Thank you very much.
I'd like the committee to know how futuristic and wonderful Dr. Simard's work is, but it is futuristic. Certainly, Dr. Narod's discovery of the breast cancer gene was pivotal, but we're dealing with guidelines now that deal with average-risk women. Only 5% of women are high risk, and the vast majority of women who get breast cancer have no risk factors, not even a mother with breast cancer. In fact, having dense breasts is the most prevalent risk factor.
What the committee should understand—and I'm sorry to hear that Dr. Narod does not know this—is that the study with which Dr. Narod was associated, the Canadian national breast screening study, has been discredited. Although it was supposed to be a randomized trial, the randomization was flawed—corrupt you could say—and that explains why that study was the only randomized trial among eight others that did not show mortality reduction. We know why that study didn't show reduced deaths among women in the mammogram group.
For average-risk women, they should have a risk assessment. Right now, not all women can have the polygenic risk score that Dr. Simard spoke so well about, but women should be assessed for their risk. There are online risk tools that are free and easy to use, and average-risk women should start at age 40. If a women is shown to be at increased risk or at very high risk, she might start sooner, but otherwise, it should start at age 40 and, ideally, be annual because when women are premenopausal, the hormones made by their ovaries cause their breast cancers to grow faster.
That's why we must start screening women, especially Black, Asian and Hispanic women.... Indigenous women, in fact, have the same analogous inequities that we see for Black American women. They tend to get more aggressive cancers, and they're more likely to die from their cancers. Those inequities have to be addressed.
The other big inequity is for women with dense breasts. Now, that's something that no one can control. You can't control your breast density, yet women with dense breasts are more likely to get cancer, and we have a harder time seeing those cancers on their mammograms. We know that we can find them. We can find them with ultrasounds. If they're really high risk, we can find them with MRIs, but of course, MRIs are much more expensive and less accessible. It's not their fault that they have dense breasts. They deserve the same opportunity for early detection as women with non-dense breasts.