Madame Chair and dear members of this committee, I would like to thank you for this opportunity.
I support the Breast Density Awareness Act because I believe this act will provide very important information for Canadian women with regard to their breast health. This act can help save lives and can prevent advanced stages of the cancer.
When we talk about breast density, we are referring to the percentage of glandular tissue versus fatty tissue. That's just an explanation of breast density. Glandular tissue consists of milk-producing cells.
Breast density affects quite a large percentage of women, regardless of age and race. Women with dense breasts have five to six times more risk of having cancer. However, women are not informed after having mammograms as to whether or not they have dense breasts. That's why this act is so important.
Dr. Norman Boyd, a leader in breast cancer research at Princess Margaret Hospital, says, “Cancer turns up five times more often in women with extremely dense breasts, signalling the importance of a risk factor rarely discussed with the patients. It has been ignored to an absolutely unbelievable degree.” A poll in 2010 showed that 95% of North American women don't know their breast density. Less than one woman in ten over age 40 was informed by her doctor about breast density issues.
The important facts behind breast density are that 66% of pre-menopausal women and 25% of post-menopausal women have dense breasts. Women whose breast tissue density is over 75% have five to six times more risk of having cancer. Cancer originating from dense breasts is more aggressive, and breast density is one of the strongest predictors of failure of mammography screening programs.
It's obvious we need an adjunctive screening tool to screen dense breasts. It needs to fulfill WHO's criteria for screening. Since the mid-1970s researchers have been looking for the role of ultrasound as a screening tool. All of the results show very promising numbers for screening dense breasts after mammograms. Some authors of studies have even suggested that ultrasound should be the initial imaging used for younger women.
There is a table in your handouts. It shows how over 52,000 women were screened using mammogram and ultrasound. In the end, 186 cancer cases that were missed by mammograms were diagnosed through ultrasound. That's a significant number.
We have two different types of ultrasound these days. One is general ultrasound. We call it hand-held ultrasound. Those machines are used for general purposes. They are good. They save lives. They improve quality of life because they catch the cancer in the early stages, and they also save the cost of treating patients at the advanced stage, but they are very operator-dependent and time-consuming.
They came up with new machines. They are designed just for screening breast tissues, and they are called automated 3-D whole breast ultrasounds. These machines are really fast. They provide high-resolution three-dimensional images. They eliminate the human factor, and the radiologist can see the slices of the whole breast, so if there are multicentric cancers, they can see them in one image. Of course the sensitivity is much higher than that of the hand-held ultrasound, and they are reliable for following up with the survivors.
As my conclusion, I will say that Canadian women definitely need to be informed and educated about breast density. They are supposed to know what other tests are available for them.
The life-saving strategy should be catching the cancer in the earliest possible stage. We can't prevent this disease yet, but early diagnosis saves lives. Ultrasound is capable of detecting dense breast tissues, but automated 3-D ultrasound is a better tool for that purpose. Of the cancers detected by ultrasound, 93% are in the early stage and easier to treat.
As my recommendations, I will say we definitely need a standard mammography reporting system nationwide. We need to educate women. We need to educate health care providers. Women should know about their breast density after they go through a mammogram test. Also, they have to be informed about supplementary tests. Advanced technology with higher sensitivity should be used for effective screening and early diagnosis, and timely action for the changes is necessary before we lose many more lives.
Thank you for your attention.