What a Yellowknife woman wants N.W.T.ers to know about breast cancer screening

When Yellowknifer Mabel Wong was in her 40s in the early 2000s, she was able to get a mammogram in the territory.

By 2013, she decided, despite getting the all-clear from her tests, she wanted to take it a step further: she wanted a copy of her mammogram report. 

That's when she discovered she has what's considered to be "dense breasts," which puts her at higher risk for developing breast cancer.

"On the mammogram, it said that there were no lesions, nothing outstanding in the findings, but I had dense breasts, and I had no idea what that meant," Wong said.

"I went on the internet and discovered that having dense breasts made me at higher risk … because the density of the breast made the images on the mammogram not so clear."

Wong said over the years she's had to self-advocate for her health, and to dig up a lot of information on her own. She's  now hoping the territory will change some of its policies so others will have an easier time navigating breast cancer screening.

CBC spoke with Wong about her health-care journey over the years. These are the top three things Wong thinks others should know about getting screened for breast cancer in the N.W.T.

Know whether you have dense breasts

Dense breasts means having more glandular and fibrous tissues, and less fatty tissue. It's fairly common — about 43 per cent of women 40 and older have dense breasts.

However, it's impossible to tell if you have dense breasts by self-examination or even a medical examination. Only a radiologist looking at a mammogram can tell if someone has dense breasts.

The problem right now, said Wong, is women in N.W.T. aren't being told that information when they get their mammogram results.

A mammogram is basically an X-ray image of the breast. Some find it uncomfortable, but it's not a painful procedure. A screening also consists of a visual and physical inspection of the breasts.

"I would like to see women being given information about their breast density," said Wong, who has four sisters, all of whom also have dense breasts. "Having that information is just another tool in our toolbox to prevent breast cancer."

Jenna Long, the territorial manager for cancer care at the N.W.T. Health and Social Services Authority, said providing information on breast density is something the N.W.T. is considering doing in the future in result letters to patients — as opposed to people having to ask for it.

In the meantime, she said that information is available to patients through a primary care provider or a community health centre.

Long said that might help people "have a more holistic understanding of their individual risk."

In the N.W.T., she said, breast cancer is the leading cancer diagnosis for women and non-binary people with breasts, and it's also the third leading cause of cancer-related deaths for that same population. 

"So it is an urgent and very important conversation to have," she said.

Age for screening starts at 50, but it's possible to start sooner

Wong said she wants to see the age eligibility for getting screened in the territory to be lowered.

The N.W.T.'s current recommendation, which came into effect in 2013, is that people with "average risk" should be screened between 50 to 74 years old every two years. Those aged 40 to 49, and over 75, are advised to speak with their health-care provider about "the benefits and harms of mammography," the territory's website says.

A handful of other Canadian jurisdictions follow similar recommendations.

The policy is based on national study published in the '90s, which found that the risk of diagnosing a false-positive when normal lumps are found, or overexposure to the radiation of a mammography X-ray, overrode the effectiveness of offering screening to women in their 40s.

Dr. Jean Seely, a professor of radiology at the University of Ottawa and the regional breast imaging lead for cancer for the Ottawa region, said the national study which N.W.T. and other jurisdictions base their policies on was flawed.

Seely has been advocating for provinces and territories to lower their screening eligibility to age 40.

She said starting screening at age 40 has a "big impact," as she said about 17 per cent of breast cancers occur when people are in their 40s, and when they're diagnosed, they're more likely to be at a more advanced stage.

"Not including women in their 40s in the screening programs is a real problem," she said.

"[It] probably explains why breast cancer is the number one cause of cancer deaths in Canada, in women younger than 55."

Seely also said Canadians have the right to be screened beginning at 40, and said people should feel empowered to insist on it to their health-care provider, even if they're not deemed high risk.

Long said the N.W.T.'s current policy doesn't mean women in the territory can't be screened under 50 years old.

Those with higher risk of getting breast cancer, like those with a family history of the disease or those who show possible symptoms, are encouraged to speak with their doctors, as they could be eligible to start screening sooner.

"We're really hoping to promote the importance of breast cancer screening and early detection," she said.

"So, really trying to get the message out there that if you're eligible for mammography screening, if you think you might be eligible for mammography screening, to start having those conversations with your healthcare provider."

N.W.T. mammogram machines can't detect cancers very well in some breasts

As for those with dense breasts, at present, the mammogram machines in the territory, including the kind offered at Stanton Territorial Hospital, can't easily detect cancer. 

Instead, someone would need to know they have dense breasts, then have a 3D mammogram or special ultrasound outside the territory, like in Edmonton.

That's what Wong did, on her own dime, for years. She continues to get screening there, but is now covered by the N.W.T. government as she was deemed higher risk due to a family history of breast cancer.

Long said Stanton may soon upgrade its mammography machine, since the Run For Our Lives committee fundraised to buy a new 3D digital tomosynthesis machine. 

"We're quite excited about that because that really does have some very positive impacts for women, as an example, who have quite dense breasts," Long said. "So it'll allow for a much more … robust imaging of that breast tissue."