Ontario Breast Screening Program opens door for younger women at high risk for breast cancer

 

By Dr. Yun Yee Chow, Radiologist, Rouge Valley Health System

Cancer Care Ontario has recently announced the expansion of the Ontario Breast Screening Program (OBSP) to include screening for women aged 30 to 69, who are at high risk for breast cancer. The funding, which went into effect July 1, 2011, provides younger women at higher risk for developing breast cancer with annual mammograms and magnetic resonance imaging (MRI) scans.

Prior to the announcement, only women 50 and over were eligible for OBSP mammography screening. Early detection can significantly improve the chances of survival once diagnosed with breast cancer. This new development is great news for women under 50 who are at high risk for breast cancer.

The OBSP was formed in 1990 primarily for screening and allowed patients to receive a mammogram without obtaining a requisition from their family physician. In effect, they refer themselves, making the service more accessible for many women. It provided an environment with quality of care assurance, Canadian Association of Radiologists (CAR) accreditation and standardized reports and reminders. The breast screening clinic’s system navigator also helps to facilitate and guide the patients through urgent surgical and cancer care referrals.

The general screening OBSP population includes women 50 years of age and older, who have no acute breast symptoms or problems, no implants, no personal history of breast cancer, and have not had a mammogram in the past 11 months.

The newly-expanded high risk program will be available initially at certain sites called OBSP Assessment Centres with a family doctor or nurse practitioner referral only.  A genetic assessment can be arranged for certain gene mutations such as BRCA1and BRCA2, which can be seen in first degree relatives such as mother, sister or child.

Rouge Valley Centenary is currently in the process of becoming such a centre, with Rouge Valley Ajax & Pickering expected to follow in the near future.  The centres will feature state-of-the-art radiologic equipment and services, while surgical and oncologic departments will be available to breast patients. Our new system navigator, Channie Mak is on hand to help guide patients through difficult and complex breast issues.

Approximately 34,000 women in Ontario are at high risk of developing breast cancer. It is expected that the stringent screening process with MRI and mammography will detect an additional 17 cancers a year for every 1,000 women screened.

For most women, genetic screening assessments will be needed to determine whether or not they are at high-risk for breast cancer. However, high-risk factors include:

• Women who are known to be carriers of the BRCA1 or BRCA2 gene mutation;
• Women with a first degree relative that is a known carrier of the BRCA gene mutation carrier;
• Women with strong family history in first and second degree relatives with breast and ovarian cancer;
• Patients who have had chest irradiation for cancer prior to 30 years of age.
  

Speak with your physician for more information on genetic testing.

Women at high risk have a 25 per cent or greater lifetime risk of developing breast cancer. In other words, their risk is two to five times higher than most other women. Many of these breast cancers detected in younger women are more aggressive than those seen at a later age.

Finding breast cancer early means:

• A better chance of treating and curing  the cancer successfully;
• A lesser chance that the cancer will spread;
• More treatment options.

Currently the five-year survival rate for breast cancer in Ontario is 88 per cent. Mammography is still considered the screening tool of choice. Both Rouge Valley Centenary and Rouge Valley Ajax Pickering’s breast clinics feature new low-dose full-field digital mammography units, as well the capability to perform stereotactic and ultrasound guided breast biopsies. This means that our patients have access to the highest standard of breast screening care, right in their own community.

Remember that prevention and early detection are key to living a long life. If you're not sure about what screening test to arrange, or how frequently you should be screened, you can have your questions answered by a short Cancer Care Ontario self screening on- line tool here or ask your family physician.

And learn more about Rouge Valley’s mammography program here.

Re-investing in our hospital

By John Aldis, vice-president, corporate and post-acute services, chief financial officer, Rouge Valley Health System

As reported in the treasurer’s report at the Rouge Valley Health System (RVHS) 13th Annual General Meeting of Members, held on June 28, it has been another very successful year for us. Fiscal 2010–2011, the third and final year of the hospital’s deficit elimination plan has been our best yet. RVHS achieved an operating surplus of $8.9 million, which was $3.7 million better than planned.

Overall hospital revenues increased by 4.1%, while our operating costs climbed 2.6% compared to the previous year.

Driving our success this past year has been exceptional revenue performance and our continued focus on operating efficiencies and cost containment through our Lean management philosophy. As part of our operating plan, RVHS put a major focus on revenue enhancement this past year.

In addition to securing additional post-construction operating funds for new space and expanded programs as part of our Rouge Valley Ajax and Pickering (RVAP) redevelopment, the hospital received bonus funding for achieving wait time improvement targets in our emergency departments at both sites. And we attracted additional funding during the year for performing more CT and MRI scans, more surgical procedures targeted by the government for reduced wait times, and more priority program cardiac procedures than we had planned. Finally, the hospital also secured new funding from the Central East Local Health Integration Network to open a 20-bed transitional restorative care program at RVAP.

We have already re-invested some of our financial surplus directly into patient care. Approximately $1.3 million was spent on various quality of care improvement initiatives, staff education and training, as well as new furniture, equipment, and mattresses that will help reduce the risk and spread of hospital infections. In addition, RVHS will use part of last year’s surplus in the current year to accelerate investment in major capital equipment and renew our aging facilities’ infrastructure.

While our capital needs far exceed available funding, the hospital was able to invest close to $74 million in capital this year—most of which was related to completion of the RVAP redevelopment.

Fundraising is critical to our hospital’s financial well-being, and 2010–11 was no exception. The RVHS Foundation donated and transferred $687,000 to the hospital this year in support of much-needed capital purchases. Thank you to all donors, volunteers and Foundation staff. 

We continue to make the most of every dollar raised by aligning the Foundation’s fundraising goals and efforts with the strategic priorities of the hospital.

Rouge Valley’s working capital deficit continued to improve and ended the year at $31 million. Improved cash flow and prudent cash management has enabled RVHS to build up cash reserves through the year, reducing short-term borrowing needs and reliance on debt to fund minor capital expenditures.  

Rouge Valley continues to be a very busy place. This year, the hospital treated approximately 29,000 inpatients, provided 52,000 mental health, rehab and complex continuing care patient days, and registered 109,000 patient visits across our two emergency departments. On the outpatient side, we had 190,000 clinic visits and performed 16,500 day surgery cases.

Thank you to our staff, who have done such a tremendous job in meeting the health care needs of the growing and aging populations of our east Toronto and west Durham communities.

Protecting your skin is key to enjoying your summer

By Dr. Mansour Bendago, Division Head of Plastic Surgery, Rouge Valley Health System

Seeing the beautiful sunshine and feeling those warm rays on our skin is a welcome change from the cold harsh winter, and long wet spring. But in order to get the most out of the summer season, it’s important that we always make protecting our skin a priority. 

Not protecting your skin can make it more susceptible to ultra violet (UV) damage, which can result in skin cancer. And this is possible whether your skin is light or dark. You even need sun protection when the skies are overcast.

Preventing Skin Damage  

Skin is divided into six categories, ranging from one (no pigmentation) to six (very dark). People whose skin ranges between one and three are more susceptible to skin damage from the sun, although those with darker skin are not exempt.

What you need to protect your skin   

Take great care in protecting your skin from sun’s harsh UV rays, especially areas that are typically more exposed to the sun, like the face, shoulders, arms, and legs, especially below the knees. You should use a sun screen that is sun protection factor (SPF) 30 or greater. Wear a hat with a brim to give your face added UV protection. Be sure to wear sunglasses that offer UV protection.

Sunscreen is a must for children above six months of age. And because their eye tissue is delicate and their pupils are larger, their eyes are more susceptible to UV damage than adults. So they should wear sunglasses when they’re outside. Wearing a hat can help to protect their face and eyes.

Adults and children alike should also keep themselves hydrated by drinking water, especially when they’re out in the sun.

Melanoma – What to Look For 

One of the reasons we should take great care in our skin is to prevent melanoma, a very aggressive form of skin cancer. Here are some signs to look for: 

- Moles become asymmetrical in appearance, where one half is unlike the other;

- Their normally well-defined borders become irregular in appearance;

- The colour of mole starts to change;

- Itchiness or bleeding of the mole;

- The mole appears like an ulcer or a scar.

If you notice these types of changes, contact your physician immediately.

So while you go out and enjoy your summer, please remember to always protect your body’s largest organ – your skin! 

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Related news - 

Read an article about port-wine stain and how Rouge Valley is treating children with this serious skin condition. Rouge Valley is one of only two hospitals in Ontario, which treats this condition.

Physician Interview: Prevalence of heart disease in black community

View the full video interview on Rouge Valley’s YouTube channel.

Cardiologist Dr. Paul Galiwango is the medical manager of cardiac imaging at Rouge Valley Health System (RVHS). Here he discusses his particular interest and insights on the issue of heart disease and hypertension faced by the black community.

Q: What is hypertension?
A: Hypertension is high blood pressure. The heart pumps blood into vessels; and if the pressure is too high, the heart has to work harder to pump blood. Over the long term, it leads to damage of the lining of the vessels, and increases the chances of blood clots, strokes, and blood vessels bursting. There are usually no symptoms, which is why it’s important for patients to visit their physician regularly, so that we can try to detect it at that silent stage—before it wreaks any damage.

Q: Why are blacks more susceptible to hypertension, heart failure and stroke?
A: We certainly know that hypertension affects the black community more disproportionately. We see an increase in frequency, and we see it at younger ages. In addition to that, hypertension is often more resistant to treatment on patients in the black community. And it seems to have a particularly malignant vascular effect in terms of organ damage to the heart, kidneys, and brain. Why we see that is still a subject of fierce debate. I think it is multi-factorial. There are some genetic studies that suggest  there are some unique aspects in the way the kidneys handle the sodium load, which makes blacks more sensitive to salt. And salt affects the cause of high blood pressure—so we call it sodium-sensitive hypertension. And then there are also some lifestyle issues. For example, if you look to the American south, there tend to be some very high-sodium diets, and high prevalence of obesity. So this also contributes to the hypertension rates.

Q: Why do stroke and heart failure tend to present so young in blacks?
A: It certainly seems to be linked to the prevalence of hypertension coming at a younger age. There was a large study that came out last year that looked at a very diverse group–whites, blacks, Hispanics–and followed them for 20 years. What they found was the prevalence of heart failure at a young age (younger than 50 years old) was about 20 times higher in blacks than in the non-black participants. And the lion’s share of that contributed to hypertension. Researchers saw that for every 10 millimetre increase in blood pressure in a black person in their 20s, you double the risk for heart failure in their 40s.  It’s sobering, but what’s encouraging is that it’s a treatable condition.

Q: When you see black patients, how do you treat them? What sort of programs do you put them on? Is it particularly unique?
A: In any patient who I see with hypertension, I treat aggressively. Hypertension is silent, and it’s easy for it to progress without the patient even realizing it. With black patients, there are some nuances—we do know that they respond differently to certain classes of drugs that are commonly used for hypertension, like ACE Inhibitors, Beta Blockers. Data has suggested that medications such as these may be less effective in the black population. So I would tend to stay away from those, at least at first, and go to more effective drugs like Calcium Channel Blockers and Diacide Diuretics.
    I also really underscore the importance for everyone—particularly in the black population—of trying to avoid salt in their diet. People often recoil at that suggestion at first, but you do find that with time, the palate adapts, and you get used to it. There’s just so much sodium already in packaged foods, it’s best to try and cut out salt anywhere you can. I recommend just not adding it to table food, or when you’re cooking. In fact, I’ve learned to cut salt out of my own diet.

Q: What do we do at Rouge Valley to treat this population?
A: The cardiologists at Rouge Valley are all very cognizant of these issues, and can aggressively manage heart hypertension in all patients, and know what to do when they see anyone approach. We have a very diverse community in Toronto and Durham—blacks, South Asians, Asians, etc.—so we deal with everyone appropriately. But I’d also emphasize that the cardiac rehab program is an excellent one, and it gives all the patients the tools they need to live a healthier lifestyle—and aids in helping them to abandon some of the more harmful habits, like smoking, or a high-sodium diet. So we also refer a lot of our patients to that program.
    It’s important for physicians who are treating black patients whose hypertension has gotten quite difficult to treat, not to give up and refer those patients on to a specialist for evaluation. It’s possible that the medication might need to be tweaked, or replaced. A lot of times, it’s a bit frustrating to have a patient on medication for a while, and their blood pressure isn’t coming down. But if that’s the case, they really should be referred on. You can get there, but you just have to persist.