Happy New Year, Georgian Life readers! Nurses and medical practitioners, depicted as cape-wearing superheroes for their pandemic efforts, display an unparalleled commitment, shelving personal lives to ensure the health and well-being of our family and friends.

Nurses like Shelley Westergard, clinical coordinator and nurse navigator for the high-risk Ontario Breast Screening Program (OBSP) at the Princess Margaret Cancer Center (PMCC), are instrumental to the success of programs aimed to triage cancer patients through genetic screening, diagnostics and treatment trajectory. There are 30 high-risk OBSP screening locations across Ontario.

The high-risk OBSP is specific for women aged 30-69, and a referral to the program is required. In addition, to be eligible for direct entry into the program, the women must meet at least one of the following under Category A including:

1) be a carrier of a gene mutation with increased cancer risk (for example, BRCA1 or BRCA2)

2) have a first-degree relative who is a carrier of a gene mutation

3) previously assessed by a genetic clinic as having >25% lifetime risk of breast cancer based on family history, or 

4) received chest radiation (not chest x-ray) as part of treatment for Hodgkin’s lymphoma, Wilm’s tumor, or neuroblastoma before age 30. 

A genetic assessment consisting of counselling and/or testing is required to determine eligibility for those who meet criteria under Category B, including: 

1) have a first-degree relative of a carrier of a gene mutation with no previous genetic counselling or testing

2) have a family history of breast or ovarian cancer suggestive of a hereditary cancer syndrome, or

3) have breast or ovarian cancer in those of Ashkenazi Jewish descent. 

Shelley’s role includes triaging and consulting with referring physicians, conducting new patient consultations, educating patients about the program, analyzing diagnostic imaging results, biopsies, and other breast treatments, and providing psychosocial support. Shelley enjoys educating her patients with the findings. “I like to bring them down to a level to feel empowered about their choices. If we find something in its early stage, intervention is less invasive.” Shelley helps patients gain the necessary knowledge and access to educational resources relating to their diagnosis. “Full education is essential, don’t rely on Google!”

Shelley works collaboratively with a diverse oncology health care team of specialists, including the psychosocial department, to facilitate necessary care. “Psychosocial support is an integral part of navigation. While the screening program is instrumental in identifying early breast cancer changes, it can be anxiety-provoking.” Anxiety stems from being identified at higher risk, fear of possible or actual cancer diagnosis, decision-making to promote health and well-being, and cancer prevention. “I really want to support my patients and provide tools and strategies that help empower them through the program to expedite care in a timely manner.”  

Shelley has developed a tracking system that tracks women entered in the program from enrollment to screening, diagnostic, and treatment trajectories. The system allows Shelley to track and support patients while on hold for breast surveillance due to pregnancy, breastfeeding, cancer treatments, or if patients decide to transfer to other screening sites or who may be palliative. Shelley described, “Without consistent tracing, it would be impossible to know where any of my patients are putting them at risk of falling off the screening track.” 

Shelley’s dedication to the program is paramount. “I love helping my patients. It is exciting to see women at higher risk for developing breast cancer proactively participating in annual breast MRI and mammography surveillance and making educated and informed decisions about their breast health care. Early detection and prevention of breast cancer enables less invasive treatment intervention. Despite the high volume of work required to run the program, it is a very rewarding job.” 

Thanks to Shelley’s dedication to the program, more than 1000 women have been identified as carriers of a deleterious gene mutation implicated in breast cancer at PMCC; most common are BRCA1, BRCA2, or Neurofibromatosis Type 1 (NF1) gene mutation. Although the high-risk OBSP is essential, government funding and available resources are key to program sustainability, retention, and growth. “Without funding, we cannot adequately provide the necessary services.” 

Submitted by: Dr. Oliver Kent, Cancer researcher and Senior Scientist at adMare BioInnovations.  

Do you have an idea or question you would like to read about in the Cancer Chat? Email (kent.uhn@gmail.com) or text (438-874-6546) and let me know!