in the Canadian province of British Columbia.
That was 17 years ago, and even at that time the province, which has a population about the same size as Ireland but a landmass about 13 times greater than ours, was offering free mammography screening to asymptomatic women aged 40 to 69 years.
In the Republic the national breast cancer screening programme is only offered to women aged 50 to 64 years, and it still has to begin screening eligible women in counties Kerry, Sligo, Leitrim and Donegal. While it is Government policy to extend BreastCheck to women up to 70 years, there is as yet no timeframe for this.
The chief executive of the National Cancer Screening Service (NCSS) Tony O'Brien, says the extension of the age range for BreastCheck, both upwards and downwards, has been the subject of discussion at the breast cancer screening board.
He says there was very strong evidence that the first priority should be to screen women aged 50 to 64 years, the next was to extend it to women up to 70 years, and there was "emerging and developing evidence" of the benefits of extending it to women below the age of 50 years.
He says the NCSS has in recent days commissioned an internal review of the evidence on screening women from age 47 upwards, and this will inform its decision-making. He expects the review to be completed within months.
Why then is breast cancer screening already being offered to women in Canada from 40 years upwards? "They felt there were enough younger women who were being diagnosed . . . we know that catching smaller tumours earlier gives a better chance of a good outcome," says Caldwell.
"Am I glad I was screened at 46 years? Absolutely. Technology picked up what my doctor could not . . . I asked my oncologist during treatment what my prognosis would have been, had I not had that tumour picked up at 46 years, had I waited until 50 years to be screened? . . . he turned away from me and his body language told me everything," she recalls.
Her early diagnosis, she points out, also gave her more options. She ended up with a two-inch scar after a lumpectomy, followed by radiation treatment, and was able to avoid an "amputation" of her breast.
Caldwell, who went on to establish the Canadian Breast Cancer Foundation in the British Columbia/Yukon Region which, among other things advocates for best services for patients, says it's "unfortunate" BreastCheck, which only began screening here in 2000, wasn't provided to all regions in the State sooner.
But breast cancer screening in British Columbia operates in a different way. It's up to women to ring up and make an appointment for screening. They don't get a letter in the post calling them for screening, as with BreastCheck. As a result, uptake of the programme in British Columbia is, she says, less than 50 per cent. Here uptake in 2006 was around 78 per cent among eligible women called for screening.
Meanwhile, Caldwell, who is here to speak at a conference on surviving breast cancer at the weekend, points out that a cervical cancer screening programme has been in place in British Columbia for years. It is only now being rolled out in the Republic.
On her radiation treatment, she says she was able to avail of this in her home city of Vancouver but she met other patients at the treatment centre who had travelled hundreds of miles for the therapy.
There are now five specialist cancer treatment centres in British Columbia, but at the time there were just two. People didn't like travelling for the therapy or didn't find it easy, but realised it was something which had to be done to receive the best care, she says.
She suggests there are no long journeys in the Republic compared to in British Columbia. She explains that in British Columbia people travel 1,500 miles - three hours flying time - from the city of Prince George to Vancouver for radiation treatment, and women in the Republic should also realise that travelling to a specialist centre for the best possible care can be the difference between life and death.
She is thus singing from the same hymn-book as Prof Tom Keane, director of the Irish cancer control programme, who wants to centralise breast cancer surgery and radiotherapy into eight designated centres. Dr Keane, an Irish native, worked in British Columbia for years before being seconded here for two years to reorganise our cancer services in a bid to improve outcomes.
Asked if women with breast cancer were also occasionally misdiagnosed in Canada, as they recently have been here, Caldwell says it is important to stress mammography will not pick up everything. She also refers to an ongoing public inquiry in eastern Canada into how mistakes at a laboratory led to almost 400 Newfoundland and Labrador breast cancer patients receiving inaccurate results from hormone receptor tests between 1997 to 2005.
More than 100 of those patients have died, though it may never be known how many of them, if any, died as a result of missing out on treatment.
Meanwhile, to the many women who undergo a breast cancer diagnosis here each year - some 2,379 new cases of breast cancer were diagnosed in 2005 - she says not to be afraid to phone all your friends and ask for support: "Women find it hard to ask for help, but this is a time you need to ask for help."
She advises these women to educate themselves about their options, to bring another person with them to each medical consultation "because you won't remember everything" and to get counselling if necessary. However, her overwhelming message for those who are diagnosed is one of hope. Just as she survived breast cancer, so too can other women.
Judy Caldwell will speak at a conference entitled Surviving Breast Cancer at Dublin's Alexander Hotel this Saturday. Other speakers at the conference, organised by Europa Donna Ireland, include Prof Tom Keane and Prof Niall O'Higgins, head of the department of surgery at the RCSI
The website of the Canadian Breast Cancer Association can be accessed at www.cbcf.org. The Irish Cancer Society's Action Breast Cancer helpline can be accessed at 1800 30 90 40.