London surgeon welcomes increased screenings in fight against breast cancer

London got a difficult reminder last week about the terrible toll that breast cancer continues to take. 

On Thursday, Rebecca McColl, a mother of three, died after a battle with breast cancer. She was 42. Originally from Hamilton, she'd played basketball for the Western Mustangs starting in 2000. More recently, she was a teacher at Laurie Hawkins Public School in Ingersoll.

An online campaign raised more than $64,000 in donations for her family.

"Though our time with her was much too short, we feel fortunate to have shared our lives with someone so special," read a post on the fundraising page.

The Canadian Cancer Society estimates about one in eight Canadian women will develop breast cancer during their lifetime. One in 36 women will die from it.

Partly in response to a study that suggests breast cancer rates are increasing among younger women, in October, the Ontario government lowered the minimum age a patient can self-refer for a mammogram from 50 to 40.

It's a change that will lead to an increase in screening, which is expected to save lives. It's also a change that raises new challenges for care teams.

"We have seen an increase in volume for sure," said Dr. Sarah Knowles, a breast surgical oncologist at St. Joseph's Health Care in London. She's also the medical director of the hospital's breast care program. "We're figuring out how to get through all the numbers. We're definitely doing it, but it has been a challenge." 

Knowles, who was not involved in McColl's care, believes increased screening will mean better health outcomes for patients. For example, finding a lump earlier may mean a patient's treatment course will involve a lumpectomy instead of a more intense surgery such as a mastectomy. 

One challenge of increased screening is accommodating patients who have high-density breast tissue, something that's more common in younger patients. 

St. Joe's uses contrast-enhanced mammography, which uses dye alongside a digital mammogram. It's a process that produces clear images that can reveal even the smallest lesions in the breast tissue. 

"It's more detailed and gives a really clear picture of where cancer is in the breast," said Knowles. "It allows me to look at these images and then translate that into what I'm going to be doing in the operating room."

Increased screening makes it more likely cancer will be caught earlier, but it also will mean an increase in false positives, which Knowles said the hospital is working to manage. 

The big question, of course, is whether access to mammogram screening at a younger age leads to higher breast cancer survival rates for patients.

Knowles said the answer won't emerge definitively until a few years' worth of data is in hand. 

"That's the hard part," she said. "You don't have that immediate answer until you're looking at survival rates five years from now, 10 years from now." 

So, if mammogram self-referrals are available earlier, where does that leave self-exams? Knowles said they're still a good idea.

"It's empowering for women to feel comfortable with their bodies and take care of their health, so if that is a part of it for them, then I totally advocate for self-exams," she said.