Health committee  Ovarian cancer is increasing in women with endometriosis. It is anywhere between one-and-a-half times to twice the relative risk of having cancer. It comes down again to the importance of imaging and being able to recognize it, because the first signs are typically seen on imaging, and being able to have the resources to follow these patients over time to make sure that cancer doesn't develop.

Health committee  For instance, some bowel lesions are small. Then they can be excised with a technique that spare the back of the bowel, versus once the lesion has gotten to be very large, then we have to do a larger resection of the complete bowel. So there are two different techniques. One is associated with half the risk of complication that you can see after.

Health committee  Yes, thank you for bringing up mental health as one of the big concerns, because it is. It is under-represented and undertreated. In our centre, we try to have physiotherapists come on board with us as well. We had several back-and-forth discussions because they were all very interested in the subject and wanted to help.

Health committee  That's a very good question. It's hard to know, because many women with endometriosis are very asymptomatic. That even means that people who have horrible disease—when we enter the pelvis, they have stage four endometriosis—may be asymptomatic. They may have no symptoms. That being said, if we look at studies, probably 15% to 20% of endometriosis cases are more severe, so they're stage three to four.

Health committee  That's also a very good question, because everybody feels pain differently. Depending on where the endometriosis occurs, if it affects the nerves; then it can cause different pain as well. What I can say is that, when somebody doesn't respond to anti-inflammatories such as Advil plus Tylenol, the first line is birth control.

Health committee  Thank you for your question. As you know, when endometriosis becomes severe, it can start invading the adjacent organs, whether it's the bladder, the bowel, the diaphragm or even the pelvic nerves. The symptoms the patients will present are slightly different, depending on the organ that is injured.

Health committee  Absolutely, and countless times we have had referrals of patients who have undergone resection of the bowel nodule, thinking it was cancer and finding out it was endometriosis, and they have been sent to us to treat. Again, it's taking care of something that was treated differently, because treating cancer is not the same as treating endometriosis.

Health committee  Thanks. I trained in a centre that did a few hundred bowel surgeries a year. In France, care has been very centralized toward centres that they call “of excellence”, where they have all these multidisciplinary approaches. What's really beautiful about the process is that there's a pathway for every patient.

Health committee  I think this comes down to CME, continued medical education. To be able to teach, you need the experts. One of the big things that we need to look at, when we look at endometriosis, is that the care for endometriosis today is very different from what it was 20 years ago. Twenty years ago we had a handful of people who were experts, but like a tree that grows, one branch becomes two becomes three and those divide further.

Health committee  Thank you for the question. I absolutely agree with what you're mentioning. When patients come to see us and we give them a diagnosis of endometriosis, one of the first things they ask is why they have endometriosis. There we are all looking at them and trying to give an answer when we really don't know why.

Health committee  Thank you, Mr. Chair and members of the House of Commons. All of us here know someone affected by endometriosis, whether we realize it or not. That's because even though it affects one in 10 women and countless gender-diverse individuals, it often leaves people silently suffering with debilitating pain and absenteeism from work or school.

Health committee  Many countries around the world—such as France, Australia and Denmark—have set national action plans for endometriosis care. While in Canada we have expertise in endometriosis, what is missing is a comprehensive action plan to allocate funds and resources to centres with endometriosis expertise.