Breast cancer is one of the most common types of cancer affecting women in Canada. About 1 in 8 women develop breast cancer in their lifetime. Starting in the cells of the breast, tumours can infiltrate nearby tissue or spread to other parts of the body. Breast cancer can be treated with surgery, drug therapy, and radiation therapy, but not all breast cancers are the same. Since every patient will respond to these treatments differently, predicting a tumour’s response to therapy can improve patient outcomes.

Dr. William Tran, radiotherapist and senior scientist in the Odette Cancer Program, has teamed up with Dr. Fang-I Lu, a breast pathologist at Sunnybrook and associate professor at the University of Toronto and together, they are developing AI technology to improve radiation therapy treatment for breast cancer patients.

The team is mapping the tumour immune microenvironment, the complex ecosystem of cells surrounding the breast’s tumour. Since the immune system plays a role in clearing tumour cells, the team aims to measure the probability of a tumour’s response to high-dose radiation treatment in women with high-risk breast cancer. The project involves taking thousands of tumour images and complex computational methods to recognize biomarkers associated with the tumour-killing effects of radiation treatment.

Dr. Fang-I Lu and Dr. William Tran analyze an annotated pathology sample.

“Our work will allow doctors to determine which patients will benefit most from radiation therapy,” explains Dr. Lu. “The ability to predict a tumour’s response to certain types of therapy has the potential to support more personalized and effective treatment plans for patients with advanced breast cancer.”

Radiation therapy is a common type of treatment for many cancers. The treatment uses high-energy beams to destroy the genetic material in cancerous cells that control how the cells grow and spread. Radiation therapy can also damage healthy cells in the body, which can cause short-term and long-term side effects like hair loss and fatigue. “Personalizing the treatment plan using AI can help optimize treatment outcomes while minimizing the side effects,” adds Dr. Tran, who is also an associate professor at the University of Toronto. “Our AI-based prediction model will help spare patients who are unlikely to benefit from radiation treatment from the short and long-term side effects associated with exposure to that type of therapy.”

Since 2018, the team has been researching the use of AI and digital pathology to map breast tissue samples and measure their resistance to neoadjuvant chemotherapy treatments. With this newest model currently undergoing planning for early-phase clinical trial testing, Dr. Tran hopes to continue improving personalized cancer treatment planning in the radiation oncology clinic.

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“Rightfully a lot of attention is paid at the time of diagnosis and active treatment,” Dr. Al-Khaifi said. “Many breast cancer survivors have told me that while they felt they had a lot of information and support during their active treatment, once treatment stopped, they lost the continuity of care with the physician.”

It means patients are often left wondering what to expect, what to watch out for with respect to cancer recurrence, and what to do about ongoing side effects of treatment.

“After treatment ends, it’s very common for side effects to continue,” Dr. Al-Khaifi said. “It’s not just a ‘return to normal life.’ Pain. Lymphedema. Anxiety. Depression. Self-image changes. Sexual dysfunction. Menopausal symptoms that are caused by cancer treatment. And the fear of the cancer coming back. All of these contribute to the patient’s quality of life.”

Long-term survival rates after the diagnosis of breast cancer are improving, with a 5-year survival rate in Canada of 90 per cent.

“The continuing improvement in survival rate, coupled with an aging population, contribute to an increase in survival population. As a result, follow-up care with a focus on quality of care is increasingly important,” Dr. Al-Khaifi said. “Research shows that a quarter of breast cancer survivors report anxiety, depression and fears around recurrence, and anecdotally based on my experience with breast cancer patients, I believe the rate is much higher.”

Dr. Al-Khaifi wanted to improve the lives of breast cancer survivors and that’s why she developed and proposed the Sunnybrook Breast Cancer Survivorship Care Clinic. Currently she is the physician lead of the survivorship program at the Louise Temerty Breast Centre.

“I met a patient who had completed treatment and had a good prognosis. She was so acutely anxious of cancer recurrence and her self-image was so low after her body changes that she told me she didn’t leave the house. As a healthcare team, we have to support the whole person. We have to provide women like this with more support and resources after their active treatments like chemotherapy and radiation end.”

Dr. Al-Khaifi works with patients to create an action plan and address their side effects and concerns, and promote a healthy lifestyle to help reduce the risk of recurrence. She also works closely with family doctors to assist in the transition of care back to the community physician.

“Research shows family physician-led survivorship care is as good as specialist care with no difference in recurrence-related serious clinical events. Patients are generally more pleased with their care because it’s closer to home and more comprehensive, and their quality of life improves.“

The care is also individualized, she adds.

“Everyone is different, and everyone responds and reacts to cancer treatment differently. We use a practice-based, evidence-based and personalized approach to help support the whole person through their cancer journey.”

The approach can also have an impact on the healthcare system, she adds, by helping open up cancer physicians’ caseloads for active treatment patients.

“Plus, educating patients on what’s ahead and providing follow-up plans can help reduce fears, which reduces the demand for unplanned care and the amount of imaging, and the costs associated with that.

“So, this approach can be cost effective and beneficial for the healthcare system as well as patients. Further, this may support better coordination between cancer teams and family physicians through treatment summaries and survivorship care plans.”

The post Dr. Muna Al-Khaifi on closing the gap in breast cancer treatment appeared first on Your Health Matters.

Odette Cancer Research Program scientist William Tran, MRT(T), PhD, set out to evaluate and improve care for women with breast cancer who undergo neoadjuvant chemotherapy to shrink their tumour ahead of surgery.

“Our overall goal was to see if we could predict the tumour’s response to chemotherapy. If we can better understand that, we could potentially empower our clinicians to adapt each patient’s therapy based on their risk of being either chemotherapy-resistant or chemotherapy-responsive,” he explains.

Donor support enabled the purchase of a digital pathology system, which is capable of mapping breast tissue samples and producing an intricate depiction of the tumour’s biology in just a few hours – but only with the patient data to power it.

Looking to the past to invent the future of pathology

To deliver on that piece of puzzle, Dr. Tran partnered with Dr. Fang-I Lu. The Sunnybrook pathologist and member of the Anatomic Pathology team knew that the key to precision oncology was to gather data from past breast biopsies to inform the development of a predictive algorithm.

“Think of digital pathology like a self-driving car that is capable of recognizing other cars and pedestrians on the road,” she says. “The more roads the self-driving car goes on, the smarter it gets. In much the same way, the more data we feed into the digital pathology system, the better equipped it is to recognize cancer’s many features.”

Dr. Lu and Dr. Tran began the arduous process of digging through Sunnybrook’s archived files, searching for the thousands of patients treated with neoadjuvant chemotherapy since the program’s inception in 2019.  Dr. Lu’s quest for breast biopsy samples even took her deep into the hospital’s basement archives.

The largest tumour biobank of its kind in Canada

From a cohort of 1,200 patients, they amassed 485 tumour samples – the largest collection of its kind in the country.

“We were able to extract these samples, look at the digital slides and then evaluate clinical and pathological characteristics that then became pivotal in training the digital pathology system,” says Dr. Tran.

This initial “training phase” laid the foundation for much of the groundbreaking work Dr. Tran and his colleagues are conducting today.

Together with Sunnybrook medical oncologist Dr. Kasia Jerzak, Dr. Tran is testing the ability of the digital pathology system to find biomarkers and assess treatment response for very aggressive and locally advanced breast cancers – a step that he says can be completed in one-third of the time of the previous manual screening and analysis process. An accelerated timeline has the ability to both reduce stress for patients awaiting test results and improve the efficiency and effectiveness of personalized treatment planning and delivery.

A pathologist’s powerful ally

For Dr. Lu, the possibilities are game-changing. “In so many instances now, the computer is outperforming pathologists. It can even recognize features that can’t be seen with the naked eye. For pathologists like me, digital pathology is a powerful ally. It’s another set of eyes constantly checking and complementing my work.”

One of the team’s biggest priorities is to uncover the biomarkers associated with what medical oncologists call a “complete pathologic response,” the complete eradication of the tumour cells within the breast and surrounding lymph nodes. Research has shown a correlation between complete pathologic response and long-term survival.

Again, Dr. Lu has proved pivotal to much of this work.

“After we built the artificial intelligence framework, we invited her to look at our models and assess whether or not they were feasible,” explains Dr. Tran.

The team was recently awarded a $250,000 grant from the New Frontiers in Research Fund (Canadian Tri-Agency Organizations) to further refine the algorithm toward a goal of introducing it into clinical practice within the next year. Donor support was a key part of that successful application, providing the leverage the researchers needed to secure the federal government grant.

Says Dr. Tran: “We couldn’t do this work without our dedicated donors. Donor support is ensuring Sunnybrook continues to lead in this emerging and exciting field.”

The post Using the combined powers of AI and philanthropy to improve cancer treatment planning appeared first on Your Health Matters.

But now, nearly a year later, there’s another crisis brewing beneath the surface: undetected breast cancers.

In a regular year, about 73,000 women participate in the Ontario Breast Screening Program (OBSP), which invites women aged 50-74 for a screening mammogram every two years. Each year, about 430 of those women go on to receive a diagnosis of breast cancer.

Last year, just 28,000 Ontario women underwent screening mammography. Those tests detected 148 cancers, most at their early stages. The missing mammograms mean about 200 more women in Ontario have undetected breast cancers.

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Screening mammography is a test done on people who are at risk of getting cancer, but have no symptoms of the disease. The goal of a screening test is to detect breast cancer in its earliest stage, when it’s more curable and requires less aggressive treatment. Research shows that early detection helps reduce breast cancer deaths.

The decline in screening tests means instead of catching a cancer when it is small and undetectable by a physical exam, a woman seeks medical care when she notices a lump or change in her breast. By then, it’s more likely the cancer will be advanced. And while we can’t turn back time to know if an advanced cancer might have been seen on a screening test, we do know that a screening test is one step we can take to try to catch breast cancer early.

At Sunnybrook, our OBSP screening site reopened last summer when we were permitted to do so, and since, the team has been holding some “Saturday Blitzes” to get through the backlog of breast screening tests. Our backlog is cleared, and if you are due for a mammogram, we want to see you.

If you missed a mammogram in 2020 or are due for one in 2021, please call your health-care provider or screening site and book it today.

We have heard from women that they were frightened to come to the hospital. We have also heard that some didn’t think their screening would take place because it isn’t important. It is important and we want to reassure you, it is safe. We have COVID-19 safety rules in place to protect you and our staff.

And, if something highly suspicious is spotted on your test, your health-care professional can refer you to the Marion Solway Breast Rapid Diagnostic Unit, where investigation with a diagnostic mammogram, ultrasound and biopsy are performed and a rapid diagnosis provided within 24-48 hours of those tests.

It’s particularly important for high-risk women to undergo routine screening. If you have a family history of breast and/or ovarian cancer, you can be referred to the High-Risk Breast Clinic at Sunnybrook’s Louise Temerty Breast Cancer Centre where our team of physicians, radiologists who specialize in breast imaging and genetic counsellors can assess if you are at high-risk of developing breast cancer and if so, provide you with recommendations for screening and risk-reducing strategies.

As always, if you notice a lump or change in your breast, please contact your health-care provider right away.

As 2021 gets underway with COVID-19 still a part of it, we all must balance the risks of COVID-19 against the harms related to interruptions in cancer screening, including the development of more cases of advanced cancer requiring more aggressive treatments, utilization of health care resources and cancer-related deaths. Please ask your health-care provider about cervical, lung and colorectal cancer screening as well. If you do not have a family doctor or nurse practitioner, contact Health Care Connect by calling 1-800-445-1822 or visit ontario.ca/healthcareconnect to be connected to a primary care provider.

What are you doing next Saturday? We hope you’ll consider booking your mammogram screening test. It could save your life.

If you have breast tissue, it is recommended that you be screened according to provincial guidelines, regardless of your gender identity or sexual identity. Ontario Health (Cancer Care Ontario) is working to implement a policy for the inclusion of trans and gender diverse people in its organized screening programs. More info can be found here.

Blog authors:

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For the 2SLGBTQ+ community, there are many barriers to healthcare that lead to lower cancer screening rates, says Dr. Ed Kucharski, Chief Medical Officer for Casey House and Assistant Professor at the Temerty Faculty of Medicine, University of Toronto.

“There’s actually not a lot of research because we haven’t historically collected gender identity or sexual identity with screening data,” he says. “But we do know that many in the 2SLGBTQ+ community screen for cancer at lower rates and that can lead to missed cancer, or cancer being diagnosed at a later stage when there are fewer treatment options.”

Dr. Kucharski says a greater number of 2SLGBTQ+ people don’t have primary care providers (family physicians or nurse practitioners, for example), or may avoid medical care due to fear of or past experience of homophobia or transphobia. They may also have been denied or avoid healthcare because their appearance doesn’t match the gender marker on their health card.

“It can also be because healthcare discussions are focused elsewhere and screening then just doesn’t come up,” he says. “For gay men, healthcare discussions have historically focused on HIV or STI screening and less so on cancer screening.”

Dr. Kucharski encourages everyone: If you are eligible for screening, you should be screened, regardless of gender identity and/or sexual orientation. “The trick for us as providers is to do it in a culturally competent manner,” he says.

And, he adds, there’s no one-size-fits-all approach.

“Generally, when recommending screening with my patients, I suggest we look at the organ systems that are present,” says Dr. Kucharski. “From there, we can start conversations carefully, with the understanding that the thought of screening can be very unsettling to some 2SLGBTQ+ people.

“But knowing that cancer screening can help find cancers early, it’s important that we all consider taking part in screening programs or other preventative measures.”

In Ontario, there are four provincial screening programs aimed at finding cancers before you would notice any symptoms.

Here’s an overview of each from Dr. Kucharski:

Cervical Cancer Screening:

Anyone with a cervix who is over the age of 25 and has ever been sexually active should be screened for cervical cancer. Sexually active means any skin-to-skin genital contact with anyone of any gender. In Ontario, cervical cancer screening is a Pap test, which looks for changes in cells in the cervix.

For trans men who are taking testosterone, we still recommend a Pap test, if you have a cervix. If you’ve had a hysterectomy, talk to your doctor to determine if you should still undergo Pap tests — it will depend on what type of hysterectomy you’ve had.

Most trans women who have had gender-affirming surgery do not need cervical cancer screening because the surgery typically does not include the creation of a cervix.

The vast majority of cervical cancer is caused by human papillomavirus (HPV). Whether you take part in screening or not, consider speaking to your primary care provider about getting the HPV vaccine.

Colorectal Cancer Screening:

If you are 50 years of age or over, you should be screened for colorectal cancer, regardless of your sexual or gender identity.

To determine your risk and the best type of screening for you, speak with your primary care provider and/or go to mycanceriq.ca

Gender identity or sexual orientation does not affect colorectal cancer risk. Here’s more information about colorectal cancer screening, including a new and better screening test available in Ontario.

Breast / Chest Cancer Screening:

If you have breast tissue, it’s recommended that you be screened according to the provincial guidelines, regardless of your gender or sexual identity.

That means if you are between ages 50-74, it’s recommended you get screened with mammography every two years. Screening is the best way to find breast cancer early.

For trans men: If you’ve had a chest surgery and have no breast tissue, your risk of breast cancer is reduced. Talk to your primary care provider about your individual risk or go to mycanceriq.ca. If you have not had a chest/top surgery, you should consider mammography screening. To make a screening more comfortable, providers can call ahead to ask about the Ontario Breast Screening Program site’s experience working with LGBTQ2S patients. Further, some patients might consider bringing a friend for support.

For trans women: if you’ve been on gender-affirming hormones (like estrogen) for 5 or more years, and you are over age 50, it’s recommended you take part in mammography screening every two years.

Lung Cancer Screening:

Members of the 2SLGBTQ+ community smoke at higher rates than the general population, says Dr. Kucharski, which makes it important to know if you are eligible for Ontario’s lung cancer screening program.

If you are between the ages of 55 to 74 and have smoked cigarettes daily for at least 20 years (cumulative; it doesn’t have to be 20 consecutive years), you should speak to your doctor (or contact an Ontario Lung Screening Program site yourself) about whether you are eligible for screening, regardless of sexual or gender identity.

The cancer screening is done on individuals who may be at risk of getting lung cancer, but who generally feel well.

You can find more information about Ontario’s lung cancer screening program here.

A Note about Anal Cancer:

Men who have sex with men have a higher risk of anal cancer, which is caused by HPV. Men who have sex with men who also have HIV have an even higher risk of anal cancer. While there’s no formal screening program for anal cancer, some providers do recommend and provide an anal Pap test to check for cell changes. Men who have sex with men should also strongly consider the HPV vaccine, which helps reduce the risk of HPV infection.

Resources:

Rainbow Health Ontario

Sherbourne Health Centre

Canadian Cancer Society

Check It Out Guys

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*This post was reviewed and amended June 10, 2022

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Breast cancer is the most commonly diagnosed cancer in Ontario women. One in eight women will be diagnosed with breast cancer in her lifetime. In Ontario, breast cancer happens mostly in women ages 50 to 74 (61 percent of cases). Regular breast cancer screening is important because it can find cancer early when it may be smaller and easier to treat.

Limiting alcohol can reduce your risk. A healthy lifestyle, including limiting alcohol, can reduce your risk of breast cancer. Other factors that may lower a woman’s chance of getting breast cancer are not smoking or using tobacco products, having a healthy body weight, and being physically fit.

Breast cancer has one of the highest survival rates out of all of the cancers in Ontario. Studies show that regular mammograms (and proper follow up testing for abnormal results) lower the risk of dying from breast cancer in women ages 50 to 74. Deaths from breast cancer in the Ontario population went down by about 47 percent in women ages 50 to 74 from 1990 to 2013. This decrease in deaths is probably due to improvements in breast cancer treatment and more women getting screened.

Between 1990 and 2017, more than 39,000 breast cancers have been found by the Ontario Breast Screening Program (OBSP) through mammography, most of which were in early stages. From the start of the program in 1990 to July 2017, over 1.9 million women ages 50 to 74 had a mammogram through the OBSP, resulting in more than 7.4 million mammograms completed.  The OBSP recommends that most women ages 50 to 74 get screened every two years with mammography. Eligible women can make their own appointments or be referred for screening by a healthcare provider.

Changes in the breast are not always signs of cancer. All women – regardless of age or risk factors – should be breast aware. This means knowing how your breasts normally look and feel so you can tell if there are changes.

This Breast Cancer Awareness Month, talk with your healthcare provider about breast screening.  For more information, visit www.cancercareontario.ca/bcam

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“Living with metastatic breast cancer is a life-altering experience where physically and emotionally, your day-to-day functionality becomes challenging,” she says.

Metastatic – also called Stage 4 – means the cancer has spread to other parts of the body.

Karima’s experience with metastatic breast cancer began four years ago when she found a lump in her breast.

“Initially, I thought it was going to be a lumpectomy with a good prognosis,” she recalls. But her surgeon called the day before the surgery saying the margins — the outer edges of the tumour that was removed during biopsy — didn’t look good. Karima underwent a full mastectomy and the removal of 24 lymph nodes. It was then found that the cancer had spread to the bone.

“I was extremely naive,” Karima says. “I didn’t know what metastatic breast cancer was or understand the magnitude and ramifications of the disease.”

There is no cure for metastatic breast cancer. Treatments may include hormonal therapy, chemotherapy, targeted therapy or a combo of all of these to shrink the tumours and manage symptoms.

Karima says the diagnosis shocked her, and, the mom of three started bargaining in her mind.

“I just kept saying ‘Please, can I have three more years,’” Karima says. “The reality I was facing was very grim. Googling stage 4 cancer isn’t pleasant.”

“Stage 4 is like the forgotten stage. It feels like there’s money and there’s awareness for early detection and the early stages. But then, stage 4 … I feel like then you turn into a statistics.”

The hardest part, Karima says, is trying to explain her experience with metastatic breast cancer to others.

“I am never going to be cancer free. Also, from the outside I don’t look like I have cancer. I don’t show any signs of pain, anxiety, or fatigue,” she says. “People say things like ‘when do you stop your drugs? What happens now?’ and those things are hard to hear.”

Through her experience, though, Karima says she’s found a strength she didn’t know she had. She wants to raise awareness about metastatic breast cancer and its challenges.

“I’m involved in the breast cancer community and I have an amazing support network, including my husband and kids and family,” she says. “I have also been very blessed to have an amazing medical team and support at Sunnybrook.

“I cherish each moment and day that I am blessed with.”

Karima shared her story as a part of Sunnybrook’s Breast Cancer Awareness Month Photo Essay. See the photo gallery here.

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Karin, being a here-and-now, one-step-at-a-time kind of person, coped more calmly than me. Desperate to regain a feeling of control, I coped with my shock and distress by springing into hyper-focused, goal-directed action. I focused my efforts on trying to connect us to expert services. My take-charge manner was very necessary at that stage, but my high need for control could have become a problem beyond that point.

During our first appointment with the oncologist, he astutely recognized my personality type and assertively told me to step back and let him take over. He cautioned me to not try to research and interpret medical information or make treatment decisions: he was in charge. At that moment, I felt like I had been standing outside my burning house with a garden hose after calling 911. Several fire trucks with lights flashing and sirens blaring had pulled up. I felt I had been politely but urgently pushed aside, told by the fire chief “You can step back now sir!” I was anxious relinquishing control, but at the same time immensely relieved.

From that time on, we just showed up for treatment and hoped for the best – we simply put our energies into engaging fully in daily life. We focused on the priority of taking care of our children, our relationship, spending time with extended family and friends, and doing meaningful work.

Many people urged us to be more ‘proactive’ about ensuring Karin’s health. We received a lot of unsolicited advice from many different quarters regarding treatments, alternative therapies, and healthy lifestyle measures which were said to be assured to beat the cancer and prevent recurrence. Most of the advice, while well-intended, involved measures lacking any reliable evidence.

Karin and I were painfully aware of the prognostic uncertainties of her cancer. We had a strong sense that there was nothing we could do to alter the not very reassuring statistics of the best available medical treatments. This realization was deeply unsettling, and the urge to deny it and believe otherwise was very strong.

When you’re diagnosed with cancer, it’s natural to wonder “What did I do to cause this?” and “What can I personally do to re-take control and improve the outcome?” But this need to identify causes and solutions in order to feel in control is a double-edged sword, fraught with potential for guilt and self-blame. The reality is that most of the factors causing cancer are either random or so biologically complex that for practical purposes, we can regard them as random, and beyond our control.

Most people don’t like the idea that randomness rules our lives. Studiesⁱ show that when we feel insecure and lacking control, we are even more likely than usual to perceive illusory patterns of causation. Patients commonly over-estimate the role of their own actions or lifestyle in causing their cancer and in determining the future course of their illness. Too often, people become excessively obsessed with things like diet, when what they really need to do is focus on the things in their life that give them meaning, and matter most to them.

Furthermore, many people cope with adversity by believing that life events happen for a cosmically intended reason. This belief too is a double-edged sword: while it can comfort some people, others, whose adversity seems to have no redeeming features, feel anguished or alienated by the inevitable question ‘Why me?’ In my psychiatric practice I have counseled many such people, whose experiences with illness or catastrophic life events have left them struggling to come to terms with the randomness of life.

Twelve years later, Karin remains in remission (though she did have a recurrence five years ago, which fortunately turned out to be minor, after several frightening weeks of uncertainty). One is never really out of the woods with cancer.

Despite all the anxiety and uncertainty, or maybe because of it, Karin’s and my experience of her cancer heightened our sense that our lives are suffused with meaning. I don’t want to romanticize the experience with the selective memory of hindsight, but some of our most moving and meaningful interactions with people occurred in our time of crisis. We were the grateful beneficiaries of very much kindness and caring. We had a great sense of clarity of priority and purpose. Relationships mattered most to us. For quite a while we didn’t ‘sweat the small stuff.’ We have tried to keep these lessons in mind, even though human nature relapses much more surely than does cancer, and we find ourselves ‘sweating the small stuff’ all too often now.

To be clear, all this meaning was made by us and by our support system and by other caring people; everyone was doing their utmost to make the best of a really bad situation. I don’t believe that the meaning of such a life circumstance is predetermined – none of the good that came from it was ‘meant to be’. (How can anyone in good conscience judge their own circumstances as having ‘happened for a reason’ when thinking about their own positive outcome, knowing that others have unmitigated tragic outcomes?) Nor am I endorsing the ‘cult of positivity’ surrounding cancer – I would never suggest that ‘cancer was a blessing’. It could have turned out very badly. We fully recognize that our positive outcome was heavily determined by dumb luck.

Coming to terms with randomness is frightening, but it does liberate us from the tendency to blame ourselves for illnesses we didn’t cause. It also ought to stop us from judging others for their misfortune. And an understanding of randomness should make us think twice about pressuring people with unhelpful advice of unproven therapies that are based on mistaken attributions of causality.

People with different personalities differ in how intensely they need and expect to be in control of their livesⁱⁱ, and in their level of anxiety when experiencing a lack of control. As a naturally high-control person myself, relinquishing it when circumstances required doing so did not come easily to me. My work now often involves trying to help patients with high-control personalities like mine who are experiencing random adversity to recognize the limits of their control. People like us need help letting go, tolerating uncertainty, and focusing on living life to the full, as meaningfully as possible. Here and now. Each day is precious and uncertain. In this way, cancer is just like life in general, only more so.

i. Whitson, J. A., and A. D. Galinsky. “Lacking Control Increases Illusory Pattern Perception.” Science 322, no. 5898 (Oct 03 2008): 115-7. 

ii. The personality trait we are talking about is also referred to as conscientiousness, which is considered one of the ‘Big Five’ personality traits:  https://en.wikipedia.org/wiki/Big_Five_personality_traits

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When Lan moved to Canada at the age of 8, she knew four words in English: yes, no, telephone and elephant.

So when Yvette asked Lan to play in the schoolyard at recess, “I knew there was a 25 per cent chance she’d say ‘yes’,” Yvette says.

“Or elephant,” Lan jokes.

Despite not initially sharing a spoken language, the pair became best friends.

“We didn’t need words,” Yvette says. “Kids are like that.”

The two remained close into adulthood – coming in and out of each other’s lives during various points and over long-distances, and always picking up where they left off.

In 2016, Lan — now a married mother of three — visited her doctor after noticing a dimpling of the skin and a pain that would not go away. Tests confirmed Lan’s fear: she had breast cancer.

“When many people started to come in and out of the room, looking at my scans, that’s when I got scared. It was a very sinking feeling,” Lan says.

Lan, left, and Yvette, right, on a visit to Niagara Falls at around age 9.

After telling her husband about the diagnosis, Lan called Yvette.

Yvette, now a married mother of two, had news of her own to share.

“I felt a lump in my breast,” Yvette says. “Tests confirmed it was cancer.”

Just four days apart, the two best friends learned they were both facing breast cancer. They’d both be undergoing surgery. And radiation. And chemotherapy.

“I was just sad and worried at first,” Lan said. “And then angry. ‘How could this be happening to both of us? Who will be my strength if she too is going through this? And how will I be strong for her when I want to breakdown?’”

It didn’t take long for that anger to subside, Lan said. The friends quickly realized that they could remain each other’s crucial support through this shared experience.

“We cried together. We talked about our fear of dying. We got each other out of the house to take walks when we felt so ill on the chemo,” she adds. “It was ok to be vulnerable.”

Yvette agrees.

“We can share the complex emotions that you feel during this without having to articulate it in words,” she said. “We had no words when we first met. And we don’t always need words now.”

Yvette and Lan shared their story as a part of Sunnybrook’s Breast Cancer Awareness Month Photo Essay. See the photo gallery here.

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The Answer: No professional organization in Canada or the United States recommends testing for the BRCA1 or BRCA2 genetic mutations based solely on ancestry. However, Jewish women are believed to be more likely to test positive for one of those two genetic mutations, compared to women tested at random. Consequently, testing is often recommended for Jewish women with family histories of cancer.

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