Mom's late cancer diagnosis highlights health-care challenges Black women face, expert says

When Nadine McKenzie felt some pain in her chest in early September, she initially dismissed it.

But when the pain persisted, she decided to get it checked out. She knew it wouldn't be an easy process, because like many Ontarians, she's on a wait list for a family doctor.

McKenzie, a 39-year-old single mom with two young daughters, says for two weeks she attempted to get into walk-in clinics and ended up relying on Telehealth Ontario and her own research.

"The clinics were always too busy," she said.

"One day, I said, 'Forget it. I just need to go to the emergency room and take the eight hours and sit down and get this checked,'" said McKenzie, who lives about 48 kilometres east of Toronto in Ajax.

Tests revealed an abnormally large growth in her right breast in a short amount of time. On Sept.19, McKenzie says doctors confirmed it was an advanced breast cancer. Later she would find out it was Stage 4.

"It was no longer about curing it, it was about treating it and managing my life," she said.

From spending hours trying to determine what was wrong, to feeling dismissed by doctors and having friends help connect her with an oncologist, McKenzie says the entire process required a lot of help and self-advocacy. Experts say this is partly due to a shortage of family doctors in the province, and also the result of systemic barriers Black and other racialized women face in the health-care system.

The province says it's taking several measures to address the shortage of health-care workers. But McKenzie says part of the challenge was that even when she was doing her own research, she didn't see herself reflected in the images online. She wonders if all of these things contributed to a later stage diagnosis. 

"When I decided to become my own Google doctor and start looking into things I was not able to find any breast that looked like mine when I searched for breast cancer," she said.

"But I was able to find white breasts of every kind at every stage of cancer."

McKenzie says signs like looking for redness in the skin didn't apply to her, and that she would have acted with a lot more urgency if that information was more readily available, and if there were more resources specifically for Black women.

'Systemic barriers and racism' a big problem, doctor says

McKenzie's story is a common one, says Dr. Mojola Omole, a breast surgical oncologist and general surgeon with the Scarborough Health Network who's also a member of the Black Physicians' Association of Ontario.

"A lot of people are using walk-in clinics more," she said, citing a shortage of family doctors in the province and also noting studies that show Black Canadians are more likely to rely on walk-ins as their primary source of physicians. 

"This is more pronounced in the Black community. Black people's health, when we talk about access, is one of the big issues in terms of systemic barriers and racism when accessing a family doctor," said Omole.

Omole agrees more needs to be done to ensure there is more education and representation in marginalized communities when it comes to breast cancer awareness and research.

"It starts with not knowing this is something that affects your community," she said. Omole adds the pandemic made the problem worse when cancer screenings were put on hold.

New data from the Ontario Medical Association (OMA) shows about 400,000 fewer mammograms happened during the pandemic than would have been expected, and that cancers were more advanced at diagnoses.

According to the OMA, screenings have returned to forecasted levels, but experts worry there are undiagnosed cases of breast cancer yet to appear.

While this wasn't the specific case for McKenzie, Omole says it is one of many reasons why there is an urgent need to increase the number of family doctors and also ensure there are more resources and information available to racialized communities. 

"The majority of my patients are Black or racialized patients and on average ... we see later stage disease in our communities than elsewhere," she said. Omole adds she's been advocating for the guidelines to recommend that Black women start screening for breast cancer at age 40.

Working to boost health-care system, province says

In a written statement, the Ontario Ministry of Health says it's taking several steps to increase the number of health-care workers, including doctors.

"The next phase of our plan will add up to 6,000 more health care workers to Ontario's health workforce, in addition to the 11,400 health care professionals already added to the system since winter 2020," the statement said.

The province says it's also working to break down barriers to support more nimble movement of physicians between provinces and territories. The statement also says the province is trying to get more internationally educated physicians to play a part in Ontario's health-care system.

The ministry also says it's investing in growing medical education and training in the province.

McKenzie wonders if she had a family doctor and was more aware of the importance of breast exams, whether her cancer would have been caught sooner.

Through posting about her experience on social media and having friends share a gofundme page, she is already noticing more people in her circle encouraging others to get screened for cancer. But she says that information should already be prevalent in the community.

"It shouldn't have to get to a point where it's someone that you know, it should be that we already know that we need to get tested."

With her daughters' futures at the top of her mind, McKenzie is embracing a positive outlook over the coming weeks as she prepares to undergo several rounds of chemotherapy. She hopes sharing her story provokes change.

"I know they're going to watch me go through this journey and despite how afraid I really am inside, I can't show them that," she said.

"I know that I'm not done raising them," McKenzie added. 

"Cancer picked the wrong person, because I have to get through this for my daughters."

For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.