When Amanda Cosgrove turned 40, she asked her family doctor if she could get a mammogram as an early screening tool for breast cancer. Her doctor asked a few questions about her family history and told her she didn’t meet federal guidelines, and didn’t qualify for the screening in Ontario until she turned 50.
Cosgrove was surprised and confused, but “just let it go”.
When her cancer was confirmed, Cosgrove mentioned to the physician in charge that she had tried to get a mammogram three years earlier, but was told she didn’t meet the guidelines.
“(The doctor) looked at me and said, ‘Those guidelines are totally out of date. Tell all your girlfriends to get a mammogram.’ I was dumbfounded.”
Those federal guidelines, which are currently under review, still recommend routine breast cancer screening begin at age 50, but this week Ontario became the latest province to begin routine mammograms at age 40, based on growing evidence that waiting until 50 is costing lives.
This week’s announcement by Ontario Health Minister Sylvia Jones that the province would lower the age for regular, publicly funded breast cancer screening to 40, had Cosgrove thinking about “what ifs”, something she tries not to do.
After difficult treatments that included a double mastectomy, months of chemotherapy and radiation, Cosgrove says she is confident if she had been given a mammogram when she initially asked for one, her cancer would have been discovered significantly earlier and that would have meant less harsh treatment.
“I feel pretty strongly that I probably wouldn’t have had to go through chemotherapy if the screening was open.”
She and other patients, and advocates applauded Ontario’s move this week.
“It is overdue, but really a welcome announcement,” said Ottawa’s Carolyn Holland, 45, who was also diagnosed with breast cancer in her 40s. “My hope is this will mean many women in their 40s will not go through what I went through.”
When she was 43, Holland discovered lumps in both breasts. Her doctor’s first assessment was that it was probably not breast cancer, in part because of her age.
Despite that, she sent Holland for testing, which, after months-long waits, revealed she had two different types of cancer, including invasive ductal carcinoma in the left breast.
Holland began chemo immediately and then, after eight sessions, underwent a double mastectomy and removal of some lymph glands. She later underwent radiation treatment and remains on the drug tamoxifen, which is a hormone suppressant aimed at preventing a recurrence.
It has been a long, difficult process that has left Holland with some lingering after-effects. Holland says she hopes other women can avoid later diagnosis because routine mammograms are now available at 40.
“I find it shocking. Women have Pap tests (a diagnostic tool to screen for cervical cancer) from the age of 16 or 18. We do this to catch cervical cancer early. The fact that we didn’t treat breast screening the same way to me was confusing.
“Had it been caught earlier, the likelihood is that I wouldn’t need a bilateral mastectomy or even chemo.”
Dr. Jean Seely, head of breast imaging at The Ottawa Hospital and professor at uOttawa’s faculty of medicine, is among leading researchers on breast screening and a key advocate for beginning routine mammograms at age 40.
“I am delighted,” she said of this week’s announcement about lower the age for routine mammograms in Ontario, allowing eligible women, non-binary, trans and two-spirit people between the ages of 40 and 74 to self refer to a mammogram every two years beginning in the fall of 2024.
“I have been advocating for this for over 20 years. This is going to save lives.”
Among other things, Seely’s research has shown that there were significantly lower numbers of women living with advanced stage breast cancer diagnoses in provinces that had lowered the age for routine screening from 50 to 40.
Seely is also involved in a yet-to-be published study showing rates of breast cancer among women in their 40s has increased significantly in the past five years. She said the incidence of breast cancer in women in their 40s is now higher than it was for women in their 50s in 1989 when routine screening began.
The Canadian Task Force on Preventative Health Care currently recommends women between 40 and 49 who are not high risk not be routinely screened for breast cancer. The guidelines do allow some women in that age group to be screened if they wish after a consultation with their physician, but Seely and others say women almost always have been turned down.
“We know hundreds of women were denied a screening because their family doctor refused,” she said.
The task force is currently conducting a comprehensive evidence-based review to update its cancer screening guidelines.
“All available evidence is being reviewed as part of this process,” said co-chair Dr. Guylène Thériault, who is a family physician and professor in the Outaouais.
The task force has, in the past, relied heavily on older randomized control trials, including one that critics have analyzed and say is seriously flawed. More recent observational research supports the life-saving benefits of earlier screening, says Seely.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian Press. All rights reserved.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
The Canadian Press. All rights reserved.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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