Nunavut women must travel south for mammograms

MICHAELA RODRIGUE

IQALUIT — Regular mammograms for women past the age of 50 may reduce the number of deaths caused by breast cancer by a third, researchers says

But women in Nunavut must travel outside the territory to access this sometimes life-saving procedure — and some people are calling for change.

Nunavut does not have a mammography — or breast x-ray — machine within its borders.

Mammograms can often detect lumps a fraction of the size of those felt by hand, and women across Canada are told to get a mammogram at least once every three years once they reach the age of 50.

Nunavut women are advised to get a mamogram once every three years, said Dr. Chuck MacNeil, director of medical affairs for the Baffin Region Health and Social Services Board.

But they must travel, often at their own cost, to take advantage of the technology.

“We adopted the NWT policy. Women who are going to Ottawa for other reasons, or out on vacation, should be arranging mammograms,” MacNeil said.

“Women over 50 should definitely be pushed or encouraged,” he said. The health boards will help women schedule mammograms, he said.

If a woman doesn’t get her mammogram after a three-year period she is eligible to be flown down, MacNeil said.

Nunavut’s health boards also fly down women for diagnostic mammograms, if a physical exam detects a lesion or lump they believe should be x-rayed, MacNeil said.

“We still send women who have a suspicious lesions,” MacNeil said.

But Veronica Dewar, the president of Pauktuutit, the Inuit women’s association , says women in Nunavut deserve to have a mammogram machine within the territory. And she says nurses in Nunavut communities are so overworked, little time is left over for public education on breast cancer.

“The northern communities are being left behind, everything is down South,” Dewar said. “If in Ottawa there was no facility, they’d be yelling and fighting about it.”

Dewar herself had to fight to receive a mammogram when she found a lump in her breast three years ago in Rankin Inlet.

The nurse believed the lump was benign, but Dewar insisted on having a mammogram.

Doctors in Winnipeg later determined that Dewar’s lump was indeed benign, but Dewar said she doesn’t regret the fight.

“The [southern] doctors said ‘good for you, it shouldn’t be that way,'” Dewar said.

About eight out of 10 lumps turn-out to be benign.

However, some say Nunavut’s cash strapped health-care system and the low incidence of breast cancer in Nunavut means that other illnesses are given a higher priority.

“If we were going to take our money at the moment, cancer of the cervix is a bigger one. We just have a lot of problems that I think we could spend big money on,” MacNeil said.

“The women who need this procedure are probably better handled by education and making sure that they do get their mammogram done when they’re out for something else.”

MacNeil points to a study conducted by the GNWT before division that found that because the incidence of breast cancer in Nunavut is low, a mobile mammography machine isn’t justified.

One case of breast cancer was diagnosed last year in Nunavut. From 1992 to 1998, 15 cases of breast cancer were reported.

And Nunavut’s chief medical officer Ann Roberts, warns that routine mammograms won’t eradicate deaths due to breast cancer.

In fact mammograms can miss lumps felt by women. And, Roberts stresses, it will take more than a mammogram machine and a technician to protect women.

She said woman who should be tested will have to be targetted, and that proper case follow-up also needs to be conducted.

“It’s more than buying a machine,” Roberts said.

Dr. Andre Corriveau is director of population health for the GNWT. He conducted the study that led to the formulation of the NWT’s breast screening policy and found that a mobile mammogram machine is not necessary for Nunavut. He said such a machine would likely increase the number of false positive results in Nunavut.

That would increase the number of unneccessary biopsies or trips South and put women through unneccessary anxiety, Corriveau said.

As well, because there are no roads connecting Nunavut’s communities, women would still have to fly to Iqaluit to take advantage of a mobile unit.

But Pauktuutit said it would be easier for women to travel to Iqaluit instead of to the South.

“If there would be one place in the North to go, at least they’d be close to the people they know. People who can speak their own language is vital,” Dewar said.

Right now, Nunavut’s health board stresses the importance of breast self-examination, MacNeil said.

Women are called in to their local community health units for their annual physical exams, which include a breast exam, MacNeil said. During those exams, the importance of breast self-examination is also stressed.

Nunavut’s chief medical officer said the Nunavut government hasn’t yet formed a new policy for breast cancer prevention since division. Feasibility and cost benefit studies would still need to be conducted.

Last week, Iqaluit’s community health unit held a breast cancer information session to coincide with Breast Cancer Awareness Month.

Video demonstrations of breast self exams were shown, and nylon breasts containing lumps were used for practice.

Micah Arreak, Iqaluit’s health promotion officer, said women should find out whether their family history includes breast cancer and perform self-examinations once a month approximately seven days after their menstral cycle.

Women should also reduce the amount of fat in their diet and research suggests that breast-feeding children may offer future protection to mothers.