text: At the centre of care
  Diana Ip's journey from fertility struggles to breast cancer diagnosis underscores the importance of patient-centred care.
  Diana Ip and her husband had been trying to conceive for years – first naturally and later through fertility treatments – when she found a lump in her breast in October of 2021. The discovery came at an especially precarious time: she had one embryo left and was six weeks away from her final fertility treatment. At nearly 40 years old, and after years of failed attempts, she and her husband planned to give up if this time was unsuccessful.
  Like many women, Diana was in the shower when she first felt the small, hard lump just under the skin of her right breast. It didn’t hurt, but she was sure it hadn’t been there the day before. Concerned, she called her doctor and booked an ultrasound.
  “Initially my doctor told me, ‘You’re young, you don’t have a family history of breast cancer, I’m not worried about it,’” Diana recalls, adding that the results came back as “likely benign.”
  Diana wasn’t convinced. She continued to worry about the lump, subconsciously feeling for it, the same way you keep going back to a loose tooth. According to Statistics Canada, one in eight Canadian women will be diagnosed with breast cancer in their lifetime, so it was only natural for Diana’s anxiety to kick into high gear.
  Then, a friend, who is a breast cancer survivor herself, recommended seeing Dr. Crystal Pallister, a general surgeon at the Breast Health Centre at Oak Valley Health’s Markham Stouffville Hospital to get a second opinion. That’s how Diana discovered that the lump was, in fact, malignant.
  “I am so grateful that Dr. Pallister was willing to look at it,” she says. “I can’t imagine if we had waited, to be honest, and all the things that I would’ve had to go through.”
  Listening to concerns
  When Diana first met with Dr. Pallister in January 2022, she relayed her worries about simply monitoring the lump every six months – as initially advised by her family doctor – especially given her upcoming final fertility treatment and what a later cancer diagnosis might mean if she became pregnant. She worried the lump was actually growing and asked for it to be removed. “I didn’t know if it was me overreacting, or if it was anxiety,” she notes.
  Dr. Pallister, however, was sympathetic to Diana’s fears. She agreed to remove the lump that day and send it for testing. “I said no problem, let’s just do it. I was very surprised that it was cancer, but my experience is that you never know,” she explains. “If someone says, ‘This doesn’t feel right,’ who am I to say keep it in? And I’m so glad that I listened to her and took everything into consideration.”
  Diana received the news that it was stage one invasive ductal breast cancer the day before her 40th birthday, which was just a week after her lumpectomy. She remembers sitting in an exam room, wiping tears from her eyes and thinking about how her friend had reassured her that Dr. Pallister would take care of her.
  If Diana hadn’t been referred to the Breast Health Centre at MSH, she likely would have had to see one doctor, get a mammogram or ultrasound, wait for results, then get a biopsy and wait for those results – all at different clinics – which would be anxiety-inducing for any person. That lengthy, complicated process is what motivated Dr. Pallister, in 2007, to advocate for patient-centred care at MSH and create a one-stop-shop model for breast cancer care.
  I do consider Dr. Pallister to be like our angel. If she hadn’t operated, I don’t know if we would have gotten pregnant.
  A patient-centred approach to care
  The newly relocated Breast Health Centre opened its doors in May 2022 and is a welcoming space meant to help patients remain comfortable and calm during challenging times, and to further support the care model Dr. Pallister created. Its construction was made possible by the generosity of MSH’s donors, especially the Wright family, and the important work of the MSH Foundation.
  “Patients are referred by their doctor for whatever breast-related concern they have,” Dr. Pallister explains. “Let’s say they find a lump, or something shows up on a preliminary X-ray. They can come in and see the surgeon and the nurse practitioner and get all the necessary X-rays and a biopsy that same day, and then be seen within a week for results and a surgical plan if necessary.”
  The short turnaround time between appointments is in stark contrast to the more common experience of waiting for weeks between the initial diagnosis and seeing a surgeon, she adds.
  Delivering a positive outcome
  Once Diana received her diagnosis, the experts at MSH’s Breast Health Centre launched into action. And in February 2022, Diana was scheduled for a second surgery, during which Dr. Pallister removed slightly more tissue surrounding the original lump and performed a sentinel lymph node biopsy to confirm the cancer hadn’t spread. They were all relieved to find out it hadn’t. And after additional consultation with her oncology team and husband, Diana, who is now cancer free, decided to opt out of radiation, in the hopes that when she had her final fertility treatment it would be successful.
  It turned out she didn’t need that last fertility treatment after all – to everyone’s surprise, Diana and her husband conceived naturally in May. Dr. Pallister, Kumaran and the entire team at the Breast Health Centre celebrated this development and can’t wait to meet her baby, due to arrive in the new year.
  Gale and Graham Wright Breast Health Centre