Reflections on CBCS 2025

“One size fits all is no longer adequate.” These words resonate weeks after I first heard them while attending the 2025 Canadian Breast Cancer Symposium (CBSC) in June, alongside the amazing Rethink team, as a patient advocate. These words were spoken by a keynote patient speaker, one of two fellow patients who shared their stories of delayed diagnosis and the real-life consequences when this happens. Their voices were incredibly powerful and continue to resonate deeply as I heard so much of my own story reflected in theirs.

I found my lump at age thirty-six. Despite presenting to the doctor multiple times over the course of three years, I did not receive a diagnosis until I was thirty-nine. The physicians who examined me were diligent in sending me for imaging, but my tumour unfortunately evaded the traditional diagnostics.

A full year before my cancer was diagnosed, I was sent for an urgent ultrasound and mammogram due to the worrying clinical signs observed by a locum family physician during my breast exam. She told me diagnostic imaging with both mammogram and ultrasound was now the standard of care for women over thirty-five presenting with a palpable finding. On the day of my scheduled imaging, however, I was told that I was ineligible for a mammogram due to a recent early miscarriage; that the pregnancy attempts and associated hormones could skew the results and a mammogram would only be offered if the ultrasound showed something suspicious. The radiologist read my ultrasound in real time and results were relayed to me via the technician who sent me home with an “all clear.” I had been living for years with a quiet anxiety about my growing lump, and hearing once again the imaging was clear was a welcome but temporary reprieve from my worry.

In retrospect, I wish I had advocated for myself to ensure the radiologist understood the nuances of my situation. Did he know I had a three-year history of a growing and palpable lump? Of my increased risk for breast cancer due to a combination of family history, ethnicity, and dense breasts? That the examining physician had expressed significant concern about clinical signs that were worrisome for breast cancer? Was denying me access to a mammogram really worth the risk of a false positive given the well documented clinical history? Why was this decision not made in consultation with me, the patient? And more importantly, if a mammogram was not felt to be useful, why was I not sent for more sensitive imaging like MRI?

Since being diagnosed with breast cancer last summer – after a fourth round of imaging finally turned up a stage two cancer – I have ruminated over these questions. The growing lump, which was smaller than a pea when I first found it, turned out to be malignant. And now, additional questions have been added to the mix: if my cancer had been detected earlier, could I have avoided the aggressive treatments now being suggested? Should I have advocated for myself more boldly? What changes are needed within our healthcare systems to prevent this from happening to other young women?

Listening to the patient keynote speakers at the CBSC helped me realize I am not alone in both the experience of my diagnosis and in grappling with these questions. Stories of delayed diagnosis due to both imaging that is insufficient, and decisions made by healthcare providers that prevent access to appropriate diagnostics are unfortunately not uncommon. After my diagnosis, I was commended by friends and family for being “persistent.” While my experience as a healthcare worker gave me the confidence to seek repeat imaging, I worry for those who do not have the same privileged knowledge or the insight that self-advocacy is appropriate and sometimes necessary.

The powerful patient stories shared at CBCS 2025 were complimented by research presented by both radiologists and oncologists that further highlights the need for updated – and more nuanced – guidelines for both breast cancer screening and detection. There was much discussion about supplemental screening technologies – including abbreviated MRI, contrast enhanced mammogram, and artificial intelligence – that can potentially reduce mortality through improved detection when used for the right patient at the right time. I learned that there is data to support the use of these modalities in higher risk populations – including for patients like me who have dense breasts, higher than average risk due to ethnicity, and a personal history of breast cancer diagnosed before fifty years of age.

Learning about this research has left me with conflicted feelings: a sense of optimism thanks to the emerging evidence these new technologies have the potential to improve detection and, by extension, the potential to reduce risk of mortality. But also, a sense of frustration about the delay in getting these new research findings into practice; this hits close to home as my current care plan does not yet reflect this new evidence.

While the dance between patient stories and emerging research can at times feel tense, in moments, I also witnessed the potential for this dialogue to be a catalyst for deep understanding and transformative change. In the telling of her story, one of the patient speakers remarked, “I wish I had asked more questions.” Later that morning, a physician presenter reflected on this comment and tacitly acknowledged the pain behind this statement by stating “I wish you didn’t have to.” This was a profound moment for me, not only because of the empathy in this response, but because it demonstrated the power of hearing patient voices represented at the table alongside the clinical evidence. It is my hope that such conversations between healthcare professionals and patients can and will continue. In an ideal world, perhaps these conversations can even support the transformation of our healthcare system – including to one in which a one-size-fits-all approach to breast cancer screening and diagnosis is no longer the norm.

— Danielle Brettler, CBCS 2025 patient advocate