Today I'm introducing you to Shira Farber. Shira is a force: she's a passionate entrepreneur, a proud mother of three and an advocate. Shira owns the mobile music school called The JamLab that offers virtual and in- person lessons to individuals and organizations across the GTA. She's also a a breast cancer patient and fierce advocate for better breast health and earlier screenings. Shira has been featured on this subject in the media and been invited to speak both provincially and federally about changing screening guidelines for Canadian women. She volunteers with an incredible organization called Dense Breasts Canada.
You have an important story to share in relation to breast screeing and breast density, can you tell us about your personal experience? Shortly after my 48th birthday, I found an abnormality in my breast and was diagnosed with an advanced stage of breast cancer. I was completely blind sided by the news. I had no known family history of breast cancer, had been genetically tested as part of a pilot research project which came back as low risk and felt reassured that I had nothing to be concerned about. When I turned 40, I asked my family doctor if I would need to start having mammograms and I was told that the provincial and federal guidelines had changed their recommendations to begin screening at 50. I had also been advised, like many women my age, not to do monthly self breast exams because they were "inaccurate" and "anxiety provoking". I had not been consistent in seeing my family doctor over covid lockdowns and had a tendency to push off check ups, as a busy, working mom and one of the caregivers to my parents.
If I had known I required an annual mammogram starting at 40 and that over 80% of breast cancers are not hereditary, I would have been more likely to be more assertive about my health. I do not blame my family doctor for the situation, as she was simply following national guidelines which are erroneously believed to be best practice. This is something breast cancer advocates like myself are working very hard to change.
I remember asking my surgical oncologist after she delivered the news about my diagnosis if I was going to be OK and her response was, " It's not too late but I wish we had found it earlier". This is because finding breast cancer before it spreads can reduce the need for harsher treatments and in some cases can prevent the risk of metastasis and recurrences.
My treatment consisted of aggressive chemotherapy, a mastectomy with no option of immediate reconstruction, a complete sentinel node dissection of almost 40 nodes that resulted in permanent lymphedema, followed by radiation. One year after my first surgery, I underwent a delayed mastectomy on the contralateral side and a complex reconstruction using my abdominal tissue which has required one additional surgery and possibly more in the future.
I suffered serious cardiac related issues from radiation treatment and required weeks of hospitalization. My joints and bones have been severely impacted by chemotherapy and hormone therapy drugs and I developed iron deficiency anemia. To prevent the risk of recurrence, I continue to have treatments that can result in serious side effects, including jaw necrosis.
Although, I am grateful to be alive, it can often be challenging to navigate my new physical appearance and mobility limitations. Cancer has not just changed my life but it has impacted those closest to me. I am very fortunate to have the most wonderful husband, children, family and friends but I see how they experience the emotional and physical stress of the disease as a secondary cancer. I will continue to require treatment for most, if not all of my life to prevent recurrence. This is my new reality.
What do you want women over 40 to know? After the shock of the diagnosis and an understanding of what was involved in treatment, I started to do some research about something I had seen on my mammogram which indicated that I had category C dense breasts. I contacted Jennie Dale, the co-chair of Dense Breasts Canada and discovered that breast density had nothing to do with breast size but was actually referring to the amount of fibrous and glandular tissue in a woman's breast compared to fatty tissue, as seen on a mammogram.
Dense breasts typically require supplementary testing like an ultrasound or MRI because it's very difficult to detect. About half of women over the age of 40 have heterogeneously dense breasts (Category C) and 10 percent have extremely dense breasts (Category D) which is why it is so important to start mammograms earlier, so you know whether or not you will require supplemental testing.
Women with dense breasts have a higher incidence rate of breast cancer. One analogy is that when radiologists are looking at a mammogram for cancerous tissues of a woman with dense breasts, it is like looking for a snowball in a snowstorm. Starting screening at 50 makes absolutely no sense, especially as we see the growing incidence of advanced breast cancers rising in younger women and a high prevalence in racialized populations.
I also want women to know that the current national guidelines are patriarchal in nature and biased against screening for all cancers. Some provinces have lowered the screening age but it isn't consistent across the board. As a woman living in Ontario, my cancer was found later than it would have been had I been living in British Columbia.
The Canadian Task Force on Preventive Health Care who creates these guidelines believe women can't handle the transient anxiety of a callback, which they define as a "false positive". Their recommendations do not reflect current evidence which clearly demonstrates earlier screening saves lives.
Cancer advocates including physicians and patients have been mobilizing and working hard to get this message out and draw attention to what we believe to be a national travesty equating to countless unnecessary deaths and suffering for women. The truth is that it shouldn't be us. We are exhausted and we already have cancer. We need younger, healthy women and medical professionals to send a message to their MPs, and the Minister of Health that the task force responsible for these guidelines needs to start screening women at 40 and in some cases depending on individualized risks, even earlier.
What is one piece of advice that you'd give to women over 40? Part of practicing good breast health includes exercise, nutrition, not smoking and limiting or avoiding alcohol. But breast cancer waiting rooms are full of patients who have done all those things and still get this disease. The best way to reduce your risk is early detection. Start your annual mammograms at 40, earlier if you and your doctor think you are at higher risk, find out your density and follow up with supplemental screening if you are in the C or D category.
Some provinces will provide this information in the mail after your mammogram. Also, learn how to do a proper monthly breast exam. Breast cancer doesn't always present as a lump. If your doctors refuse to send you for screenings because they are misinformed by the guidelines, self-refer if your province will allow it or find another medical professional that will do it for you. Do not take no for an answer.
Tell us about your morning self-care routine. Because of my mobility challenges, range of motion issues and joint pain attributed to surgeries and medications, my body literally cannot function until I exercise. So after coffee, I do a minimum of twenty minutes of stretching and strength building exercises prescribed by my physical therapist and then head to the treadmill or out for a walk. Other than a shower and changing my clothes and trying to figure out how to control my chemo curls, there's not a lot of other self-care happening.
What's your favourite, nourishing breakfast? Black Coffee, home made sour dough toast with avocado, tomato, poached egg, feta, kale, pumpkin seeds, drizzled with siracha.
Do you have any favourite personal development books or podcasts that you go back to? Chemo fog and cancer fatigue are real things and unfortunately, I find it very challenging to sustain the necessary attention for reading which is something I used to love. But I am a podcast fanatic and listen to at least one every day, usually about music. Right now, my top three are "The Sound Podcast", "Dolly Parton's America" and "Bandsplain".
What do you value? COMMUNITY is everything to me. I am blessed with the most wonderful friends, family and neighbours. I come from a large extended family and my parents emphasized the importance of prioritizing those connections and I've always been the kind of person that will talk to strangers on the street and invite new friends into my life. I try and find community wherever I go whether it's with my music loving friends, the parents of my children's friends, my oldest childhood friends or new work connections. Most recently through my diagnosis and advocacy work, I am part of a new sisterhood of women living with cancer.
When it comes to mindset, are there any mantras that you live by?
"Never say no to free concert tickets"- When a miracle comes, take it. It will be the best show you almost missed.
"It is a sign of strength to ask for help."- I think this is one of my greatest learning experiences from cancer. Taking pride in doing everything by yourself just leaves you exhausted and bitter. I love to help others, so when someone offers to make my life easier and I know it's coming from a loving place, I am happy to take them up on it.
"Is this spoon worthy?"- Christine Miserandino coined this phrase while trying to visually describe what it is like living with lupus. She demonstrated starting her day with twelve spoons and how each activity she did throughout the day used one or two spoons. Because of that she needed to plan how to expend her energy. Recovering from cancer and ongoing treatment is exhausting. It is a fatigue that is impossible to describe until you have lived it yourself. Getting dressed uses a spoon, taking a shower two spoons, a long zoom meeting can sometimes use three. Thinking about how I exert this energy has helped me prioritize my life and find balance to each day and to also ensure my body gets the rest it needs.
What is your most important feel good routine? I make sure to tell the people most important to me that I love them.
What's your number one indulgence? Cheese. I could live on bread and cheese for the rest of my life.
Can you share some of your favourite resources with us?
Victoria Quilts Canada: This non-profit organization sends a beautiful, cozy free handcrafted quilt to anyone undergoing cancer treatment.
Know Your Lemons: This is an amazing website that teaches you how to do a breast self-exam and how to identify changes in your body.
