Despite medical advancements, inequalities remain in the healthcare industry. Marginalized communities continue to face healthcare disparities, and female cancer patients are one example. 

A 2015 study funded by the National Cancer Action Team and the Department of Health Cancer Policy Team in England found that female patients experienced a longer lag time for symptoms to diagnosis for bladder, colorectal, gastric, head and neck, lung, and lymphoma cancers. Researchers called for interventions to reduce cancer diagnostic intervals by addressing age and gender inequalities. 

Females and low-income patients also often experienced longer diagnosis intervals for a brain tumour. Brain Tumour Charity conducted a study in 2016, finding that males were more likely than females to be diagnosed within a year of initial symptoms. Females were more likely than males to wait ten or more months between their first visit to a doctor and diagnosis. 

These experiences are prevalent in the diagnosis and treatment of breast cancer. 

Robin Beasley, a breast cancer survivor and co-founder of Be The Choice, spent four years undiagnosed because her healthcare providers relied solely on mammograms for cancer imaging. Since her mammograms returned negative every year, her healthcare provider did not give her a cancer diagnosis.  

“I intuitively felt there was something going on,” Beasley said. “I felt a lump, but my care provider said to me […] I’m not worried about you.” Given that Beasley was in her thirties and had a healthy diet and lifestyle, her healthcare provider did not believe that she could have had cancer. 

Years later, Beasley received an MRI, biopsy, and mammogram for another injury. Both the MRI and biopsy detected cancer cells, but the mammogram continued to display a negative result. 

“I had to fight to get a mammogram in my thirties, and they came back negative, but I had cancer the whole time,” Beasley said. 

Although the Ontario Breast Screening Program expanded in 2011 to screen high-risk females from age 30-69 years using MRI and digital mammography, the website only displays mammograms as the breast screening option.  

However, the efficacy of mammograms has long been a debated topic. 

A study published in The New England Journal of Medicine in 2012 found that breast cancer was over-diagnosed in 1.3 million US females from 1976 to 2008. In 2008 alone, the study estimated that 70,000 females were misdiagnosed, accounting for ⅓ of all breast cancer diagnoses.  

The study also found that mammograms have only a small effect on breast cancer’s death rate.  

In 2018, a study by Cardiff University found that there needs to be a more democratic discussion over breast screening by providing “The full picture of breast screening to the public.” 

In February 2020, the Journal of the National Cancer Institute published a study comparing the benefits of breast cancer screening with mammography and MRI. It found that for females aged 30-39, MRIs may be more sufficient for cancer detection, while mammography is more effective for females aged 50-69 years with annual MRIs. 

Beasley discussed that many females do not want to take mammograms because it is a painful process. The patient’s breast would be placed between a flat support plate and compressed with a parallel plate. X-rays passing through the breast would reach the detector on the opposite side to form a digital image, the mammogram. 

Not only were the mammograms painful, but they were also ineffective for Beasley. It was ultimately through the MRI imaging for another injury combined with a biopsy that diagnosed Beasley with breast cancer. Without that injury, Beasley would have continued to remain undiagnosed. 

“It’s a struggle to get good care as a woman,” Beasley said. “It’s imperative to get these diagnoses in time, but we have a problem with obtaining a diagnosis in proper time, so I don’t know how to make those ends meet.”  

Melanie Adrian, a law professor at Carleton University and the co-founder of Be the Choice, also experienced difficulties with receiving treatment for breast cancer. She found that treatment options were not clearly laid out, “In fact, they were incomplete,” Adrian said. 

Adrian’s healthcare providers told her that they would need to perform a mastectomy, the surgical removal of the entire breast. After speaking with friends and colleagues, Adrian found that there are other techniques. 

Since 2002, breast-conserving surgeries have been commonplace in the surgical treatment of breast cancer. According to a review published in American Family Physician, the preferred treatment method for patients with early breast cancer is a conservative surgical therapy, often lumpectomy and axillary dissection, in tandem with breast irradiation. There were also other techniques, such as sentinel node biopsy, fine needle aspirations, core-needle biopsies, which can all conserve breasts.  

Researchers from Taiwan studied patients who underwent endoscopy-assisted breast surgeries (EABS) from May 2009 to December 2014. They found that EABS is a safe and minimally invasive procedure. In the treatment of breast cancer, mastectomies were not the only available option. 

“What I realized was that I was only getting half the story,” Adrian said. “That was a huge failure on the system’s part.” 

At the time, Adrian’s doctors were all males. “I don’t doubt there’s a gender element in this,” she said. “They missed some of the psychosocial elements of the care path that really needed to be taken into consideration.” Since her doctors were all men, they did not consider the psychological impact of living as a one-breast woman from her thirties and onward.

As Adrian was coming out of her treatment, she began wondering about how many other women had their breasts removed without knowing about alternative treatment options. 

“All those women made decisions thinking those were their only options,” she said. “That was a failure of our healthcare systems, and failure of those doctors to provide information to their patients.” 

Adrian adds that Ontario’s Health Care Consent Act ensures that patients must be informed by their health care practitioners of treatment information.

In 2013, Adrian wrote “Not Available Here,” an opinion piece in the Ottawa Citizen. She addressed Ottawa Hospital’s lack of healthcare providers equipped to treat breast cancer and the pressing need for more available treatment options. 

Her efforts paid off. From 2014-2015, Ottawa Hospital recruited six new breast surgeons, three breast radiologists, two plastic/reconstructive surgeons, and two family physicians focusing on breast problems. They also developed more psychosocial support as part of the Psychosocial Oncology Program where social workers provide individual counselling to cancer patients. 

Adrian wanted to make breast cancer imaging and treatment information more accessible and transparent to other breast cancer patients. In 2012, she co-founded Be the Choice with Beasley, a non-profit run mainly by volunteers. Its “Decision Trees” are free online tools that outline different treatment options at each stage of breast cancer and subsequent steps. They have served over 20,000 breast cancer patients. 

“We keep Be the Choice going because more and more patients are diagnosed every day,” Adrian said. Beasley hopes that others can benefit from the research that many did not receive on time. 

“Ultimately better healthcare is about understanding people as humans,” Adrian said. “How do we better invite people into a system that is about well-being and not about disease?”