Thank you.
I am Dr. Paula Gordon, and I'll start.
Thank you for the opportunity to be here today.
I am a breast radiologist. I've been in practice for over 40 years, reading mammograms and ultrasounds, and doing needle biopsies and other breast procedures. I've volunteered with Jennie Dale and Dense Breasts Canada for seven years as their medical adviser, advocating for optimal breast cancer screening.
Breast cancer is common. One in eight Canadian women will be diagnosed with breast cancer during her lifetime. Mammograms are low-dose X-rays of the breasts that allow us to detect cancers earlier, before there are symptoms. Breast cancer treatments are less intensive and outcomes are better, when cancers are diagnosed at an early stage. The five-year survival rate for stage 1 breast cancer is 99%, but it's only 22% for stage 4.
Some breasts have more normal glandular tissue than fat, and we call these “dense breasts”. These people have a higher risk of getting cancer, and mammograms are less effective at finding their cancers. They benefit from supplemental imaging, typically with ultrasound or MRI, based on the patient's risk.
The current task force guidelines recommend against screening women younger than 50 and older than 74, against additional screening for people with dense breasts, and against doing breast self-exams. Experts disagree with these guidelines, which were created using a flawed process. The same process has impaired other guidelines on women's health. The Canadian task force is an arm's-length body with no accountability and no requirement to monitor the impact of their guidelines.
In the past, the task force has intentionally excluded subject matter experts from their guideline panels. Without expert input, the task force based recommendations on decades-old trials that included, almost exclusively, white women, so they discriminate against racialized women. The guidelines discriminate against women with dense breasts and against women older than 74, who have the highest mortality from breast cancer. The guidelines have led to inequity of access among provinces. A Canadian woman's access to early detection of breast cancer should not depend on where she lives.
The panel for the 2024 update includes family doctors, a nurse practitioner, a gastroenterologist and a kidney specialist. For the first time, four experts are included; however, the task force methods manual states, “Clinical and content experts do not provide input or vote on the direction or strength of recommendations”.
To ensure Canadian women have access to equitable and optimal breast screening, we ask that the guideline process be reformed to ensure appropriate oversight, use of current research and meaningful input from experts.
Jennie.