How to Save a Life

Regarding Canadian Breast Cancer Screening Guidelines

"Step one, you say we need to talk"....

In December 2018, The Canadian Task Force on Preventative Health (CTFPH) published the Breast Cancer Update to their 2011 recommendations on screening for breast cancer in average-risk women aged 40–74 years. Now, the 2018 update is not as "new" as it may seem, not a lot has actually changed since 2011. However, it was 2018 when my life changed, and when I developed a brand new perspective. Since it's the 2018 guidelines in effect now, I'll focus on those.

Do not be dumb like me. You may substitute the word "dumb" for naive, ignorant, and/or unaffected. Do not wait until affected personally to become knowledgeable. 

Let me tell you why this matters, leaving out as much medical jargon and statistics as I can, because:

     1. I'm not a doctor, clinician, or researcher (you likely aren't either).
     2. I'm not a statistician.
     3. Medical jargon and statistics are boring to a lot of people.

First, let me break down some key recommendations from the recommendation guidelines for women not at increased risk:

• Not screening with mammography for women aged 40 to 49 years.
• Screening with mammography every two to three years for women aged 50 to 69 years.
• Screening with mammography every two to three years for women aged 70 to 74 years.
• Not using magnetic resonance imaging (MRI), tomosynthesis or ultrasound to screen for breast cancer in women not at increased risk.
• Not performing clinical breast examinations to screen for breast cancer.
• Not advising women to practice breast self-examination to screen for breast cancer.
• It is recommended that care providers engage in shared decision-making with women.

Some news outlets are praising the new guidelines saying that they "give women more of a voice in their health care decisions" and are "empowering women to take charge of their health when it comes to breast cancer screening." This is really the main recommendation that changed in the 2018 guidelines so I can see why they are touting that point. But I call hogwash! Yes, this recommendation was added to the guidelines and I applaud that. However, I didn't need to see it in print to know that I have a choice in my own healthcare, or to know that I need to be and am my own best advocate. 

Again, I am not a doctor. I cannot breakdown the benefit vs. risk in regard to mammography, nor can I adequately explain all the science behind the guidelines or the criticisms of same. In this regard I will defer to experts in the field, such as Dr. Paula Gordon and the many experts who agree with her, who are adamantly opposed to these guidelines. Dr Gordon very succinctly explains her criticism in an opinion piece published in The Province. Read it.

On the Government of Canada website you will find this tidbit of information, I'm assuming compiled by actual researchers:

• Breast cancer is the second most common cancer in Canada. 
• In 2017 an estimated 26,300 Canadian women will be diagnosed with breast cancer and 5,000 will die of it.
• Breast cancer accounts for approximately 26% on new cases of cancer and 13% of all cancer deaths in Canadian women.
• 1 in 8 women are expected to develop breast cancer during her lifetime and 1 in 31 will die of it.

Rethink Breast Cancer states that in females the lifetime probability of developing cancer is 12.4%.

Breast cancer diagnosis statistics by age are as follows:

• 70+ years = 32%
• 50 to 69 years = 51%
• 40 to 49 years = 13%
• Under 40 years = 4% to 5%

It should also be noted that women diagnosed under the age of 50 have the highest incidence of death. That means that upward of 18% of young women are more likely to die.

Ok, enough with the statistics and jargon. I may have got a little carried away with them, but the big thing to know is that breast cancer is prevalent in Canada, and it does kill people.

Step two, "lay down a list of what is wrong"....

Full disclosure. I was diagnosed with triple negative breast cancer at the age of 38. I was considered to be at a higher risk because my mother was diagnosed with the same at age 41 (not high enough to be eligible for genetic testing, but that's a story for another day). You know who wasn't considered high risk though? My mom. There was no incidence of breast cancer in our family previous to her. My maternal grandmother did die from fully metastasized cancer, however the primary origin is unknown. 

So here is where I, as a layman, take particular issue with these guidelines.

1. Despite the guidelines, and even in the guidelines, it is still recommended that a woman promptly informs her physician when she becomes aware of an unusual change in the feel or appearance of her breast(s). There is no age recommendation on this, it applies to all. 

• How is a woman to recognize "unusual changes" without having a baseline to compare to, and especially to recognize these changes early? A baseline is developed by performing routine checks of ones own breasts, i.e: performing self-exams, which is not recommended. 
• If self-exams are not recommended, how much research and promotional material will be available to advise women on self-exams and make them more knowledgeable as to which changes to look for, and how to look for them?

2. The guidelines recommend that physicians and women engage in shared dialogue and decision-making in regard to screening.

• When the guidelines recommend against screening, clinical exams and self-exams, guidelines that physicians follow, how many doctors recommend otherwise? How many patients are knowledgeable in their own health and guidelines to request otherwise? How thorough can this conversation really be in a 10 minute allocated appointment?  
• How many people can refute the doctor and can adamantly and succinctly argue against the doctor and the guidelines and really, with gusto, advocate for their own health care? Answer: not many. 

3. By not recommending clinical exams, the guidelines are recommending that there is no physician record for future comparison. There will be no baseline.

4. The CTFPH makes the recommendations that they do based largely on the harm that screening causes. What are these harms you ask?

• False positives - This doesn't mean that everyone who receives a false positive is told they have cancer and receive treatment. It does mean that the person is recalled for further testing, such as repeat mammograms, MRI, or ultrasound etc., to determine if there is a malignancy. This can cause stress and anxiety on a person,
• Unnecessary biopsy - If a mass is found that appears as though it may be malignant, the woman may receive a biopsy. The woman's breast is numbed, and a thin hollow needle is used to remove a tissue sample from the mass. This takes about 10 minutes all in. The sample is then sent to pathology. They say this can be traumatic to a person. 
• Receiving treatment unnecessarily - The term used is "overdiagnosis" meaning that it is more likely that the person will die of something else before the cancer proves fatal. There is no tool to measure this. There is no way to know if I will be hit by a bus before the cancer gets me, or if I may have a heart attack before dying of cancer. So treat the cancer!! 

I had a biopsy, it sucked. Not the actual procedure, that was relatively painless because the area was numbed. But it hurt after the freezing wore off. Not a "holy crap I feel like I'm dying" kind of hurt, not even a "hey, can I get a prescription for painkillers" kind of hurt. It was just uncomfortable for quite a while. The waiting however..... the waiting was the worst! I will admit to being anxious during this time period. But you know what would have sucked worse than that? Dying from fully metastasized cancer, primary unknown, like my grandma.  

Women are not delicate little flowers who cannot handle the anxiety of further tests. "Instead of protecting women from screening, it’s time to start saving women’s lives." (Dr. Paula Gordon)

5. What are the benefits of screening for breast cancer according to the CTFPH?

• The benefits of breast cancer screening according to the same people who wrote these guidelines are, in two words, not dying. Verbatim: "There is evidence that shows that screening lowers a woman’s risk of dying from breast cancer." One would think that that is important....

6. According to the statistics above, 4% to 5% of those diagnosed with breast cancer are under the age of 40 and 13% are between the ages of 40 and 49. 

• How is it proposed that these woman are diagnosed without performing self-exams, clinical exams, mammograms, or using other screening tools?
• Throughout the course of my treatment I met many women under the age of 50 who were diagnosed without having any of the qualifications that would have defined them as high risk (my mother would also fall into this category). If they did not find a lump themselves, or notice a dimpling or nipple change, they may not have been diagnosed when they were (and often this was beyond Stage 1. It doesn't take a doctor to know that a higher stage equals a worse prognosis).
• According to some critics of these guidelines, approximately 400 Canadian women per year will die because of these guidelines. How many of these people will be wives, or mothers? How many will not have lived long enough to have the opportunity to be a wife or mother? They are all somebodies daughter. If 400 people died in an accident or a disaster, that would be called a tragedy. 
• Who is the CTFPH to say that these lives don't matter? 

7. With things being as they are, even today, there is a prevalence of women who are misdiagnosed, especially if they are younger. I have no statistics on this, all I have are the stories of the women who I met during the course of my treatment. In the grand scheme of things, based on the length of my treatment and the number of people I met, the number of those willing to talk, and because I can't be in all places at all times, the number of people I met was fairly limited.... Statistically, all I can say is that a lot of the survivors I met were under the age of 50 and misdiagnosed, not listened to, or told they were too young, before actually being correctly diagnosed. Way too many. 

These guidelines do not help to correct this situation. In fact, I can only assume that they will make the situation worse because they reinforce that breast cancer is an older persons disease. It is not; Cancer does not discriminate!

Step three, "try to slip past his defense"....

The only way to cause change in this regard is to make noise. Side note: The CTFPH is funded by tax dollars.

Write to your Member of Parliament (MP). Write to your provincial MLA. Write to the Minister of Health. Make. Some. Noise. These people are elected to represent the issues of their constituents so don't be afraid to utilize them.

When writing to an elected official, keep your letter short and to the point, focusing on one issue and include a clear action plan. Try to include a personal story; let them know why you are passionate about this issue. Let them know you expect a reply and give them means to contact you. Finally, be sure to be polite.

*January 29 edit* There is now a petition that may be signed online to demand that the Minister of Health rejects the guidelines. 
https://www.change.org/p/demand-that-the-health-minister-reject-dangerous-breast-cancer-screening-guidelines-that-will-cost-lives

On January 28, Global News published the article regarding the guidelines titled: "New breast cancer screening guidelines are outdated and dangerous, experts say." The cause against the CTFPH is gaining momentum!

Step four, "and pray to God he hears you"....

Amen.

Taking responsibility for your own health, speaking out, and fighting for what you believe to be right -----

That is how you can save a life.

This may not be an issue that you are passionate about, and that's ok. Perhaps it has never affected you, or hit close to home. That's a great thing! But for the 1 in 8 women that it will affect, and for the spouses, parents, children, and friends of those 1 in 8 women, I beseech you to speak out. 

Which one of us would the CTFPH sacrifice?

**Early detection saves lives. 

Let's give women and doctors the tools to detect early.**

Regarding Instant Pot French Onion Soup

First off, let me just say, I did not start this blog to write about cooking, even though the first and second blog posts have turned out to be about food. I am not a chef, I have no special culinary skills, nor the imagination to create my own recipes. I do, however, want to write about things about which I have 2₵ to say. This is the very thing that expert blog writers advise against; apparently I am supposed to find my niche and stick to it. I suppose it’s a good thing that I’m not out to be an expert….

Anyway, today I decided to tackle French Onion Soup with the new Instant Pot. I have never made French Onion Soup before, but Dear Husband and I both love it, and I happened across a simple enough recipe for the new Pot, so badda boom, let’s try it. (Hopefully there’s no actual boom!)

It’s about 2:30pm and I start taking out all the ingredients and prepping the kitchen. I review the recipe, courtesy of The Typical Mom. Onions (yellow and green), check.  Butter, salt, Worcestershire, thyme, beef broth, all check. I don’t have day old French bread, but I do have Mini Baguette Crisps by Ace Bakery, those will do. I’m also choosing to use Swiss instead of Mozza because I make my own choices. Gruyere would typically be used, but I don’t have that, and I probably couldn’t taste the difference if I was doing a blind-folded taste test, à la #birdbox.

I’ve also decided to make an elk roast with this dinner. French Onion Soup is great, but Dear Husband has been working all day and he loves him some meat. Santa put this Canadian Moose Seasoning in Dear Husband’s stocking last year, so I just season the roast up with that, give it a sear and throw it in a dish to bake. (For those wondering, yes I do know that moose and elk are not the same, however they are both mammals from the Cervidae family and I’m pretty confident that this spice does not include anything that can be used solely on moose meat. I'm pretty sure this spice, despite it's name, could be used on Reindeer as well *gasp*). Anyway.... I could cook this roast in the Instant Pot as well, but having only the one insert makes that seem like more trouble than it’s worth for right now.

But wait! I forgot the beauty of Instant Pot cooking. It’s fast!! And it’s still only 2:35pm at this point. This particular recipe, from start to finish, prep to filling my face, should only take approximately 15 minutes, 25 minutes if you're easily distracted like myself. So, I put the perishables back in the refrigerator and go live my life for a couple more hours….

Queue the classic song to signify time passing -- the Jeopardy theme song! For those who didn’t know, there are now a few episodes of Jeopardy available on Netflix! I feel that chemo has killed a few brain cells so I turn that on and try to hone my skills and kill some time. The Tournament of Champions series is streaming, so I feel really smart when I get one right! (Truth be told, I wouldn’t have known any more of those answers pre-chemo either).

A sufficient amount of time passes then I’m back in the kitchen, albeit a little bit more knowledgeable. I have my ingredients, again, and I am ready to cook, again!

I melt the butter in the Instant Pot using the sauté feature, as directed, however I then sear my elk roast in the Pot and that same butter. Searing helps to lock in all that natural meatiness of flavour, or so I’ve gathered from watching MasterChef. Doing so in the same pan that I’m about to cook the soup in can only add more flavour to the broth.

Then I take to chopping the onions, a taunting task. No, it is not The Onion Memory that makes me cry, it is indeed the actual onions, and cry I did.

Once upon a time, a college professor asked me to analyse this poem:

Real onion tears

“It is the onion, memory,
that makes me cry.
Because there's everything and nothing to be said,
the clock with hands held up before its face,
stammers softly on, trying to complete a phrase--
while we, together and apart,
repeat unfinished festures got by heart.”

The Onion Memory, by Craig Raine

Don’t ask me what that means; I’ve always been way too literal to interpret poetry. I can vaguely remember the same professor reprimanding me when I said the poem was about onions. If you read the poem, please feel free to comment below on what you think it means.... I'm pretty sure I received the lowest grade I ever received in the class with this confounded poem. Additionally, seriously, is "festures" even a word?

Side note: Some of you may be thinking: "hey, that looks like way more than three onions chopped" and you would be correct. I cannot cook for two, so there will be leftovers in my freezer.

Carrying on, this particular recipe tells me that if I have thyme, oops sorry, TIME, than I can caramelize the onions. Well, I have both time and thyme, so that is exactly what I do. The caramelizing process took longer than my scheduled 15 minute cook time, but it should make a difference. From what I understand, caramelizing brings out the natural sugars in the onions. I don't have quite enough patience to fully complete the caramelizing process, and since it was listed as optional, I don't stress about it. 

Partially caramelized

Into the Pot goes the beef broth, I seal the lid onto the Pot, say my little prayer  that this time will not be the time the Pot explodes, and set the timer as advised. It takes a number of minutes for the Pot to pressure up, something which was not mentioned in the recipe instructions, so I spend about 10 minutes wondering if I did it right or if I did in fact create a bomb. But then the timer starts to count down from 3 minutes. Crisis averted. 

Once the three minutes has completed, I do a quick release, prepare the buns (horseradish for me, not for Dear Husband), and cut the roast (which has been resting for a bit now). When safe to do so, I remove the pressure cooker lid, ladle the soup into crockery bowls, top with the crusty baguettes, Swiss cheese, and green onion, throw in the oven under broil for 5 minutes. Then, presto, dinner is served!

In future, I think I will attempt to make my own beef broth (probably out of elk, moose or deer, so not beef at all) instead of buying pre-made. There are an abundance of directions on how to make broth in the Instant Pot as well, and I bet I could make a pile of it and freeze for future use. The heart of French Onion Soup is the broth, so the better that is, the better the soup. Overall it was good enough, perhaps a little sweet, but that could be down to the onions. Also, I think that wine is often added to the broth when making this particular type of soup. No offense to The Typical Mom, by the name I’d guess she’s cooking for kids, but in my opinion, wine makes things better, so next time I make French Onion Soup, there will be wine. 

The Day the Instant Pot Changed My Life: Pork Ribs

I did it! I jumped on the Instant Pot craze (repeat, Instant Pot, not InstaPot). Walmart had an amazing Black Friday sale: $48.88 for an 8 qt Lux, so I figured, why not? The second worst that can happen is it becomes another kitchen appliance that collects dust before I sell it on the Facebook Marketplace (if anyone needs a juicer, do I have a deal for you!). The first worst, of course, is that I blow up my house. 

Yesterday, I opened the box and despite what I believe were some instructional shortcomings on behalf of the writers of the Instant Pot manual, I survived the pressure test. Praise be.

Step one, of course, saw me spending hours delving through my Facebook groups, and Pinterest looking for what I hope is the perfect recipe - and of course finding dozens of recipes for other things, as well as some paintings to try, dog toys to buy, and a couple Bible verses to keep me encouraged. I’ve been working on this step since the day I sent the order for the Pot (you can safely assume anytime from here forward that anytime I refer to “the Pot,” that I am speaking of the Instant Pot and not, the recently legalized in Canada, marijuana).

To be honest, I selected a recipe which I thought would be great and purchased all of my ingredients on a shopping trip the other day. The ingredients needed consisted of pork ribs. Everything else I had on hand. It wasn’t until this morning, after rereading this recipe, that it occurred to me that there had to be better out there.

And then I found it – Instant Pot Baby Back Ribs, courtesy of the recipe blog “I Wash You Dry." It required a second trip to the grocery store, but after completing a thorough cost benefit analysis - my friendly neighbourhood Walker’s IGA is only about a 60 second drive away, the temperature had risen from -25°C to a pleasant 1°C, and anything worth doing is worth doing right – I decide it’s worth it and head to the store for the missing ingredients.

The first step in the recipe is to remove the skin from bottom side of the rack of ribs, a task which is supposed to be simple, but for some reason I struggle with. Honestly, until I read this recipe I had no idea that this was a step that a person was supposed to do, and I’ve made ribs dozens of times (typically my grandma’s sweet and sour ribs, but that’s a topic for another day). Admittedly, I didn’t think the risk was worth the reward. It took forever to remove what I did, and ain’t nobody got time for that. If there’s anything these past 10 months have taught me, it’s that life is just too short for some things. However, since I did get the silverskin off about half, we’ll find out if this is a step I should take moving forward or not.

Next comes the dry rub. 1/4 cup brown sugar (a loose quarter cup because the recipe didn’t specify that it was to be firmly packed, and let’s be honest, less sugar is better, especially the second week of January when resolutions are strong), 1 teaspoon each salt, pepper, onion powder, and garlic powder (I am fortunate enough to have one of the best garlic suppliers in the world, hailing from Lillooet, BC - seriously worth the drive to the summer Friday farmer's market), 1/4 teaspoon cayenne pepper (and a dash extra for good measure), and 2 tablespoons chili powder. I added some smoked paprika because I had it in the cupboard and it just seemed like flavour that would work. I did omit the dried parsley and cumin. Spices are expensive, and I already had to buy onion powder and cayenne because I had ran out previously. Besides, I’ve always been of the opinion that the only parsley worth using is fresh parsley, otherwise it’s just decoration, and even fresh, most of the time it’s just to pretty it up. And cumin, who even knows what that is? I didn’t buy that on principle. There is a list of spices that I have never in my life owned or used, and cumin is one of them. If I’ve made it nearly 39 years without cumin, one more meal will be just fine. Maybe some time in the future I’ll splurge and get me some cumin, but today is not that day. "Nope, not today."

I’m a big believer in Costco sized and club size packs, even though there’s typically only two people that I cook for, myself and Dear Husband. Jumbo size can save tons of money and time. As well, one of my first ever volunteer jobs was at a summer Bible camp for 100+ kids, counsellors and staff every week. Not only did this camp job reward me with some of the best experiences of my entire life (Lake of the Trees Bible Camp, look it up, I encourage any BC kid to go), but it also taught me how to cook for the masses, a skill that stubbornly remains all these years later. It’s why I bought the 8 qt Instant Pot - because I know full well that any meal I plan for two ends up a meal for at least 12, or alternatively, days and days of leftovers. I have learned to embrace this. At the very least, it means I only have to cook every two days. And I have really learned to appreciate having ready-to-heat meals in the freezer.

What this means for now is that I have more than twice the amount of ribs that I need for today’s recipe, and I made too much dry rub. No problem. I rub down that second rack of pork deliciousness and grab my handy FoodSaver vacuum sealer. This is THE kitchen gadget for anyone who freezer cooks or packages their own wild game. The second rack of ribs, after being coated with the dry rub and vacuum sealed, will live in my freezer for a few weeks, until it’s time to have ribs again, with the added bonus that they have been essentially marinated and I can skip all the preparatory steps next time.

Back to the task at hand, I measure out the required water, and the two ingredients that caused me to go to the store – apple cider vinegar and liquid smoke. These are the main ingredients the first recipe I chose was missing. Apple cider vinegar will help to tenderize the meat, and both will add additional flavour. I was going to forgo the liquid smoke, another ingredient I never bothered to buy before today, always being partial to the actual grill, but it’s January, it's cold, and it was cheap enough, so I decided to try it.

It’s at this point where Dear Husband gets called into work. He’s seen the ribs in the fridge, he’s heard me talk about the supposed glory of the Instant Pot. Off he goes, mouth-watering, to earn the income that allows me to purchase things like liquid smoke, and even cumin if I ever decided. Don’t worry, he’ll be home late tonight and a plate full of ribs will be waiting.

Into the Pot goes the liquid ingredients, and I wrap the ribs around the Pot and set on the trivet. Close the lid, lock into place, press “meat” on the Pot, set for 25 minutes and pray that this doesn’t end with the house exploding.

And this is where the magic happens…. I don’t know all the science as to what goes on in the Pot. All I know is that whatever it does, it does it fast, and as it turns out, well.

25 minutes goes past, and then I let the Pot do a natural release for 10 minutes, after which I do a quick release (and lived to tell about it). There was some minor panic when the red float valve didn’t pop up, but I said a little prayer and it all worked out for the best.

These ribs were fall off the bone perfect already! I can tell because they were literally falling off the bone.

Back to the recipe…. The writer says to place the ribs on a foil lined baking sheet, brush with barbecue sauce of choice and broil for 5 minutes. This is all well and good, but I will pause to mention the glorious invention of parchment paper. I don’t remember who told me, not all that long ago, that once I tried parchment I’d never go back to foil, but they were 100% correct and a very wise person indeed! Tin foil has its place in the world, but lining pans is not it!

5 minutes under broil, served with some Taylor Buffalo Blue chopped salad that I found at Costco the other day, and a glass of wine (cause why not?). Don’t ask me if this wine pairs well, I’m no connoisseur, but I am a fan of sweet white wines like this Palm Cove Moscato and Rieslings like Relax (these are my two favourites, if you’re ever looking for an impersonal gift for me, wink wink).

Sweet Baby Ray these ribs are delicious! Never again will I spend hours boiling and seasoning and baking, etc. Today will henceforth be known as the day the Instant Pot changed my life. I guess I better find some more recipes to cook in this thing because it’s not going anywhere.