Evidence of meeting #67 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was implants.
A recording is available from Parliament.
11:35 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
My next question is for Dr. Tervaert.
Dr. Tervaert, is there any specific techniques or approach that health care professionals can use to address the challenge of the mammogram for women who have breast implants?
11:35 a.m.
Professor of Medicine, University of Alberta, As an Individual
I'm sorry...?
11:35 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
They can get abnormalities. When the breast implant population goes for mammograms, I know there are challenges.
11:35 a.m.
Professor of Medicine, University of Alberta, As an Individual
Yes, those are the challenges with breast implants and mammograms. Breast implants, especially the older breast implants, are leaking, and if you have the pressure of a mammogram it can cause more leakage and you can rupture the breast implant. The FDA warns against this, and I personally also warn my patients. Ultrasounds seem to be the best screening method for breast implants, and MRI is another option but an expensive option.
However, ultrasound should be a very good alternative, and it is not yet the rule to have that in Canada.
11:35 a.m.
President, Canadian Society of Plastic Surgeons
I would just add that clinically the radiologists say there's really no problem. What they do is additional views to look around the implant in the breast, so the radiologists are quite comfortable doing mammography on implants.
11:35 a.m.
Professor of Medicine, University of Alberta, As an Individual
Yes, but I see it the other way. Many patients tell me that their problems actually start after the mammogram, so I'm not sure that radiologists see that.
11:35 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
I want to ask this question of both of you.
How would a breast implant registry help with monitoring and tracking cases of BIA-ALCL?
11:35 a.m.
Professor of Medicine, University of Alberta, As an Individual
For ALCL, it's clear that if you combine pathology data with the breast implant registry, it would be easy to see exactly which breast implant was used. For instance, it's been considered that it's mostly a macrotextured issue, because an allergen was blamed for that. However, the Korea scandal in 2021 was actually that microtextured implants also can cause ALCL. That was the implant that was specifically made in Korea, but also the manufacturer was causing fault and did not have a really microtextured envelope originally from the technical files, which they should have done.
It's important to go back and see exactly which implant caused the ALCL.
11:40 a.m.
President, Canadian Society of Plastic Surgeons
Thank you.
All I would add is that, if you have a registry of a million patients, and say 100,000 had a certain type of implant that was associated with an issue, then almost immediately you could contact those 100,000 patients, with whatever number of surgeons, to highlight that this is a risk and offer early surveillance.
Much like breast cancer and lung cancer, early diagnosis is going to improve the results of the treatment for the cancer that results.
Obviously then, if there's a cluster of cases, you can take that implant off the market.
11:40 a.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Morris.
Mr. Thériault, you have the floor for six minutes.
11:40 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Dr. Greaves, I'm pleasantly surprised at your position on the need for a registry, but, at the same time, it puzzles me.
I have here the Overall Summary of Advice from the virtual meeting of the Scientific Advisory Committee on February 23 2021. It contains several recommendations, including this one:
5. Revisit possibilities surrounding the development of a registry to track the use (effectiveness, safety) of high-risk devices.
That seems like a much weaker position than the one you are taking today.
Did the scientific advisory committee you are part of hold another meeting to strengthen its position?
11:40 a.m.
Chair, Scientific Advisory Committee on Health Products for Women
Thank you for that question.
We have been in a variety of discussions over the past three years at the committee, reviewing the issue of whether or not there should be mandatory data provided on a variety of drugs.
11:40 a.m.
Liberal
The Chair Liberal Sean Casey
Dr. Greaves, hang on for one second.
Is there a problem with interpretation?
11:40 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Interpretation is working now.
However, the witness will have to start again from the beginning.
11:40 a.m.
Liberal
The Chair Liberal Sean Casey
Dr. Greaves, could you answer the question from the top? We lost translation momentarily.
11:40 a.m.
Chair, Scientific Advisory Committee on Health Products for Women
Sure.
At the committee, we've had a number of discussions about devices, including breast implants. We heard testimony from patients at the committee about both cancer-related issues as well as more general issues, and consumer advocacy. We recommended that we revisit the possibility of developing the registry to track the use, effectiveness and safety of breast implants.
The committee members are well aware that these efforts to establish a registry have been ongoing for over 33 years. We want that revisited. That is one of the reasons that the best brains exchange was scheduled for March of this year.
We also recommended that there be a retrospective case study—
11:40 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
I'm sorry, but I don't have a lot of time.
The recommendation goes back to February 2021; it's now May 2023. We heard from Mr. David Boudreau from Health Canada, and he seemed quite concerned about the technical elements and the practicalities of creating a registry.
If we need a registry, don't you feel that we're dragging our feet?That's my first question.
I have a second question. Apart from the February 2021 meeting, did you discuss breast implants at any of the other meetings which are on the list I have here?
11:40 a.m.
Chair, Scientific Advisory Committee on Health Products for Women
We have discussed breast implants, in the context of discussing medical devices in the medical device action plan, numerous times. The details of that might not appear in the actual minutes because they are summaries. However, we have recommended that the breast implant registry be revisited.
We've also recommended that breast implants be considered as a retrospective case study, to investigate exactly how they were regulated in Canada and to identify the gaps that led to the current situation. We've certainly recommended that we provide more information to consumers on a much wider array of evidence. That is going to require, as I mentioned in my presentation, not just data from a registry, but also more specific qualitative and quantitative research on the issue that is in the public domain and that is publicly funded.
11:45 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Could you please submit to the committee the minutes of all your scientific advisory committee proceedings? There were meetings on May 16 and 17, October 29 and 30, 2021, February 23, 2021, June 2021, February 2022, and November 2022. You also mentioned March; Im assuming that was in 2023.
We requested this over a month ago, but have not received anything yet. It would be interesting for us to read.
11:45 a.m.
Chair, Scientific Advisory Committee on Health Products for Women
I think they are all on the website and publicly available.
11:45 a.m.
Bloc
Luc Thériault Bloc Montcalm, QC
No, I'm sorry, but it's not available on the website. We did our research. We were told to write to a particular address. What is available are the summaries. That's what you just mentioned. I am asking for all of the minutes, in other words, all of the proceedings.
11:45 a.m.
Chair, Scientific Advisory Committee on Health Products for Women
Okay.