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Improving Breast Health Care
for N.S. Women
A
fter more than 18 months in planning, phase
one of Nova Scotia’s comprehensive Breast Health
Centre is a reality. On March 26, 2008 a cancer
surgeon from Capital Health performed the first breast
IN THIS ISSUE cancer surgery at the IWK Health Centre, representing
a milestone in a new partnership between Capital
High Quality Health and the IWK Health Centre (IWK) and the first
Cancer Care step toward improving breast health care for Nova
Scotia women.
The Gene Team The concept grew from a need to address issues
identified by both patients and health professionals at
Hormone Receptor Capital Health and from the IWK’s strategy to strengthen
Analysis in Breast programs for women. Some issues included: old facilities,
Cancer fragmented care, communication challenges due to the
many disciplines involved in patient care, and a lack of
News and Notes operating room time, to name a few.
With its focus on women and its proximity to the
QEII Health Sciences Centre (QEII), the IWK was the
ideal partner with which to explore the potential for a
comprehensive, one-stop approach to
breast health care. Initial discussions
indicated willingness, on the part of
both organizations, to work together
and share resources to improve breast
health care for Nova Scotia women.
Discussions with the Department
of Health resulted in $420,000
in funding to assist with start-up
and operating costs. Surgery
was the obvious first step to
building the centre, as the IWK
had available operating room
time and post recovery space.
“We worked closely with
L-R: Anne McGuire, CEO, surgeons from Capital Health
IWK Health Centre and
Chris Power, CEO, (QEII), Cancer Care Nova Scotia’s
Capital Health Breast Cancer Site Team, as well as
O AL Volu
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our own anesthetists, lab technicians, and nursing staff
to ensure our first step in this new partnership was a
success,” said Anne McGuire, CEO, IWK Health Centre. “It
is early days, but reports from patients and staff of both
organizations are very positive.”
Using existing space at the IWK, weekly breast
health clinics have been established. All patients
requiring breast surgery are referred to the IWK for
surgical consults, surgery and follow-up appointments.
Two Breast Health Nurse Coordinators, modeled after
Cancer Patient Navigators, were hired to help navigate
patients through the process of care.
“The nurse coordinators play a crucial role in
educating patients about what to expect prior to and
following surgery, allaying their fears and answering
their questions,” said Chris Power, CEO, Capital Health.
“The creation of these positions is just one example of
the ways we have focused on doing what is best from
the patient perspective. Using this
lens, we have and continue to make
decisions for the right reasons.”
Breast Health Coordinators
conduct pre-admission
assessments, coordinate blood
work, schedule sentinel
node biopsies and book
the operating rooms.
They provide pre- and
post-operative teaching
so that patients know
what to expect in terms
of pain management,
drain care and
exercises following
surgery. They
(continued on
following page)

Improving Breast Health Care (cont’d from front page)
are the primary contact for patients and they are key to
the development of a coordinated, seamless approach to
breast health care.
This comprehensive approach to breast health care
has been highly successful in other cities. Of note, is the
Marvelle Koffler Breast Centre at Mount Sinai Hospital in
Toronto. Established in 1995, the centre offers patients
the services of a range of health providers under one
roof in areas including: surgery, medicine, radiology,
pathology, psychiatry, nursing, nutrition, social work and
palliative care.
Like the Marvelle Koffler Breast Centre, Nova
Scotia’s comprehensive Breast Health Centre will
grow to include the coordination of care for all breast
disease including breast cancer, as well as prevention,
Health Professionals lauded for high quality cancer care
W e often talk about and acknowledge the impact
cancer has on patients and families, but we seldom
stop to consider its impact on the health professionals
who provide the treatment and care. They work long hours,
developing treatment plans with patients, listening to
their fears, providing them with advice, celebrating their
victories over the disease and supporting them when they
are not responding to treatment. It is often emotionally and
physically draining, but also very rewarding, especially
when you hear you are making a difference.
Health professionals heard this loud and clear in
survey results, released in April 2008, by Cancer Care
Nova Scotia. For the third time in a row, cancer patients
in Nova Scotia rated their quality of care higher than the
national average.
“My personal journey has been blessed with
support of all in the health system,” said Joe VanBuskirk,
a cancer patient who lives in New Glasgow. “I have had
all of my treatments and most of my consultations with
my oncologist in New Glasgow, thanks to doctors who
are willing to travel early in the morning from Halifax to
see patients here. It really does make coping with cancer
easier.”
Dr. Wojciech Morzycki, one of the medical oncologists
from the Capital Health Cancer Care Program who travels
to see patients in New Glasgow, said the greatest reward
for a health professional is hearing you are meeting
patients’ needs.
“We see, first‑hand, the tremendous toll
cancer has on patients and families. Knowing we
C A N C E R C A R E N O
screening, diagnosis, treatment, recovery, follow-up and
palliative care.
The advantages of such an approach: improved
access to high quality treatment and care for patients;
easier communication and interaction among health
professionals, enhanced recruitment opportunities and
a more robust research environment. Also important, is
collaboration to make the best use of scarce resources.
While this new approach will take time to be realized,
resources, commitment and energy, both Chris Power and
Anne McGuire agree, “It’s the right thing to do, and it’s not
about if, it’s about when.”
Proceeds from the Weekend to End Breast Cancer, being held in Halifax
from August 15-17, will help fund development of the Nova Scotia’s
comprehensive Breast Health Centre. For information on the event, visit
www.endcancer.ca
are helping to ease their burden by travelling to
communities closer to them for appointments,
makes the challenges of doing so worthwhile.”
More than 98 per cent of respondents from the Cape
Breton Cancer Centre in Sydney, 98.6 per cent from the
Nova Scotia Cancer Centre in Halifax and all respondents
visiting satellite oncology sites reported their experience
as excellent, very good or good. The Canadian average
is 97 per cent.
“The results of this survey show the high calibre of
staff and government commitment to ensuring quality
cancer treatment for Nova Scotians,” said Health Minister
Chris d’Entremont. “Programs like patient navigation,
satellite oncology and continuing education for health
professionals are helping to ensure that Nova Scotians
have access to the best care possible.”
Theresa Marie Underhill, Chief Operating Officer, Cancer
Care Nova Scotia, said the survey results are striking.
“As our health system is challenged to meet the increasing
number of cancer patients and the growing complexity of
care in the face of staff shortages, it is remarkable
indeed that we, as a province, can achieve such
impressive results.
“While it is gratifying to hear we are doing well in most
areas, there is always room for improvement. Patients
said they need better access to professionals to help them
address their anxiety, fears and other emotional‑support
issues. Cancer Care Nova Scotia is working with supportive
care professionals on tools, strategies, and practical ways
to improve access and address these issues.”
 HE AR TS
V A S C O T I A Y
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The Gene Team: Offering Advice and Expertise
F
ive years ago, Reny Vandervaart was told her
cousin had a rare hereditary condition called
Birt-Hogg-Dube (BHD) syndrome, which is
often associated with lung cysts and kidney cancers.
Genetic testing was completed in her family and a
genetic change, called a mutation, was found. As BHD
is hereditary, it was suggested all family members be
tested to see if they carried the mutation. Initially, the
Dartmouth resident didn’t give the issue any serious
thought – until 10 of 19 members of her family were
found to carry the mutation.
Recently, Mrs. Vandervaart’s sister was also found
to have the mutation, and the lung cysts and kidney
tumours associated with it. “At that point,” she said, “I
thought I should be responsible and have the test. But I
didn’t know how to get tested.”
Her family doctor referred her to the Maritime
Hereditary Cancer Service (MHCS), based at the IWK
Health Centre. Mrs. Vandervaart met with a genetic
counsellor, who explained the genetic testing process
and discussed related issues.
“The genetic counselling (process) was very
helpful,” she said. “If it wasn’t available, I don’t know
what I’d have done.”
Many Nova Scotians, like Mrs. Vandervaart, are not
familiar with the Maritime Hereditary Cancer Service.
While the majority of cancers happen by chance alone,
for other people, cancer tends to run in their family
and can be caused by a mutation in the genetic code.
Individuals and families affected by such hereditary
cancer syndromes have a much higher chance of
developing cancer over their lifetime than people in the
general population.
The MHCS offers assessment, education,
counselling, genetic testing, interpretation of test
results, and screening recommendations for individuals
and families who may have a hereditary cancer risk. The
team includes genetic counsellors, medical geneticists,
social workers, and an oncologist, all of whom work
closely with other health professionals.
“We use a non-directive approach,” said
Patricia Steele, Genetic Counsellor, MHCS. “This
means we do not advocate for or against
genetic testing. We provide individuals with the
necessary information, and support the decision
that they make as a result.”
Genetic testing may not be appropriate for
everyone, and it may not be possible in every
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case. The genetic assessment helps determine who
will benefit from genetic testing. The most common
referrals are for hereditary breast/ovarian cancer and
colon cancer.
Many people who appear to have a strong family
history of cancer want genetic testing to determine if
they are at increased risk. Testing usually begins with
a person who has already been diagnosed with cancer.
For the first person tested in the family, it is like looking
for a ‘needle in a hay-stack.’ A specific mutation found
in one family member provides an explanation for the
pattern of cancer in that family. Then testing for that
mutation can be offered to other family members,
whether they have had cancer or not.
“For an individual family member, a test result that
shows the presence of an inherited mutation in a cancer Back row: L-R:
gene, cannot predict when cancer will develop or if it will Andrea Rideout,
happen at all,” said Ms. Steele. “It can only estimate the Natasha Vanlderstine,
Meghan Ferguson,
likelihood of developing certain types of cancer.” Nadine Dumas,
“Genetic testing and the interpretation of test Lynette Penney,
results are not always straight forward. Often, a Erika Aberg,
Cathy Huculak;
mutation is not identified in many families even though Front row, L-R:
they remain at a higher than average risk of developing Patricia Steele,
cancer because of their family history.” Julie Hathaway,
For Reny Vandervaart, finding out if she carried the Kelly Collins McNeil;
Missing: Mark Ludman,
BHD gene mutation – was important. “Information,” she Katharina Kieser
said, “is powerful when you’re dealing with your health.”
The information Mrs. Vandervaart received was Please note: The Maritime
Hereditary Cancer Service
encouraging. The BHD gene mutation was not found. operates within the
Maritime Medical Genetics
Cancer Care Nova Scotia supports the work of the Maritime Hereditary Service. This team provides
Cancer Service, through education and service development to ensure services for other hereditary
high quality, evidence-based care. conditions in addition to
For more information about the Maritime Hereditary Cancer Service, hereditary cancers.
call 902-470-8754.

Volume IX, Issue Two /
May 2008
This is a newsletter for and about
the people and issues affected by
Nova Scotia’s cancer care system.
It is produced by Cancer Care
Nova Scotia.
We welcome and encourage
everyone’s input to this
newsletter. Please submit your
stories or story ideas to:
Cancer Care Nova Scotia
Newsletter
1278 Tower Road
Bethune Building, Room 541
Halifax, Nova Scotia B3H 2Y9
Telephone: 902.473.2630
Toll-free: 1.866.599.2267
Facsimile: 902.473.4982
Email: info@ccns.nshealth.ca
If you want to be added to our
mailing list, or if you want to
regularly receive additional
copies of this newsletter for your
office or waiting room, please
contact us at the above address
with the number of newsletters
you need.
The deadline for articles and
story ideas for Volume IX, Issue
Three is June 5, 2008.
Cancer Care Nova Scotia is
a program of the Nova Scotia
Department of Health.
© Crown Copyright,
Province of Nova Scotia, 2008.
May be reprinted with permission
from Cancer Care Nova Scotia
(1-866-599-2267).
Hormone Receptor Analysis in Breast Cancer:
The System in Nova Scotia
R ecently, there has been considerable media
attention about the situation in Newfoundland
regarding errors in testing for estrogen and
progesterone receptors (ER/PR) in breast cancer.
Understandably, this issue has raised questions
among health professionals and patients across
the country, since these pathology results are very
important in determining the most effective treatment
for breast cancer patients and play an essential role
in deciding if a patient may benefit from hormonal
therapy (e.g. tamoxifen, aromatase inhibitors).
This testing is performed by a complex, multi-
step process called immunohistochemistry (IHC) and
errors are possible at many points. For this reason,
quality control measures are essential and have
become increasingly important as the guidelines for
determining a positive test result have changed over
the years, as our understanding of hormone sensitive
breast cancer has evolved.
Laboratories across Nova Scotia have a number
of steps in place to ensure accuracy in test results.
Currently, evaluation of the ER/PR status in breast
cancers removed at Dartmouth General Hospital, St
Martha’s Hospital, Aberdeen Hospital and Colchester
Regional Hospital is performed at the pathology
laboratory of Capital Health (QEII Site). ER/PR status
of breast cancers removed at South Shore Regional
Hospital, Cape Breton Regional Hospital, Valley
Regional Hospital and Yarmouth Regional Hospital is
evaluated on site at those hospitals.
The pathology laboratory at Capital Health (QEII
site) follows a number of steps to ensure accuracy of
ER/PR testing in breast cancer. These include:
(a) Procedures to ensure prompt receipt of tissue control measures, such as those outlined above, ensure
samples following surgery, and careful selection that patients continue to receive the best possible advice
of the best sample for ER/PR testing
News and Notes
(b) Involving dedicated and fully trained IHC
technologists in the preparing the slides
(c) Using an automated immunostainer which
promotes consistency of testing
(d) Interpretation of the tests by experienced
pathologists
(e) Participation in quality assurance programs
with the College of American Pathologists, and
the Canadian Association of Pathologists
(cIQc program), as well as participating in regular
continuing education on best practices in IHC testing
(f) Periodic evaluations of ER/PR positivity rates to
confirm that those at Capital Health are
comparable to those in the medical literature
(g) Re-testing of the ER/PR status of breast cancer
samples previously reported as negative, from
patients referred from other hospitals for
consultation with a cancer specialist (medical,
radiation, surgical) at Capital Health
Similar measures are also in place in our regional
hospital laboratories with on-site immunohistochemical
testing. Additional quality control measures for
some sites include re-evaluation of negative results,
sending cases to other labs for repeat testing and
close monitoring of tissue fixation. Automated
immunostainers, if not already in place, are to
be acquired in the near future. Technical work is
performed by trained laboratory technologists.
Nova Scotians can be confident that great efforts
have been, and are, in place to ensure high standards
in evaluating ER/PR status as well as other laboratory
evaluations of breast cancer. Although, in medicine 100%
accuracy can never be guaranteed, attention to quality
and recommendations for the treatment of breast cancer.

Mark June 1st on your calendar today and join us at Pier 21 in Halifax for Celebrate Life 2008, an amazing
afternoon of family entertainment. CTV’s Peter Mallette will host the event. Performers include: Terry Kelly,
Derek Caine, Gary Beals, Hallelujah Choir, and the Amethyst Scottish Dancers of Nova Scotia.
The celebration begins at 2 p.m. and the doors open at 1:30 p.m. Admission is free. Everyone is welcome.
Department
Department of Health For more information call 1-866-599-2267 or visit www.cancercare.ns.ca
Division
Section