Breast cancer survivor and health advisor Andi Shirtcliffe is warning other women to make sure they don't neglect health checks. Photo / Mark Mitchell
The Ministry of Health’s clinical chief adviser of pharmacy is embarrassed that she missed a mammogram and then discovered she had breast cancer, which had spread. Andi Shirtcliffe, talks to Jane Phare about why it’s important for women to look after their health.
Andi Shirtcliffe can’t really explain why she delayed having her annual mammogram. Life, work, family, Covid, lots of things got in the way.
By the time she got around to her mammogram appointment in October last year – two years since her last mammogram - she received terrifying news. There was a lump; she would need surgery for breast cancer. And there was more bad news to come. Histology results indicated the cancer had reached her lymph nodes. She would need chemotherapy and radiation.
More than seven months later Shirtcliffe, 57, admits she is still a little embarrassed. She’s a pharmacist, and has worked in the pharmaceutical and health sector - public, community and private – all her life and is now clinical chief adviser of pharmacy at Manatū Hauora – the Ministry of Health. How could she have let her own health checks slip?
She’d had a publicly funded mammogram every second year and, under health insurance, paid for one to be done privately every other year. But not 2021. Looking back the mother-of-two says life was busy during the pandemic, as it was for many people. Her father died and she arranged to move her mother to a supported apartment.
“A few things slipped off the radar around personal care and that was one of them. I’m embarrassed and I’m humbled, by the fact that I delayed because I just thought I was too busy. I put my own care on the back burner, and I shouldn’t have.”
Now she has two messages for women of all ages: know your body, know what your normal is and do a regular breast self-check. And don’t put off having a mammogram.
“Mammograms are uncomfortable and inelegant. I don’t know anybody who enjoys having a mammogram.” But even so, she says, get them done.
It was screening that picked up the cancer, not Shirtcliffe. Her oncologist planned four rounds of chemotherapy but the side effects were so extreme she completed only three rounds. She was admitted to hospital during the second and third treatments with high temperatures, and needed a blood transfusion to restore her white blood cells. In the end, she opted not to go through the fourth gruelling round before starting radiation.
There’s a question Shirtcliffe has never dared ask: “If I hadn’t put it off, would my breast cancer not have spread?” She’ll probably never know the answer, and she can’t rewrite her history, she says. But on the eve of leaving for the US to take up a Fulbright Scholarship during a year’s leave of absence from the ministry, Shirtcliffe wants to warn other women to pay attention to their health.
She knows she’s lucky to be free of the cancer. And lucky to be in an age group where mammograms are free every two years and that she has private health insurance to cover alternate years.
" Without screening, I could have been in a very different scenario with a very different outcome.”
Going through treatment she realised the amount of resources and organisation entailed – making appointments, taking time off work, the cost of travel and making sure children were looked after.
Once she’s completed her scholarship she hopes to put her studies to good use in the public service in New Zealand. She will complete a Master of Public Health at Johns Hopkins University’s Bloomberg School of Public Health in Baltimore, specialising in health behaviour and society.
“It’s essentially about looking at how to influence policy, strategy and regulation at government level so that it’s implemented in a way that’s meaningful and equitable for communities.”
She wants to help improve health disparities in New Zealand including waiting times for treatment.
Breast cancer wish-list
Waiting times for treatments are on the Breast Cancer Foundation’s wish-list to improve outcomes for women with breast cancer. The foundation intends to keep the pressure on political parties in the lead up to October’s election, surveying them for responses to 13 questions. On the foundation’s wish-list are:
· Increasing the age of free mammogram screening to 74 (currently free screening is approved between the ages of 45 and 69)
· Lowering the age of free mammograms for Māori and Pasifika women to 40
· Widening access to targeted drugs to treat advanced HER2-positive breast cancer
· Increased access to Keytruda to treat triple-negative breast cancer
· Earlier treatment regimes after diagnosis, including chemotherapy and radiation
So far the Greens have emerged with “yes” ticks to all 13 questions on the foundation’s list. Coming in second was New Zealand first with five “yes” answers, National and Act had three, and Labour one. The foundation plans to conduct a final survey of political parties in September.
Breast cancer more likely at 70 than at 50
The foundation’s chief executive Ah-Leen Rayner says the Government’s refusal to extend the breast screening programme to age 74 means that older women will needlessly die from undetected breast cancer because they cannot afford to pay for mammograms.
“You are more likely to get breast cancer at the age of 70 than you are at the age of 50 so it makes no sense for screening to stop at the age of 69.”
Best practice globally is to screen within 10 years of life expectancy; the average life expectancy of a woman today is 86, she says.
“We’re out of sync with other countries around the world.”
Māori and Pasifika women present with breast cancer at an earlier age than non-Māori, which is why screening needs to start earlier, Rayner says. The later the stage that breast cancer is detected, the harder it is to treat and the more outcomes decline. In addition, it becomes more expensive for an already straining hospital system to treat, she says. It makes sense to invest at the top of the cliff by screening rather than adding to the public hospital burden.
One in nine New Zealand women get breast cancer and the current delays in accessing treatment are unacceptable, Rayner says.
“We know that treatment delays are happening. We’re hearing that from patients, and clinicians in the front line.”
Although the foundation recommends an annual mammogram, women between the ages of 45 and 69 are eligible for free screening only every two years. About 30 per cent of men and women have private health insurance, which means the majority of women will need to pay for a mammogram every second year.
Costs for a standard mammogram start at about $235 with the more advanced 3D version costing $360. An ultrasound, recommended as a backup check for women with dense breasts, costs another $120. One clinic charges a total of $720 for a 3D mammogram and ultrasound. But those early detection costs pale in comparison to the cost of treating breast cancer that has spread to lymph nodes, treatment that can cost tens of thousands of dollars and continue for years. Southern Cross Health Insurance says the average claim for a woman with breast cancer is $81,000 but not all claimants have chemotherapy. With that cost added on, some claims are more than $100,000 and, in less common cases, more than $250,000.
New drug a ‘game changer’
The foundation also wants breast cancer patients to have timely access to strategic drugs that will help their recovery or prolong their lives, Rayner says. Oncologists are excited about a new drug, T-DXd (Trastuzumab deruxtecan), which is showing unprecedented results in treating HER2-positive breast cancer.
“It is widely regarded as a game changer in the same way Herceptin was 20 years ago,” she says.
The drug has been released in other countries, including Australia and Canada, but is not yet available in New Zealand. The foundation is concerned about the years-long time lapses between a new drug being submitted to Pharmac and its release to the public. For Keytruda, approved for lung cancer patients, that delay was eight years.
“Yes it was a celebration [when it was approved] but how many people died in that time?”
Jane Phare is a senior Auckland-based features and investigations journalist, former assistant editor of NZ Herald and former editor of Viva and the Weekend Herald.
Police say they are following lines of inquiry to catch the offender.