Health Committee on Nov. 27th, 2023

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Larouche.

We have Mr. Garrison, please, for two and a half minutes.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Mr. Chair.

I want to turn to something that Dr. Kaida raised, and that's the addressing of HIV/AIDS and the possible eradication of HIV/AIDS.

The federal government adopted targets a number of years ago, yet in the last budget there was no new funding and in fact not even a mention of HIV/AIDS in the federal budget. I'm wondering, I guess, how we're doing on achieving the goals that Canada set for itself in terms of eradicating HIV and whether we really recognize that those who are suffering from HIV/AIDS now have shifted.

As a gay man of a certain age, I know that HIV/AIDS has always been associated with older gay men, but we now see an incidence much more prevalent among women and, in particular, indigenous women. I wonder how we're doing on those goals we set for ourselves in eradicating HIV/AIDS.

[Dr. Angela Kaida]

Thank you again for such a great question. I'm going to speak from a research lens, and I'll invite my colleagues to speak from a policy and service delivery lens.

From a research perspective, I think we obviously have seen a complete transformation over the last 30 to 40 years in what HIV/AIDS looks like for people living in Canada. The research base, the scientific contribution to that change, has been, I would say, nothing short of remarkable.

I absolutely agree with you. I think that in HIV we do see desperate disparities in terms of what it means to be a person living with HIV today or a person at risk of acquiring HIV today. Certainly, we've seen some remarkable progress for gay men, particularly those in urban settings, whereas we have seen much less progress and some really concerning trends for women and transgender individuals, especially those in the prairie provinces of Saskatchewan and Manitoba.

In terms of meeting our targets, we certainly have not met those targets uniformly. We have some communities and populations across Canada who have exceeded the targets set by the federal government and by the community organizations themselves. Certainly, we do continue to see gender-related gaps in terms of achieving those targets.

I'm very happy to say that one of the national women's health research initiative hubs that were funded earlier this year is focused specifically on improving access to care and treatment prevention services for women and gender-diverse people living with and affected by HIV. In mobilizing that research evidence base, we are very hopeful, again, to see that help minimize the gaps we are currently seeing today.

[The Chair, Liberal, Sean Casey]

That you, Dr. Kaida.

Next we have Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks very much, Chair.

Thanks, everyone, for coming.

Ms. Moriarty, in your opening statement you talked about the high priorities of women's health. Could you enlighten the committee as to what those are?

[Cindy Moriarty]

I mentioned a number of issues in my opening statement, but I think the current priorities for.... First of all, everything is a priority for women's health. All of the issues we're looking at, we're also looking at with a lens in terms of impacts on women. Speaking for the health portfolio and not just for the department, sexual reproductive health is a key priority as are cancer research and breast cancer screening.

We have a scientific advisory committee, as my colleague mentioned, that's looking at medical devices and their impact on women, and we have the drug regulatory. There's not a health issue that doesn't have an impact on women and doesn't require that attention.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Of course there isn't; that makes perfect sense. As I heard you pose your answer, though, there were high priority areas specifically for women's health, and I was wondering if there were things.... You did mention ovarian cancer. There was $10 million in funding allotted in 2019. Can you tell us a bit about that?

I mean, ovarian cancer, as I'm sure you well know, is always detected too late, because there aren't any great screening programs for it. How are we helping women in Canada deal with ovarian cancer specifically, and how has that $10 million been spent?

[Cindy Moriarty]

I don't have a lot of depth of knowledge in terms of ovarian cancer. I'm not sure if I have anyone at the table today who can help you. If not, we can take that back and come back to you.

[The Chair, Liberal, Sean Casey]

Dr. Clifford wants in here.

[Dr. Tammy Clifford]

I'm not an expert in this space at all, but I did want to let you know about some research we have funded through CIHR, about $35 million in funding towards ovarian cancer research in the past five years. This research focuses on projects that look at point-of-care testing devices, so there's recognition there around point of care, meaning perhaps increased accessibility for those who are living outside of urban areas, improving detection and diagnosis, and, of course, treatment.

In particular, there is a large project that is going on at UBC with Dr. Samuel Aparicio working on detection in that space. Again, it's research that's under way. As Dr. Kaida mentioned in her response to an earlier question, we will be paying attention to that research as the results come out in order to implement them into care.

Thank you.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much.

Through you, Chair, I'll ask both of our guests to table that information with the committee. That would be ever so helpful, since ovarian cancer will be one of our areas of focus.

Dr. Kaida, you mentioned specifically that there were $8.3 million for women's health hubs. Again, I'm looking for more specificity around that, where the health hubs are located and maybe a line or two about what they're doing.

[Dr. Angela Kaida]

We've funded 10 national women's health research hubs across the country. We have them distributed. We have three that were funded in British Columbia and three that were funded in Alberta. We have, I think, two in Quebec and two that are based in Ontario. Across all of the hubs, one key criteria was that they had a national scope, and that involved including researchers, clinicians, people with lived and living experience, indigenous leaders, trainees, etc., from across the country. Even if a hub was specifically funded in Alberta, for instance, there was a national network of folks committed to that research area.

If I can share a couple of examples of the hubs we were able to fund—

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Dr. Kaida, we're short on time. If you wouldn't mind tabling that with the committee, that would be excellent. I'd really appreciate that.

[Dr. Angela Kaida]

I would be delighted to do so.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you. I'm sorry for interrupting.

Chair, I think I have about 30 seconds or so left. To whomever may have an answer, we often talk about how there are multiple screening programs specifically for cervical cancer that are great across this country. How do we focus on allowing one of them to come to the forefront, realizing there is provincial and territorial supervision of those projects but, sometimes, somebody's better at it than the others? How do we help that happen?

Does anybody have an answer on cervical cancer?

[Cindy Moriarty]

I'm sorry. We'll come back to you on that.

[The Chair, Liberal, Sean Casey]

Dr. Powlowski, you have the floor for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I'm surprised that Stephen didn't go where I'm going here.

On breast cancer screening guidelines, I thought I would first, as Ms. Moriarty and I think Ms. Comtois wanted to talk about this, point out that the current recommendations came from the task force on breast screening and came out in 2018, according to the government website. These are currently being reviewed, and that was as of June 2023. I wonder where that's at.

I have certainly heard a lot of concern about those recommendations, particularly from the group Dense Breasts, which is made up of breast screening experts who feel that the current recommendations are inadequate. Currently, we're not recommending any mammograms for women under 50. Certainly, some of the concerns are that Black and Asian women tend to have their peak incidence of breast cancer 10 years younger than Caucasian women. Also, women who get breast cancer early tend to have more aggressive cancers.

The U.S. Preventative Task Force draft recommendations are now that women start getting mammograms at age 40 and every two years up until age 76. Again, we're at 50.

This is potentially a big problem, if you listen to Dense Breasts. This results in quite a few women not being diagnosed with cancer as early as they should be. It is being reviewed. When will those reviews be finished? When will we have new recommendations?

I ask that to either of the two of you, Ms. Moriarty or Ms. Comtois, and hopefully someone has an answer.

[Cindy Moriarty]

I think, Annie, that one's for you.

[Annie Comtois, Executive Director, Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada]

Yes, I'm happy to take it.

On November 15, the Canadian Task Force on Preventive Health Care, which is an arm's-length independent organization, announced to their members and the public that their guidelines had to be delayed until the spring of 2024. They had initially anticipated to release them in the fall, but because of the volume and complexity of the evidence that they're currently looking at, which includes looking at evidence for women with dense breasts and looking at health equity considerations, they determined that they needed a little bit more time, and the organization they're working with requested more time. Now they're looking at spring 2024 to release the new guidelines.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I believe the task force on breast screening is an arm's-length body made up of 15, I think, primary care practitioners. Certainly, according to Dense Breasts, they had some complaints about the decisions of the committee and the fact that the committee did not include people with expertise on breast cancer or breast cancer imaging. I admit to a somewhat biased perception, because I talked to Dense Breasts, but I haven't talked to the people on the committee.

Certainly there was concern that there ought to be specialists in that group. I certainly have some sympathy, since I spent my whole life as an emergency room doctor or doing other forms of general practice. I always was happy to bring in a specialist who knew more about this than I did.

Why do we not put specialists in that group that makes these recommendations? Is there any consideration of perhaps changing the makeup of that group of people?

[Annie Comtois]

I would just start with a clarification.

It's the Canadian Task Force on Preventive Health Care. They develop a wide range of guidelines, including breast cancer screening guidelines. It's a subcommittee, a working group of the whole task force, that is developing the guidelines.

As part of that working group, they have four experts supporting them, a clinical oncologist, a surgical oncologist, a radiologist and a radiation oncologist.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Is that the group that's currently looking at making up new recommendations?

[Annie Comtois]

Exactly, yes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Then that's new. You have, in fact, changed the approach.