Health Committee on Dec. 6th, 2023

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Welcome to all the witnesses.

Yesterday I had the opportunity to meet with the Cancer Action Now association. It was a very interesting meeting. It was quite informative.

They talked about a lack of Canada-wide standards around early detection programs that cover a spectrum of services on what we call the technology side. They talked about biomarkers or genetic testing. They talked about various tests that are available, such as CT scans, MRIs, ultrasounds and mammograms.

They also talked about the need to access support and the reduction of long wait times and access to oncologists. What became very clear is that they felt we don't have an early detection program that addresses a variety of considerations. They talked about some of the jurisdictions, and the fact that ethnicity, age and demographics—all of those—play a role in that early detection.

My question is for any of the witnesses who are comfortable responding to this. Is there any jurisdiction that we could look to around best practices for early detection programs that are supported by data and modelling and cover a spectrum of aspects of cancer detection?

Would anyone like to comment?

Dr. Wilkinson, you're here in the room.

[Dr. Anna Wilkinson]

Are you talking about a jurisdiction in Canada?

[Majid Jowhari, Liberal, Richmond Hill, ON]

I'm talking about an early detection program that is standardized across Canada. Is there any country in the world that is leading in using data and modelling as well as all those other various elements to make sure they have the best early detection program, which we could model?

[Dr. Anna Wilkinson]

Our early detection programs are in essence task force guidelines. Those guidelines tell family doctors what to be doing for their patients and what test to be ordering.

[Majid Jowhari, Liberal, Richmond Hill, ON]

How does that compare to other countries who are leading on this?

[Dr. Anna Wilkinson]

I would say that our closest counterpart is the U.S. They seem to be more open to looking at newer data that's not standardized randomized control trials. They seem to be more proactive. We tend to be very reactive with our guidelines. I think they are more innovative in terms of looking towards changes that could be made. I think they would be—

[Majid Jowhari, Liberal, Richmond Hill, ON]

I'm sorry. I'm interrupting.

You're saying, if we model our early detection program after the U.S. model, then it is a good start.

[Dr. Anna Wilkinson]

I think that openness to different methodological processes would be good. When we say early detection we're talking screening, in essence. Although, you're talking about some other.... There are many things that are coming down the pipeline. One day we may be able to do a single blood test that does a screen, but we are not there yet.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Is there any country that is really leading on an early detection program?

Are you saying the U.S. is the only one leading?

[Dr. Anna Wilkinson]

I would think the U.S. would be up there. Some of the European countries are quite proactive in terms of breast screening. I would go with the U.S. probably.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Okay.

Are there any other witnesses who want to make a comment?

[Dr. Paula Gordon]

I don't think any one country does it all right. We do see, for example, in France and Austria, women with dense breasts are automatically recalled for supplemental screening. We have that now in British Columbia. Women who have category C and D breast density, can have supplemental breast ultrasound screening covered by their provincial health insurance.

We see in Europe, for example, the recognition that MRIs for women with very dense breasts, in the extremely dense breast category, has now been recommended for all women, ideally every two to three years but no less often than four years.

The U.S. just lowered its age to 40, but it's not perfect because women should be having annual mammograms in their forties and they are only doing biennial.

We have a mishmash of guidelines all over the world. I don't think any one country is an example. I think Canada can be a leader here. We can take the best of each of them.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Gordon.

I now give the floor to Ms. Larouche for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Mr. Chair.

During this meeting, which is coming to a close, we talked a lot about the importance of early diagnosis. I think we now agree that for many types of cancer, the key is early diagnosis to try to act as quickly as possible. The witnesses are saying that this is what family doctors do a lot, that is, they try to intervene as soon as possible.

Dr. Wilkinson, you talked about costs in your opening remarks. You said that a mammogram costs about $68, whereas treating breast cancer can cost about $500,000. In terms of efficiency for the system, how much less will earlier intervention ultimately cost the system than treatment at a later stage?

[Dr. Anna Wilkinson]

Absolutely.

Our study showed that if you treat DCIS, which is sort of a carcinoma in situ, that's about $15,000. Stage 1 is around $20,000. By the time you get to stage 3, you're up to around $100,000, and stage 4 is over half a million dollars.

If you think that the women in their forties are going to present at some point with their cancers, they're going to just present with later-stage cancers or, like we saw in our study, they're going to be fifty years olds with later-stage cancers or they are going to have more cancers in their fifties because we didn't treat the precancers in the forties. That all adds up to significantly more cost.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much for that.

Finally, I'd also like to thank you, Mr. Simard. You spoke briefly about the award you won, but you were being modest. The Wilder‑Penfield Award, in the scientific category, is awarded to individuals who have had an outstanding career in biomedical research. You received it for your contribution to the discovery of the BRCA2 gene. Congratulations on your work at Université Laval.

Lastly, is there anything you would like to add about this award and what it can bring to the future of research?

[Jacques Simard]

In fact, when I participated in the co‑discovery of the BRCA1 gene and, more importantly, the BRCA2 gene, it looked like it was futuristic to test women for predispositions. We know that millions of women have been tested, and that has probably saved hundreds of thousands of lives.

I think we have to rely on the evidence and the best science possible. Right now, the best science gives us an opportunity to look at all the risk factors. Breast density is one of the significant risk factors, but sometimes when you combine that risk with other risk factors, you can see that there can be a mitigation of risk.

I would also like to mention a fact that we haven't discussed much, but that Dr. Wilkinson mentioned earlier: We must not forget that the natural history of breast cancer differs according to ethnic groups. Among women of African or Asian descent, we know that breast cancer will appear almost 10 years earlier than among European women, hence the interest or relevance of always taking women's ethnic origin into account and providing them with appropriate screening.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Simard.

Next is Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Narod, did the study you did include a diverse population of ethnicities that would reflect the current Canadian population?

[Dr. Steven Narod]

They were recruited in 1983.

[Don Davies, NDP, Vancouver Kingsway, BC]

Was it controlled for multiple ethnicities?

[Dr. Steven Narod]

As far as I recall, we did not use race or ethnicity, as a covariant.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

[Dr. Steven Narod]

They were 98% white.

[Don Davies, NDP, Vancouver Kingsway, BC]

They were 98% white—were they?