she tried for a year to be diagnosed. it developed into stage 3 cancer
"i should have just been able to get a referral with no problem," says 28-year-old montrealer valerie buchanan. "they were very quick to brush me off because of my age."
jul 13 2021
9 minute read
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by: robin della corte
at the beginning of the covid-19 pandemic in march 2020, valerie buchanan discovered she had a lump in her left breast. at the time, the 27-year-old quebecer living in ottawa didn’t think it was breast cancer.
before moving back to quebec that summer, buchanan attempted several times to see a nurse or doctor in person for her lump. she also tried to get in contact with her family doctor, but her doctor at the time didn’t have their voice mail set up.
she managed to get a hold of three health-care professionals on the phone: a nurse who told her to get in contact with her family doctor, and another nurse and a doctor who believed it was either a benign cyst or a fibroadenoma (a non-cancerous tumour in the breast).
at the height of the lockdown, they deemed it not to be an emergency that required her to have it examined in person.
“they would tell me, ‘i really wouldn’t worry about cancer — you’re too young,’ ” buchanan recalled.
“i wanted to believe it was just a cyst; i really didn’t want it to be cancer. i’m not going to argue with a doctor. i knew something was wrong, but i didn’t feel like it was enough for me to go on a crusade against all the medical professionals who said don’t worry about it.”
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they instructed buchanan to alternate between hot and cold compresses every 15 minutes on the lump, which was the size of a bottle cap, and to call back if it didn’t go away.
“maybe i should have been more aggressive and asked to still be checked, but i’m not one to question what the appropriate course of action is. i’m not a doctor,” the vaudreuil-dorion resident said.
that summer she moved back to montreal and finally managed to be seen in person in august, for the first time since she discovered the lump.
her lump was now the size of an egg, and she started getting shooting pain in her breast.
however, the doctor also believed it was either a benign cyst or a fibroadenoma and advised buchanan to alternate between hot and cold compresses and to come back if it didn’t improve.
buchanan told the doctor she was given those instructions before by two other medical professionals, but the doctor insisted to keep doing it and assured her she was too young to have breast cancer.
throughout the year, buchanan was still calling public clinics, private breast clinics, imaging centres, 811 and clic santé so she could have access to a mammogram or ultrasound.
she was never able to access a breast clinic, because either she needed a referral, clinics weren’t accepting new patients, they never returned her call or she had to be over 40.
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“at one point i was just googling clinics and aimlessly calling any number i could find online, one by one,” buchanan said.
in february, her lump now the size of an avocado, buchanan developed other alarming symptoms. she decided to go back to the same clinic she went to in august.
for the first time, she got a referral for an ultrasound. however, because the referral indicated it was a cyst, it wasn’t considered an emergency and the wait was at least three months.
over the easter weekend in april, buchanan’s left arm went numb from the shoulder to elbow, as did her hand. she knew this couldn’t wait.
the following tuesday, she decided to again call every single private breast clinic, public clinic and imaging centre in montreal and ottawa in an attempt to be seen.
with no luck that day, she persisted the following day and finally found one clinic that would take her. she paid just over $2,000, which included an ultrasound, mammogram and biopsy.
the results of all those tests indicated buchanan not only had breast cancer, but a rare form — triple-negative breast cancer — and it was now at stage 3c.
“there were a couple days i was angry,” she said. “i felt numb, too, but i was ready to do whatever i had to do. my life is more important to me than my chest.”
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with the cancer now in her left breast, the lymph nodes under her left arm and the lymph nodes against her chest wall, her treatment plan was aggressive: 16 weeks of chemotherapy, a double mastectomy, followed by radiation for five weeks.
“my treatment is more aggressive now because i was diagnosed later,” buchanan said. “it stripped me of my options.”
buchanan also has two tumours: one in the lymph nodes under her left arm and one in her left breast.
had her cancer been caught sooner, she may have been able to undergo a lumpectomy and radiation instead.
“there’s a ripple effect. it’s not just about having a deadly disease — a lot of things would be more different,” buchanan said.
“i also had to worry about freezing my eggs or embryos, because there’s a 50 per cent chance chemotherapy can make me infertile. i went from thinking i didn’t have cancer to getting thrust into a new perspective of how i want to live my life if this is it.”
when she was about to begin treatment in april, buchanan looked ahead for positivity but remained disappointed with how long it took to receive the diagnosis.
“it felt like i had to go through all these circles and jump through obstacles just to see someone, depending on if the first person thinks it’s valid enough or deems my symptoms worthy enough,” she said. “i should have just been able to get a referral with no problem. they were very quick to brush me off because of my age.
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“it was always a problem before, but the pandemic made it worse.”
***
the impact of the pandemic on cancer in quebec
quebec has recognized postponing preventive screening, cancer surgeries, radiotherapy and chemotherapy has been an awful result of the pandemic, as resources in the health system were diverted to deal with covid-19 patients.
mammography, fits (fecal immunochemical tests) for colon cancer, colonoscopies and other preventive screening programs were largely on hold during the first wave.
while screening gradually started to resume in june 2020, by january mammography and fits were still down by 30 to 35 per cent compared with the same time period last year.
according to a report published at the beginning of this year from the ministère de la santé et des services sociaux (msss) that examined the pandemic’s impact on cancer care and services, at least 4,119 people with cancer were not diagnosed in quebec from march 1 to july 18, 2020.
eva villalba, executive director of coalition priorité cancer au québec, questions whether that number is now double, since it reflected only the first wave of the pandemic.
“we have been extremely concerned, and we have been vocal that we were very bothered with stoppage of screening programs,” she said.
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the msss also confirmed that from sept. 15 to oct. 12, 2019, it recorded 28,980 mammograms. from sept. 13 to oct. 10, 2020, the number of mammograms was 25,663 — a decrease of 3,317.
according to villalba, the coalition conducted two large public surveys and the results were used as recommendations for the provincial government on how to tackle the cancer backlog.
those recommendations were sent last summer, and while the government announced a nine-point plan last august to prepare for a second wave, they omitted a plan to address the backlog.
villalba says the coalition is still waiting for that plan.
dr. talía malagón, research associate at the mcgill university department of oncology and an epidemiologist who sits on the mcgill task force on the impact of covid-19 on cancer control and care, presented a plan to members of the msss.
she says based on her research through mathematical modelling, the quebec health sector must increase its capability by 10 to 20 per cent over pre-pandemic capacity from june through december to catch up on the backlog of diagnoses and cancer treatment.
this means cancer services in quebec would have to operate at 110 to 120 per cent capacity for around seven months to catch up and prevent the excess mortality that would occur due to delays in cancer care.
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“merely returning at 100 per cent is predicted to lead to excess cancer mortality because this would not tackle the backlog, leading to delays in cancer care,” malagón said.
malagón’s study also estimates there is going to be an increase of 8,000 to 10,000 deaths because of cancer by 2025 if the msss does not compensate for the impact of the pandemic on oncology.
msss spokesperson robert maranda confirms the ministry is working with its programme québécois de cancérologie to establish a recovery plan that will be developed this summer.
maranda says several developments in cancer care have already been put into action.
“the msss periodically monitors the situation in each region and when the situation requires it, it supports the establishments in finding strategies that will improve access to cancer screening and examinations,” he said.
diego mena, vice-president of strategic mission initiatives and engagement at the canadian cancer society, says that while screening programs are operating at close to pre-pandemic levels, the effects of the first wave must still be considered.
“the msss need to continue their prioritization of (oncology) activities to reduce the impacts of the pandemic on cancer patients and on their loved ones,” mena said.
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“a longer delay in cancer diagnosis will mean that we are going to have an increase in cancer numbers in the next years, but also more advanced cancer. this situation will have important consequences on the quality of life of cancer patients and an increase of cost for quebec’s health system.”
villalba agrees that the msss must prioritize cancer care in quebec and deliver a plan to tackle the backlog.
“we’re going to continue to put pressure on them until they do deliver a cancer plan that allows us to be at 120 per cent capability, because we know we can’t be at 100 and take care of everyone and not let anyone fall through the cracks — especially those that are not obvious, like (buchanan),” she said.
“these are exactly the type of people who will fall through the cracks.”
***
moving forward
the day before her first chemotherapy round, buchanan, now 28, decided to shave her hair.
“being that so much is already outside of your control with cancer, i decided in order to reclaim some control of my life, i would shave my head before treatment,” she said.
buchanan’s parents ordered her and her fiancé a special dinner that night.
“it was a really nice dinner that night, and i kind of use it as a milestone in getting one step closer to beating this cancer,” she added.
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two months into her treatment, buchanan received some good news.
the tumour in the lymph nodes under her left arm is now gone after three chemotherapy rounds — an indication that buchanan is responding well to treatment, according to her surgical oncologist. the main tumour in her left breast has also shrunk significantly, by 20 per cent.
a scan also showed no metastatic disease. she will undergo another pet and ct scan in august to see how she responded to the first type of chemotherapy, before moving on to a more aggressive treatment.
“i’ve made peace with it,” buchanan said. “i’m focusing on healing my body and taking this as an opportunity to make changes in my life.”
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