Health Committee on Dec. 6th, 2023

[Brendan Hanley, Liberal, Yukon, YT]

Since I'm the last speaker, I want to thank each of you for your testimony. This has been a really incredibly interesting and rich couple of hours. You've each added a really important perspective. I don't think we're going to solve all the controversies in this study, but it does show some of the controversies and also the complexities of navigating a way forward.

I will say that I'm from one of those jurisdictions—all the smaller jurisdictions—that have been more permissive about breast cancer screening in that age range of 40 to 50, and where we've encouraged that conversation also with primary care providers.

Dr. Wilkinson, I'll start with you. I'm really interested in your study, which I haven't seen, on what you called a “natural experiment” between jurisdictions. Would you describe it? I presume that's not a longitudinal study but more of an ecological study. Is that how you would describe it?

[Dr. Anna Wilkinson]

We basically looked at stage distribution at diagnosis for the women who lived in these jurisdictions that had organized programs and those that didn't. What we saw was significantly more stage 1, less stage 2, less stage 3 and less stage 4 for women in their forties if there was screening. They had more earlier breast cancer and less advanced cancer. In their fifties we saw a knock-on effect. Stage 2 and stage 3 were significantly greater if there was no screening in their forties.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks.

Dr. Narod, you said that you read all the scientific literature. Are you familiar with that study?

[Dr. Steven Narod]

Yes, I am.

[Brendan Hanley, Liberal, Yukon, YT]

Would you have any comment on it? I'm just wondering if there's any possibility of selection bias in that study.

[Dr. Steven Narod]

There are a lot of studies like that study. Let me put it this way. In the Canadian national breast cancer screening study, the women who had their cancers detected in the mammogram arm that were smaller and less likely to be node-positive had better survival, but the number of deaths was the same. You can't use that to....

Early detection works. It finds them when they're smaller and more likely to be node-negative. The survival of the mammogram-detected cancers was two years longer than the survival of the palpable cancers, but unless you have clear data that shows there's a difference in death—

[Dr. Anna Wilkinson]

We do.

[Dr. Steven Narod]

Go ahead.

[Dr. Anna Wilkinson]

In our survival study we looked at survival, but we also looked at incidence-based mortality to make sure we weren't looking at just lead time and—

[Brendan Hanley, Liberal, Yukon, YT]

Thank you. I have only two minutes left.

I'd love for you to submit that study and perhaps what you tried to submit as commentary as well but that was not accepted, from what you said.

Dr. Narod, I'm looking forward to your book as well as the JAMA article in 2024.

I want to shift a little bit and talk about access.

Dr. Wilkinson, I think you have a program about access to breast screening in women who do not have a primary care provider. Obviously, you've identified an area. I worry about women who, regardless of age, both in my territory but elsewhere, are not aware of screening guidelines at all, are often remote and are not accessing the available mammography programs. It's not just about geography. Sometimes it's about social access, fear, trauma or psychological access.

I wonder if you could comment on that and how we tackle that area.

[Dr. Anna Wilkinson]

For those of you who aren't familiar, we started a new program in Champlain region, the Champlain screening outreach program, which allows anyone without a family doctor to access cancer screening. More than that, it also is a proactive program. We go out and we link with different community organizations. For example, we used the COVID vaccination networks to repurpose those for cancer screening. We do a lot of education.

I think that's the model we need to move to. It's more outreach, education and finding those people who aren't accessing screening.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Wilkinson.

Thanks to all of our panel.

Go ahead, Dr. Powlowski.

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

Dr. Narod, you had a response to U of T about the accusations made about the RCT you were involved with. Would you mind submitting that to the committee?

Would Dr. Gordon also mind submitting—

[Dr. Steven Narod]

I'll give it to you, but I would rather not give it to the committee. Is that appropriate?

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

Maybe give it to the clerk.

[Dr. Steven Narod]

I'd like to give it to Dr. Hanley and to you, too. I would rather the rest of the committee not see it.

Is that appropriate?

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

I think it would probably have to go to the rest of the committee.

We can distribute it, though.

[Dr. Steven Narod]

I would rather you didn't distribute it.

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

Okay.

You can privately do whatever you want after the meeting.

[The Chair, Liberal, Sean Casey]

We're going to try to wrap this up, please.

Dr. Hanley gave a very eloquent thanks to all of our witnesses. You can take that as coming from the full committee.

I can also say to you that you are welcome—and we encourage you—to provide any additional information to the committee, separate and apart from what's been specifically requested and what's been referred to. It will all be taken into consideration in the study.

Dr. Narod, we would love to see that embargoed report when it's no longer embargoed, for example.

By all means, what you submit to the committee will be taken as part of the evidence of the study. This has been a fascinating discussion and there have clearly been times when I've interrupted you when you've had something further to say. Feel free to say it in writing.

Thank you so much for being here. Your expertise and your patience are greatly appreciated.

Colleagues, our next meeting is on Monday. We had scheduled three hours, but we're only going to need two hours, because we haven't been able to secure the attendance of Minister Champagne. We'll be meeting from 11 to one, with the first hour on the opioid study and the second hour on the Medicago issues.

Is it the will of the committee to adjourn the meeting?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

The meeting is adjourned. Thank you.