Liberal bill would expand cancer screenings for patients with high breast density

Rafah DiCostanzo has learned a lot since being diagnosed with breast cancer in March and she says one of the tough lessons learned is that Nova Scotia’s breast-screening protocol is inadequate.

“I thought an ultrasound was automatic,” said DiCostanzo, the Liberal MLA for Clayton Park West since 2017.

DiCostanzo said she has met 10 or 12 women over the last six months who had gone through breast cancer, two of whom were first diagnosed as Stage 3 or Stage 4 because a mammogram had missed the cancer.

“We know that a mammogram is really not accurate and we need to do the next, better technology, and ultrasound is an addition that really catches it,” DiCostanzo said. “If you have a lump, you automatically get both.”

A screening mammogram is an X-ray picture of the breast and can be used to check for breast cancer in women who have no signs or symptoms of the disease.

“Mammogram can’t detect some cancers,” DiCostanzo said. “Many women have been told, especially if there is breast cancer in their family or if they are a certain age, that you have dense breasts but you can’t have an ultrasound, even when you ask for it. To me, that is utterly ridiculous and sad because the human cost of chemotherapy is terrible but economically, it’s a thousand times more costly than an ultrasound.”

DiCostanzo, participating in the fall session of the Nova Scotia legislature virtually because she is undergoing treatments for breast cancer, introduced a bill Thursday that all patients diagnosed with Category C or D breast density would be provided a referral to receive an examination by ultrasound or magnetic resonance imaging (MRI) within six months of their mammogram. 

It has been established that women with dense breasts have a higher chance of contracting breast cancer and the risk escalates along with the degree of breast density.

“We must do more to ensure women in Nova Scotia with dense breasts are getting access to appropriate screening to help improve their outcomes,” DiCostanzo said in introducing the Liberal bill.

Risk factors

But Health Minister Michelle Thompson said dense breasts are not the only risk factor considered.

“Breast density is absolutely one risk factor but it is not the only one,” Thompson said. “The evidence right now is emerging. Based on the advice of our clinicians and our experts who do this work all of the time and are very invested in the appropriate screening, we will take our direction from them. We appreciate folks bringing this forward and we will continue to work and keep our eye on it and as evidence emerges it will help us make our decisions.”

Thompson said clinical evidence does not support the idea that mammograms are inaccurate. 

“I would not agree,” she said. “I think breast screening is very, very important and there are a number of ways to do that and a mammogram is one of those ways. We also have ultrasound and we also have MRIs and I think it is based on risk and the clinician’s ability to assess and ascertain the risk of individuals.

“It’s important that we as women go for breast screening and go through those protocols and again we work with our clinicians who are on the forefront and the cutting edge of the work that’s happening.”

Thompson said the department follows the directives of Dr. Sian Iles, the section head of the breast imaging program in the Central Zone of Nova Scotia and the IWK, and the program team.

Clinicians advice

“What we need to do is look at how the clinicians triage people and based on their clinical expertise, based on their experiences working with individuals who need to go on for further screening, that’s really how we decide who goes into the line,” Thompson said. “There may be people that go immediately for ultrasound as a result of a mammogram or an examination but that is really the work of the clinicians.”

Thompson said cost is not what the government considers.

“We look at best practice,” Thompson said. “We want to make sure that Nova Scotians get the right care at the right time and at the right place and so we have processes in place. There is a high-risk breast-screening program in place, one of only two provinces in the country that has that. We want to provide the best care that we can. The evidence is just emerging.”

If that evidence supports breast-cancer screening as purported in the Liberal bill, it would be considered down the road, the minister said.

That’s not soon enough for DiCostanzo, who was undergoing her last chemotherapy session Friday.

“I’m asking for something simple that is offered in two or three other provinces right now and it should be offered here,” said DiCostanzo, counting herself lucky to have found a lump that then triggered an ultrasound screening. 

‘Illogical’ 

“It is offered here if you have a lump, but if you don’t … come on. It is just illogical. Let’s catch it early and save women from going through therapy and save government money, a huge amount of money, and time. Imagine if we can save 10 or 15 women a year from going through six months of chemotherapy and radiation. The cost of that is enormous to the woman and the government.”

The Opposition Liberals say the proposed legislation would build on a 2019 policy change made by the former Liberal government that made Nova Scotia the first province in Canada to use a software that assesses breast density and automatically shares results on a woman’s mammogram report.

Jennie Dale, executive director of Dense Breasts Canada, applauded the Liberals’ effort.

“I am thrilled to see the introduction of this critical bill for screening ultrasound in women with dense breasts that would make Nova Scotia a national leader in breast-cancer screening,” Dale said in a release. 

“It’s a huge step toward ensuring early detection of breast cancer and improved outcomes. Ultrasounds can find cancers earlier in dense breasts, when they are small and have not spread to the nodes, giving women a better chance at avoiding chemotherapy and mastectomy and a better chance at survival.”