One of the most striking parts of this important article in The Walrus is author Kelly S. Thompson’s own story.

Kelly is at high risk for breast cancer and has chosen to undergo a risk-reducing double mastectomy. It is a deeply personal decision about how she wants to manage her breast cancer risk.

Her story also highlights separate but important issues: Are we ensuring women are aware of their individual risk? And can women at increased risk access screening appropriate to that risk?

In the US, Kelly receives alternating mammograms and MRIs every six months. As she prepares to return to Canada, she faces uncertainty about whether she would have access to the same high-risk screening. She also has dense breasts, which can make cancer harder to detect on a mammogram.

Many women may not know their individual risk for breast cancer. Risk is about much more than family history or genetic mutations. Breast density, reproductive history, age and other factors can all matter. Yet comprehensive risk assessment is not routinely offered, meaning some women at increased risk may never be identified.

And for women who are identified as high risk, access to enhanced screening varies across Canada. Ontario and Nova Scotia have formal high-risk screening programs, and Alberta is developing one. Ontario and Nova Scotia use the Tyrer-Cuzick risk assessment model, which considers multiple factors to help determine eligibility. We have discussed this model in many of our posts. A lifetime breast cancer risk of 25% or greater is one of the criteria used to determine eligibility for high-risk screening and annual MRI. In BC, where Kelly is moving, eligibility for high-risk screening is instead more closely tied to hereditary risk through BC’s Hereditary Cancer Program.

The article includes insights from Dr. Jean Seely, Dr. Rona Cheifetz and DBC’s medical advisor, Dr. Paula Gordon. It raises important questions about how we assess breast cancer risk and how high-risk screening is delivered across Canada.

Thank you, Kelly, for sharing your experience so openly and for bringing much-needed attention to these important issues.

Read the article here.