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Trevor Everett
International Educational Experience
Reflection Paper
March 28, 2017
My chosen topic to focus on for my international educational experience was
mammography and breast cancer screening in New Zealand. As a budding radiologist, this
is something that is of particular importance to me. Additionally, I learned while in New
Zealand that their breast cancer screening program was brought about relatively recently
(late 90s, early 2000s). To learn more about this, I interviewed one of the breast radiology
consultants at Auckland City Hospital, Dr. Jeremy Whitlock. Dr. Whitlock has been working
in New Zealand as a breast imager since 1990, and has seen the program since its infancy.
When the program first started, Dr. Whitlock said that he didn’t like how it was set
up. He talks about how it was contracted out to private companies for the first five years,
after which a review was conducted that determined the age-range of screening needed to
be increased 10 years (5 years older, 5 years younger). Because of this increased age-range,
the volume of work was significantly increased, resulting in the addition and
conglomeration of several private practice companies into one. Over the years, the breastscreening group has continued to expand and take in private groups from smaller towns in
New Zealand. Dr. Whitlock hopes that eventually there will be total unification of breast
screening in New Zealand so that standards can be made and held to help ensure patients
receive appropriate screening and diagnostic breast imaging.
In his over fifteen years of practice in breast imaging, Dr. Whitlock says that one of
the biggest changes he has observed is the addition of breast MRI in New Zealand. At first
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this was thought to be a huge improvement because it increased resolution of breast tissue
and allowed for more clear pictures of breast lesions that were found on mammography or
ultrasound. However, he reports that there was an unforeseen problem with the improved
quality of images from breast MRI: with more clear images, oftentimes lesions were seen
that he and other radiologists did not know how to interpret. In a sense it created even
more questions whose answers we did not know, resulting in unnecessary biopsies or
follow-up that wasted health care dollars.
Now, Dr. Whitlock reports that breast MRI is used more sparingly and as a staging
tool for only certain cancers. Additionally, it is used for patients with a family history of
breast cancer (BRCA1/BRCA2) because it can pick up cancers much earlier. Because of its
very high price, this is a better way to utilize health care dollars, which seems to be a focus
and important in New Zealand compared to the United States. Along the lines of comparing
the U.S. and New Zealand, another difference in breast cancer screening that Dr. Whitlock
helped me realize was that New Zealand’s program was started by the government, which
put pressure on general practitioners to ensure appropriate patients were consistently
being sent for breast cancer screening. In their initial query, the government found only
30% of lower-class New Zealand women (which is disproportionately Maori, a racial
minority) were being screened. By financially incentivizing general practitioners to screen
all patients, the government addressed the public health crisis that only wealthy
individuals were reliably being screened; ultimately they reached the goal of greater than
70% screening rates in all patient populations. This was a fantastic example of how a more
socialistic government can have a direct and life-saving impact on the public.
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I thoroughly enjoyed my time working with Dr. Whitlock and learning as much I
could from him. He was such a great ambassador of New Zealand and was always asking
me what I did on my weekends and giving me advice for what I should do the next
weekend. He took a genuine interest in my happiness and was such a fantastic mentor who
helped me see how New Zealand compares to the U.S., and in what ways it is better or
worse. For the most part, Dr. Whitlock pointed out that in a lot of ways the two country’s
screening programs are similar. Screening starts between ages 40 and 50 (unless there is a
family history of earlier breast cancer), is performed annually or biannually, and the
patient plays a central role in deciding how they want to be screened. Furthermore, the
technology in New Zealand is roughly the same, although tomosynthesis (a higher
resolution breast imaging technique) is not as widely used in New Zealand as it is in the
U.S. Overall, Dr. Whitlock thinks the breast-screening program in New Zealand (which was
implemented in the late 90s) has been quite a success; he has been there since its infancy,
and has noted great improvements in how many patients are screened and the process of
screening itself. This is very reassuring and gives me hope that healthcare is something
that, over many years, can actually be improved and help the population if planning and
time are put into it.
One of my most profound clinical experiences came during my 2nd week while
rotating on mammography. The patient we were seeing was a 28-year-old female who had
already had a mastectomy of her left breast and was coming to the clinic for a routine
screening ultrasound of her right breast. After the registrar (resident) had gone in and
performed an ultrasound, she found a small cyst that she thought was benign and needed
no further workup. Dr. Whitlock was a little more suspicious, so we went in together and
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took another look. Because it had irregular borders and complex fluid inside, we decided to
biopsy the lesion. One week later, the biopsy results came back, revealing her cancer had
returned. A follow-up staging CT scan revealed metastasis to her lungs, and her prognosis
was less than 6-months. This was such a terrible outcome for a patient who had already
been through so much, and was a stark reminder of how quickly things can change.
Culturally, my most profound experience came while I was hiking one of the “Great
Walks” on the south island near Te Anau, called the Kepler Track. This was a 3-day, 60kilometer hike that was a test of my physical abilities as well as mental. The view after
finally clearing the tree line and seeing the mountain ranges and gorges below was
indescribable. Additionally, the local Kiwis and people from around the world I met while
staying overnight in the huts were some of the nicest people I have ever met. We had
fantastic conversations about everything from work, places we had been in the world, and
where we hoped to be in the future. Also, everyone’s favorite conversation piece once they
realized I was American: Donald Trump. Although I got tired of explaining that I disagree
with him in almost every way, it was refreshing to meet people who talked so openly about
politics. In America, politics is such a taboo subject, and we are taught not to be open about
our views. But in New Zealand, everyone wants to know your opinion, share theirs, and talk
about why you think the things you do. I loved this about their country.
Traveling to New Zealand was no doubt one of the most amazing things I have ever
done in my life. I loved the culture, food, people and beautiful scenery. I will most definitely
be returning in the future, and I talked with many residents about how to move to New
Zealand and work as a radiologist. With my medical student loan debt, I will likely have to
work in the United States for 5 years after residency to pay them off, but after that, moving
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to New Zealand is a realistic prospect I am genuinely thinking about. I am so thankful that
KU Office of International Programs offered this opportunity, as I can honestly say it
changed my life forever.