“I am optimistic for the future”

In early 2019, only 5 days after my 46^th birthday, I found a lump in my breast. I went to the doctor the next morning, and he suggested I was “too young” for breast cancer. Normally, breast cancer screening was reserved for women 50 and older, however he sent me for a precautionary mammogram and ultrasound. I left the doctor’s office with very little concern and with the requisitions in hand. The mammogram was inconclusive because I have dense breasts, and the ultrasound was completed. The ultrasound technician let me know she was going to confirm the imaging showed everything the radiologist needed for his report. I didn’t think twice about him joining the technician to talk to me about what he saw. After all, that was the process in my two pregnancies, the last one being only two and half years before. Then he gave me unexpected news: he was very concerned with what he saw. A biopsy was completed the following week, as were a battery of other scans and tests.

Breast cancer statistics show that, if caught at stage 1, the five-year survival rate is almost 100%. This was reassuring. Stage 2 is ~ 92% and very survivable. The statistic for stage 3 is sobering with ~74% of patients surviving the next five years. Based on what my GP and others around me said, for the most part, breast cancer can be cured when found early. The exception is the incurable stage 4, for which the prognosis is bleak. Only ~22% of patients live five years. Of course, I was confident I’d be stage 1 or 2, since I found my lump years before I even qualified for screening.

I (impatiently) waited for the pathology, which came in two days. My lymph nodes were affected, so I would either be stage 2 or stage 3. Then I was sent for CTs and a bone scan. Those results also came in a few days later. When I thought being diagnosed with breast cancer was enough, it turned out that by the time I felt the tiny, split pea-sized lump in my right breast, my cancer had already spread to bones. It was incurable. I already knew my odds of seeing my son start grade 1 or celebrating my daughter’s tenth birthday were roughly 22%. How could it be that far advanced? Why couldn’t it have been caught earlier? In the blink of an eye, my life and my family’s life, were turned upside down. I’ve never had a room spin so fast in my head. 

The pathology results from my biopsy informed my oncologist as to the subtype of breast cancer I had. My subtype was triple-positive, meaning it had hormone receptors for estrogen and progesterone and a protein receptor called HER2. That meant I had hormone therapies available to prevent the estrogen from binding to the tumour, and immunotherapy treatments to prevent binding of the protein. The tumour grade was classified as 3, which is the most aggressive type of cancer. While hearing I had a very aggressive cancer, I took comfort in knowing that chemotherapy is most effective on grade 3 cells. The next step was genetic testing, but it did not identify a mutation in any of the 13 genes included in the breast/ovarian cancer multigene panel. The pathological and genetic information revealed from the battery of tests I received informed my oncologist in the development of my treatment plan. This was my first introduction to the basics of precision medicine.

Fast forward to 2023, when I saw a post from Marathon of Hope Cancer Centres Network (MOHCCN) looking for patients, former patients and caregivers to bring their experiences to help shape the future of precision medicine in cancer care in Canada. That’s when I was introduced to the breadth of possibilities stemming from this field in healthcare.

Statistics are clear: the earlier cancer is detected, the better the outcome. And that isn’t simply from a survivability perspective. Earlier diagnosis is also associated with less aggressive, intensive and complex treatments, shorter treatment course, and a quicker return to one’s regular activities. These are compelling reasons to want to diagnose breast cancer sooner rather than later.

Precision medicine is revolutionizing the way cancer is being detected and treated. The way it’s being applied is growing by leaps and bounds. For example, in 2019 – the year I received my diagnosis – had many “firsts” in Canada: the MOHCCN officially began its operations, Health Canada announced an investment up to $150M to accelerate precision medicine, artificial intelligence helps researchers predict if breast cancer patients will respond to chemotherapy before treatment is administered, and an Alberta company opened trials for a liquid biopsy to detect breast cancer, to name a few.

So many developments took place the span of 5.5 years, which is considered a long time for a stage 4 breast cancer patient such as myself, but is very short when it comes to cancer research. Some liquid biopsies are now being commercialized. The MOHCCN went from not having a single “Gold Cohort Case” in its program when it launched in April 2019. Today, it has almost 6,000 full genomic profiles, which will allow researchers to query the data providing oncologists vital information to help with the diagnosis and treatments of their patients, in real-time. As the number of Gold Cohort Cases increase, the more powerful the information becomes for oncologists as it relates to the diagnosis and treatment of their cancer patients.

I wish I could go back in time and get an earlier diagnosis, but that’s impossible. My fate is sealed. But I am optimistic for the future. With better screening technologies, the use of artificial intelligence and increased access to precision oncology, I am hopeful that breast cancers will be diagnosed in earlier stages, resulting in improved outcomes for the 30,000 women who hear the words “You have cancer” every year.