A Montreal woman who was told by health-care professionals that she was too young for breast cancer but later diagnosed with it, has died from the disease. Valerie Buchanan was 32 when she died at the end of February.
“I keep asking myself why anyone, but selfishly, why her?” Chris Scheepers, Buchanan’s husband told CTVNews.ca in a telephone interview. “She was a beautiful person. She was extremely driven, talented and positive. What really breaks me is our son won’t know the truly remarkable woman she was.”
Throughout 2020, Buchanan sought answers for a lump in her chest but had said she was reassured by multiple health-care professionals in Ottawa and Montreal that it was a benign cyst without sending her for imaging to confirm.
After 13 months, Buchanan eventually went to a private clinic and was diagnosed with Stage 3 triple-negative breast cancer – a biologically aggressive subtype of breast cancer. Just a few months later, she learned it was Stage 4.
In the last four years, amidst multiple surgeries – breast, chest and brain, along with multiple rounds of radiation and chemotherapy – she travelled, she advanced her interior design business, got married, and had a son.
“It was quite a fight to just get her proper care, unfortunately. It was all just very unfortunate timing,” Scheepers said. “It’s just really unfortunate that it cost this beautiful person their life at 32.”
Scheepers and Buchanan met online nearly 20 years ago – Buchanan was living in Montreal, and Scheepers was in Ottawa.
They got engaged in 2018.
Scheepers says he was inspired by Buchanan’s positivity, drive, passion, and creativity.
For their son’s first Halloween last October, Buchanan had planned a circus-themed celebration: their son would be dressed as a lion in a cage, with Scheepers as the ringmaster and Buchanan as a circus performer.
“I remember spending two hours at Home Depot alone just trying to figure out what would be the best materials for it,” Scheepers said. “I spent six hours putting together such a basic thing, but it all came together, and she was so happy. I would do it all over again if I had to.”
“Even if it was just building something like that, she gave me so much purpose.”
Rise of incidences of breast cancer in young women
Breast cancer is a prevalent health concern in Canada, ranking as the second most commonly diagnosed cancer, with an estimated 30,800 cases expected in 2024 – just behind lung cancer, which was projected to reach 32,100 cases, according to the Canadian Cancer Society.
Moreover, breast cancer is on the rise among younger women.
According to a new study published in the Canadian Association of Radiologists Journal, between 1984 and 2019, diagnoses increased by 45.5 per cent for women in their 20s, 12.5 per cent for women in their 30s, and 9.1 per cent for women in their 40s.
“It is alarming because many of the women under 50 have not had the opportunity of early detection of breast cancer through screening, and present at more advanced stages of their cancer,” Dr. Jean Seely, head of breast imaging at the Ottawa Hospital, who led the study, told CTVNews.ca in an interview.
“This means their survival is much lower than in older women whose cancers are screen-detected.”
Women under the age of 40, particularly Black women, tend to be diagnosed with more biologically aggressive and rare types of breast cancer, like triple-negative breast cancer and HER2-Positive, according to two other recent studies.
“This is all worsened by the fact that our systems are not built to diagnose these women and get them into care quickly, so they often present with later stage disease and worse outcomes,” Dr. Anna Wilkinson, a family physician and general practitioner-oncologist at the Ottawa Hospital, who led both studies, told CTVNews.ca in an interview.
Both Dr. Wilkinson and Dr. Seely published studies that highlight the positive correlation of provincial screening programs in regard to breast cancer stage at diagnosis and on the 10-year net survival.
Both studies demonstrated that screening programs that included women in their 40s resulted in significantly higher 10-year net breast cancer survival rates and significantly fewer advanced-stage diagnoses (Stage 2, 3 and 4).
Early detection of breast cancer has also been shown to be cost-effective on the health-care system because it reduces costly and lengthy treatments, another study Dr. Wilkinson led demonstrated.
“Our national guidelines that recommend not screening below the age of 50 are disadvantaging an enormous sector of our population,” Dr. Wilkinson said.
Breast cancer screening in Canada
The breast cancer screening federal guidelines are currently being updated.
Dr. Seely and Dr. Wilkinson are among other medical experts and cancer organizations advocating that the incoming guidelines recommend that screening begin for women in their 40s as opposed to age 50.
However, despite recommendations, the Canadian Task Force on Preventive Health Care did not support screening for women beginning at age 40 in its proposed guidelines released in May 2024. Instead, it maintained its current recommendation that breast cancer screening begin at age 50, every two to three years.
The task force – a federal independent body responsible for developing national guidelines for primary health-care workers on delivering preventive health care – is currently under review by an external expert review panel appointed by then-federal health minister Mark Holland, which launched in October 2024.
The external panel was tasked with submitting a report recommending changes and improvements to the task force’s structure, governance, and methodology for developing the guidelines.
The report was submitted on April 25 to the Public Health Agency of Canada, who are currently reviewing the external panel’s recommendations, the agency confirmed to CTVNews.ca in email.
The report is expected to be made public soon.
While the task force does not recommend systematic screening under the age of 50, provinces and territories have independently begun lowering the screening age within their provincial programs in collaboration with the Canadian Cancer Society, who also disapproved the proposed breast cancer screening federal guidelines.
“One of the big drivers around our shift at (Canadian Cancer Society) around breast cancer was the fact that we are seeing globally earlier onset cancer,” Kelly Wilson Cull, director of advocacy at the Canadian Cancer Society told CTVNews.ca in an interview.
“These trends are really requiring us to look at programs and question whether they’re meeting this ever evolving and expanding need.”
Ontario, British Columbia, Nova Scotia, New Brunswick, Newfoundland and Labrador, Prince Edward Island, and Yukon allow women as young as 40 to self-refer for provincial screening programs.
In Northwest Territories and Alberta, self-referral begins at 45.
In Saskatchewan, self-referral begins at 47, with a plan to lower to 40.
In Manitoba and Quebec, self-referral begins at 50 – Manitoba has plans to lower to 45 meanwhile Quebec is reviewing its policy.
Nunavut has no provincial screening program.
Ontario and Nova Scotia also offer high-risk screening programs, which is reserved for women who have a family history of breast cancer, who are carriers of gene mutations, like BRCA1 or BRCA2, have a first-degree relative with these gene mutations, or received radiation to the chest to treat another cancer.
Though, despite most provinces lowering their eligibility age in their provincial breast screening programs, Cull recognizes this model is not ideal.
“One of the challenges is that your postal code shouldn’t determine when you’re able to access breast cancer screening,” Cull said. “It creates this real inequity from province to province that you can now access a mammogram at 40 if you live in Ontario, but it’s 50 if you’re in Quebec. It’s part of why we really feel strongly about the review of the task force.”
“Our understanding of breast cancer has shifted and expanded and changed so much, and organizations like ourselves, but also all levels of government, need to be keeping pace with those changes.”
Alternative methods to screen for breast cancer
However, women younger than 40 – like Buchanan – still do not qualify for provincial breast screening programs across Canada.
Additionally, mammograms – the imaging method used in provincial breast screening programs – may be less effective at detecting tumours in dense breast tissue, which is more common in younger women.
Since some women are also at a higher risk of developing breast cancer than others, a “one-size-fits-all” approach to screening is not optimal, according to MJ DeCoteau, CEO and founder of Rethink Breast Cancer.
That’s why DeCoteau supports the innovation of developing breast cancer screening methods that address provincial gaps and the limitations of mammograms, particularly for young women.
“We want every breast cancer to be caught and treated early and for outcomes to continue to improve. Population-based screening programs for people of average risk of breast cancer are part of that, but it’s only one part,” DeCoteau said.
“With rising numbers in breast cancer cases amongst younger women, we need a new, smarter approach to identifying who is at risk. We need modernized screening programs.”
Doctors and researchers across Canada are doing just that.
Dr. Elijah Van Houten and his team at Université de Sherbrooke have developed a prototype bra – using an imaging modality that’s called elastography, which can image elasticity contrast of breast masses – that can detect breast cancer.
Dr. Jacques Simard of Université de Laval in Quebec and his team developed an at-home test, combining a saliva sample to extract DNA and a questionnaire, revealing a woman’s risk of developing breast cancer and then providing a personalized screening plan based on her risk category.
Dr. Saima Hassan and her team at the Centre hospitalier de l’Université de Montréal (CHUM) are developing a blood test to identify who are at high risk in developing breast cancer and who would benefit from a personalized screening plan.
“There will be implementation challenges, including equity issues to address, but it’s time to modernize,” DeCoteau said. “We need to prepare our health-care system for an approach like this now.”
‘Valerie’s experience is common’
Lowering the eligibility age to women in their 40s for provincial breast screening programs, along with investing in research to develop new methods for earlier breast cancer detection, are both important steps in addressing the rise in breast cancer incidences in younger women.
However, these initiatives are typically aimed at asymptomatic women – those who do not have breast cancer symptoms.
Young women who present with symptoms – such as Buchanan – often encounter age-based discrimination when seeking diagnostic screening.
According to Bukun Adegbembo, director of operations at Canadian Breast Cancer Network, Buchanan’s story is one she hears often.
“Valerie’s experience is common with many of the younger women that we speak to,” Adegbembo said. “Like Valerie, they are told that their concerns are nothing, or at least not a symptom of breast cancer. They are also told directly that they are too young to have breast cancer.”
“Breast cancer being predominantly diagnosed in older women isn’t the same thing as breast cancer does not occur in younger women. Unfortunately, it is treated as such.”
Adegbembo suggests that health-care professionals may not be dismissing younger women with symptoms, but rather trying to avoid causing unnecessary fear, as breast cancer is more common in women above the age of 50.
However, despite best intentions, dismissing symptoms can have negative health impacts on the individual, such as a later stage diagnosis, which is particularly concerning in the cases of more rare and aggressive types of breast cancer more often seen in younger women.
Dismissing symptoms or attributing them to a condition other than breast cancer can also have psychological impacts on the individual, leaving women uncertain about whether to continue advocating for themselves or to trust the health-care provider’s advice. This can ultimately lead to distrust in the health-care system.
“It’s important to continue to raise awareness that while breast cancer occurs mostly in older women, it can and does happen to younger women,” Adegbembo said.
“As we raise awareness of this, the health-care system must adapt to support women who present with concerns.”
Kimberly Carson, CEO of Breast Cancer Canada also often hears stories like Buchanan’s, which is why she also opposes the proposed breast cancer screening federal guidelines.
A 33-year-old woman from Ontario told Breast Cancer Canada the process of receiving a diagnosis was also difficult for her. She eventually presented at the emergency room for answers on a lump in her chest.
“The whole system is failing younger women right now. Unfortunately, the stories we hear about younger women that present with signs and symptoms are not taken seriously,” Carson said.
“It’s so devastating and sad that it’s come to that point where we have to beg, even when you are presenting with symptoms.”
According to Adegbembo and Carson, addressing the discrimination young women often face when seeking diagnostic imaging requires continued awareness of the rising incidence of breast cancer in young women – an awareness that can drive systemic change within the health-care system.
“We need systemic change to our (health-care system),” Carson said. “We advocate for women to know their own health, and when they do, we also need the system to respond accordingly, regardless of age.”
‘We can’t bring my girl back’
Valerie’s mother created a book that includes Buchanan’s artwork, places she visited, and photos with friends, family, and Scheepers. The book is meant for her son to read when he’s older, so he can learn all about who his mother was.
“Valerie was a beautiful girl. She was an inspiration,” Buchanan’s mother, Barbara Buchanan said. “She was a fighter. She tried and tried but the cancer just kept coming back.”
“It’s been five years of a lot of emotions and a lot of crying, a lot of praying to God, a lot of screaming, a lot of denial. It’s been so hard. I sleep maybe four hours a night. My stomach doesn’t stop aching.”
“We can’t bring my girl back.”
Buchanan had the next five Halloweens planned for herself, Scheepers, and their son.
Her theme for next Halloween was based on the American mockumentary sitcom television series The Office.
Scheepers said some of the items she planned on getting are on her online wish list.
“Life became so overwhelming,” Scheepers said. “But what I would do to just get that back. I would have done it all over again. I would have taken care of her for the rest of my life if I had to, if it meant her being around.”
In their home, Buchanan and Scheepers have matching blankets, and each night, he brings her blanket to bed with him.
“I’ll try my best to do next year’s Halloween theme as best as I can,” Scheepers said. “I hope I can be the father she wanted me to be.”
