Inside the “one-stop-shop” centre for breast health

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. 

Like many women, Ip 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],’” Ip recalls, adding that the results came back as “likely benign.” 

But Ip 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 Ip’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 (MSH), to get a second opinion. That’s how Ip discovered that the lump was, in fact, malignant. 

“I am so grateful that [Dr. Pallister] was willing to look at it,” she says. 

Patient-centred care

If Ip 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. It’s a weeks-long process that 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. 

The newly relocated Breast Health Centre opened its doors in May 2022 is a welcoming space meant to help patients remain comfortable and calm. 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] 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,” explains Dr. Pallister. 

Another unique element of the Breast Health Centre is its design and layout. Located on the main floor of the hospital, the centre features natural light and beach-like floor tiles, with a fireplace in the waiting area and nature-themed murals in the exam rooms.

“We tried to create a relaxing space for patients,” says Poobica Kumaran, a breast cancer nurse navigator at MSH. “I’ve had great feedback from patients telling me they feel like they’re at their cottage.”

Listening to concerns

When Ip first met with Dr. Pallister in January 2022, she relayed her worries about simply monitoring the lump every six months, especially given her upcoming final fertility treatment and what a cancer diagnosis might mean if she became pregnant. “I didn’t know if it was me overreacting, or if it was anxiety,” she says.

Dr. Pallister was sympathetic to Ip’s fears. She agreed to remove the lump that day and send it for testing. “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?”

Ip 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.

Navigating the system

Once Ip received her diagnosis, the experts at MSH’s Breast Health Centre launched into action. Kumaran, who is the main point of contact for all patients at the centre, guided her through the hospital journey. 

“As the nurse navigator, your role is to educate, navigate and make sure you’re there to support your patients,” Kumaran explains. “It’s like a maze, and there are lots of things going on in the patient’s mind with a diagnosis of breast cancer, so it’s nice to have someone say, ‘This is tough but we’re going to help you through the journey.’”

Kumaran scheduled Ip for a second surgery in February 2022 with Dr. Pallister 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, Ip, 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 it after all, as Ip and her husband conceived naturally in May. “This is a miracle baby,” Ip says quietly. “And 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.”