Our lemonade just got a little sweeter

What a day May 30th was for cancer care in Canada! I was energized to read the Terry Fox Foundation’s open letter calling on doctors, scientists and philanthropists to increase collaboration within the oncology community for the benefit all cancer patients. Its headline read: “This is the beginning of the end for cancer as we know it.”
It gave me goosebumps!

For context, a week ago, I was in Toronto for the Terry Fox Research Institute’s 10th Annual Scientific Meeting. Everyone I met, from researcher, clinician, board member, patient to philanthropist, felt the same: we are on the cusp of achieving Terry’s dream. I believe this letter will be one that marks an important milestone in Terry’s legacy. I signed it, as a Patient Partner, alongside the most respected oncology researchers and clinicians in North America. The digital version of the letter is available on the Terry Fox Foundations website.
Wow! What an honour!

Shifting gears away from the research and treatment sides of cancer to screening. If you follow my blog, you likely know that since my diagnosis, I have been advocating, along with so many breast cancer experts and patients, to reduce the screening age and to provide supplemental screening to women with dense breasts, such as mine. It was therefore a very emotional day when I read the draft Canadian Breast Cancer Screening Guidelines only to find out the guidelines remained mostly unchanged. Although it wasn’t unexpected – the Canadian Task Force on Preventative Health Care took out an advertorial a few weeks earlier to pre-emptively position the draft guidelines and did so under the guise of a Q&A with the Task Force’s chair. The Hill Times touts itself as having an unmatched readership of Canada’s most important public policy decion-makers in order to communicate with them before decisions are made.
This advertorial, intended to “sell” the draft guidelines prior to their release, soured my lemonade!

And while I expected exactly what was released by the Task Force on May 30, 2024, it was such a letdown. The guidelines remained virtually unchanged from the 2018 ones, which also were virtually unchanged from the 2011 ones. I shared my concerns on X as soon as I had an opportunity to read them, and later in the day, I was asked by CBC Radio in Calgary to comment on them.

CBC Radio in Calgary invited Natalie Kwadrans to comment on the draft 2024 Canadian Breast Cancer Screening Guidelines

What did not make it on air was how emotional I became when thinking about how these guidelines were going to impact the women that come behind me, the next generation such as my daughter. We all found our cancers too late. It felt like I had the wind knocked right out of me. I would die before I’d see the advocacy work myself and so many others have been doing for years, make a difference for these younger women.

These proposed guidelines mean there will be more cases like mine.

More young women will accidentally find
their cancer on their own or with incidental imaging.
More young women will hear
their breast cancer has already spread.
More young women will now be subjected to
much harsher treatments.
More young women will die needlessly early,
like five of my friends did.
Like the my friend in hospice will.
Like I will too.

Natalie Kwadrans – de novo stage 4 cancer
diagnosed in March 2019, 5 days after her 46th birthday

  • The new guidelines:
    • create even more confusion that what already exists.
      • With the Canadian guidelines having remained unchanged for so long, provinces created their own guidelines to reflect updated research.
      • Some provinces also created guidelines for women who have factors that increase their overall risk: dense breasts, ethnic or genetic predispositions, etc..
      • The Task Force’s proposed guidelines do not align with the 10 provinces that have committed to lowering their screening age.
    • create inequity for breast cancer screening across Canada;
    • grossly overestimate the “harms” of screening and underestimate the “benefits”;
    • place enormous weight on “patient’s values and preferences”, when the data was derived from retrospective analysis.
      • The analysis was done on data for which patients had been conditioned, for over a decade, to the idea that women needed to wait until 50 to begin self-examinations or screening.
      • Guidelines since 2011 have focused on communicating how the “harms” of screening significantly outweigh the benefits.  
      • Women had been repeatedly told about how much anxiety they would experience waiting for results or because they received a false-positive, which resulted in a recall.
      • Very little emphasis was placed on the reduction of required treatment associated with early detection, improved quality of life and better outcomes. As a result, patients were predisposed to “prefer” or “value” what had been indoctrinated in the over the years leading up to them requiring screening.
    • It is very difficult to accept this research at face value and research needs to be done on women’s actual preferences and values when provided with a holistic view of the pros and cons of earlier screening;
      • the Task Force’s Chair is the co-lead of family practice for Choosing Wisely Canada, whose focus is to reduce unnecessary tests and treatments in Canada, and who also is a speaker for topics such as overdiagnosis. The Task Force’s Conflict of Interest Policy is very clear as to what consists of non-financial interest (page 5, section 3.2);
      • there is no expertise on the Task Force, which results in a significant gap between what was included in the proposed guidelines, global best-practices and what is recommended by experts in their field;
      • the lack of industry and patient engagement;
    • they set a precendence as to how future guidelines are set by this Task Force . The Task for sets guidelines so for so many other illnesses, from post-partum depression screening, and hypertension, to impaired vision, diabetes and many other cancers.

The concerns identified above, if not fixed, will be perpetuated and negatively impact the health of virtually all Canadians. In fact, The Coalition for Responsible Healthcare Guidelines are very concerned with the Task Force’s “dangerous guidance” for cancer screenings.

Shortly after the Task Force released its guidelines, the Federal Minister of Health, Mark Holland, stepped in. During the press release in which he reacted to the proposed guidelines, he stated how “concerned and disappointed” with them. He did not feel the guidelines provided clear directions to health care providers, nor did they conform with what he heard from experts and patients across the country. He has now ordered full review of the process, the data and Task Force composition.  A recording of his press conference is available on the CPAC YouTube channel, and his written statement can be found on his X account. These were the changes we had been advocating for!

Minister Holland had just stirred the lemonade and added sugar to it; it tasted so much better now. Although the work is far from done, this is a big milestone for cancer screening. The heaviness that fell upon me was lifted just as quickly. We had been heard! And I cried

May 30, 2024 will forever be etched in my mind as a significant milestone for cancer care in Canada, with increased collaboration across the industry.

If you found my post interesting, feel free to buy me a coffee.

A new decade. A new life.

Thinking back to this past year, I realize how much my family and I have been through. As a result of my cancer diagnosis, our lives will never be the same. Ever. However, it should get better, but medically, it doesn’t seem like it will slow down very much, even as I stabilize and get into a routine. I expect 2020 will still keep me very busy on the medical front and I need to plan my new life accordingly.

Before jumping into how I think 2020 might play out, I looked at what I went through, and what I think the next year will look like based on routine appointments. It’s not hard to figure it out when everything is in a digital calendar!

My 2020 vision

Before starting thinking about what the next year might look like so that I can set a few goals, I decided to reread my initial consultation notes with my medical oncologist. In those, I made two lifestyle commitments to her, which I will continue doing in 2020. With that, I set myself three goals for the upcoming year.


We discussed the benefits of exercise in breast cancer patients. I am also enrolled in two exercise. In a previous blog, wrote about the Alberta Cancer Exercise (ACE) study that I am enrolled in. You can read it here. I also was recruited into the Alberta Moving Beyond Breast Cancer (AMBER) Study. While this study does not require participating in exercise, as an active person, I will continue to follow the guidelines I was given when I was initially diagnosed with breast cancer: at least 30 minutes (ideally 60 minutes) of moderate to intense physical activity, 5 times a week, though daily activity was highly recommended. 

Exercising 6 weeks post-mastectomy.


Because I have triple positive breast cancer, I need to eat a balanced diet, though there are items that I need to avoid entirely, either because they interfere with the drugs I am using to stop estrogen, progesterone or the HER2 protein receptor from binging to my cancer. And, by doing that, it allows food to promote my cancer’s growth. So, I am committed to ensuring I continue to see my oncology dietician when I start new treatments or before adding new foods or supplements to my diet. 

Establishing a routine for my new life

This will likely be the most difficult aspect of my upcoming year. How to live life within my new reality, where I will be getting ongoing treatments every 3 weeks, understanding my new limitations, building up my strength so that I can living life to its fullest and enjoy a quality of life with my family and within my new boundaries.

I don’t expect 2020 to be perfect by any stretch. I’ve lost too many things for that. However, I do expect to be able to find some peace with what I’ve lost and look for different ways to fill those gaps.

Do you find my posts inspiring? If so, feel free to buy me a coffee or contribute towards some of my uninsured medical expenses.


Segal, R. et al. Exercise for people with cancer: a clinical practice guideline. Current Oncology, [S.l.], v. 24, n. 1, p. 40-46, feb. 2017. ISSN 1718-7729. Available at: <https://current-oncology.com/index.php/oncology/article/view/3376>. Date accessed: 31 dec. 2019. doi:http://dx.doi.org/10.3747/co.24.3376.

Tello, M. (2018, June 7). Exercise as part of cancer treatment. Retrieved from https://www.health.harvard.edu/blog/exercise-as-part-of-cancer-treatment-2018061314035

Being a cancer patient will help me in business

Scenario 1

I was with my husband when I got the news from my General Practitioner (GP) doctor that I had stage 3 breast cancer. He referred me to the Calgary Breast Health Program, where I would meet with a surgeon and later, an oncologist. I did not know anything about breast cancer so before leaving, I asked my GP for a copy of my all of my results leading up to the diagnosis.

When the Breast Health Program called a few days later, an appointment was scheduled for the following week. I asked them what I should expect at my first appointment. I was told that I would meet my surgeon, who would discuss and agree on a treatment plan. Now that I knew what the agenda was, learned as much as I could about my diagnosis. I had about one week to research and understand as much as I could about my diagnosis and potential treatment. That included making sure I understood everything that was in my mammogram, ultrasound and biopsy reports. I only used reputable medical sources, cancer organizations or received information from individuals in the medical field from within my network to do my research.

Once I had a better understanding of my diagnosis. Then, I looked up typical treatment protocols for the type of cancer I had been diagnosed with. While I read protocols from other Canadian provinces, I ultimately made sure I had read every breast cancer document available on the Alberta Health Services Cancer Guidelines site. Having a ‘pre-med’ university background helped me with my understanding of a lot of the materials, and I found that some of the other Canadian jurisdictions presented the information in a more patient-friendly way. I found the Alberta site to be quite technical at times and geared more towards the physician than the patient. As I went along, I made sure I noted any questions I had.

By the time I met (accompanied by my husband for moral support) with my surgeon and oncologist, I was prepared for our conversations. I understood what she were telling me and I wasn’t overwhelmed with the information they were giving me. Because I was had done my research, I was able to ask well-informed questions, and I referred back to the questions I had jotted down to make sure I hadn’t missed anything. As a result, I was able to confidently make a decision on my treatment plan without second-guessing myself.


For my appointments, like in business, if you are being invited to a meeting, ask for expected outcomes of the meeting. Ask if pre-meeting documentation is available (if applicable) and prepare yourself accordingly. If you are the meeting leader, send out an agenda and lay out the expectations of the meeting. If pre-work is required, ask for it at the time the meeting is set up. Too many times over the course of my career have I have found meetings to be unproductive because expectations weren’t set, data wasn’t available and subsequent meetings were then required.

Scenario 2

Once treatments started, I had many routine appointments for bloodwork, cancer treatments and follow-up appointments with my oncologist. Obvious patterns quickly emerged with each appointment type. Nurses always asked the same questions. So, instead of waiting for the nurse to ask them, I come in prepared with the information typed up. While that sounds like work for me, it actually isn’t. For example, I have to report all my side-effects, so I simply log them in the calendar notes for that specific appointment. Similarly, I do the same with all the medications I take. And, usually I always have something that I need from my doctor or nurse, so I have a list of requests, such as refills, questions or concerns I want to discuss. This makes it super easy. I simply print off a copy of the calendar appointment and give that to the nurse before meeting with the doctor. I also have a copy of it on my phone that I can also refer to.

As a result of doing this, an appointment that used to take 45 minutes, mostly driven by a nurse asking me questions, The nurse takes a couple of minutes to read them and ask any questions. She usually reads as she takes my blood pressure, so this easily shaves 5 to 10 minutes off my appointment time. She takes my printed notes, attaches it to her form and reviews it with the doctor. As the doctor examines me, we discuss my questions and concerns, since she already knows what they are, and before I am even done with my doctor, the nurse comes back with any needed prescriptions. As a result, my appointments are now about 30 minutes, instead of the initial 45 minutes.


Look for opportunities to be more efficient with the routine or operational tasks, which allows you to focus on the most important items that need to be addressed. At the end of the day, it’s about being more productive and efficient with the time we have.

Did you like this post? If so, feel free to buy me a coffee or contribute towards some of my uninsured medical expenses.

Participating in cancer research

I’m excited to have been called by the AMBER Study. It’s a study that is looking at the impact of lifestyle and physical activity has on breast cancer (stages 1-3C) have on survivorship. The study started in 2012 and the final survivorship results should be available in early 2030. I’m one of the last 50 recruits being accepted into this study.

If I am going to get cancer, I might as well contribute what I can to research in the hopes of increasing survivorship for other cancer patients down the road. At least I am doing something positive for society with my shitty situation.

Today, I had anthropometric measures taken, as well as a PAR Q+ pre-screening and have a DXA Scan completed. Then, I had some fitness measures done, including the Bruce Treadmill Test. Lastly, paperwork! There are 4 questionnaires that will take approximately 3 hours complete. I have been sent home with 2 activity monitors that will be on me at all times (with the exception of bathing) for one week.

In doing my part for cancer research. I had to wear the big mask instead of the smaller mouthpiece because of my mouth sores. I dislike cardio on a good day. I dislike cardio more with a mask on even though it doesn’t change my breathing. It’s psychologically restrictive!

Are my posts motivating, uplifting or give you hope in the future of cancer research? If so, feel free to buy me a coffee or contribute towards some of my uninsured medical expenses.

Alberta is paving the Canadian path by incorporating a province-wide exercise program into cancer patients’​ treatment

I’m very excited to be participating in the Alberta Cancer Exercise (ACE) prgoram, which is study with ~1,000 cancer patients across Alberta to evaluate the impact of incorporating exercise as part of their treatment plan. I’m lucky that I was able to squeeze in at the tail end of those being accepted, since there were already over 700 patients already involved as of November 2018.

ACE was developed to provide this service, and to help individuals with cancer to better withstand and recover from cancer treatment. It is a 5-year study, which required me to have screening and fitness testing on Thursday. I officially start the program on Monday, which entails completing physical exercises tailored to your fitness level and adapted as I go through my treatments.

ACE will take my measurements again at 12-weeks, 24 weeks and at one year to see the effect of exercise on my physical activity levels, fatigue, pain and quality of life. I will also complete a questionnaire at the end of years 1 through 5. PS… That means I plan to be around in 5 years, I am not a quitter and I signed up for this study! 😉

This is just one more way that the University of AlbertaUniversity of Calgary’s Health & Wellness Lab and Alberta Health Services are working together with many other partners to make our province a top notch cancer-treatment hub.

By next year, I plan to be back hiking, skiing / snowboarding and fully enjoying the great outdoors again with my family. ACE will make sure that I keep my strength up for that! In the meantime, I will keep moving by playing with my kids!

Prescribing Exercise For Cancer Treatment

I’m motivated to stay alive. If you feel so inclined, please buy me a coffee or contribute towards some of my uninsured medical expenses.