Probably.
Evidence of meeting #94 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was risk.
A video is available from Parliament.
Evidence of meeting #94 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was risk.
A video is available from Parliament.
9:15 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay. Thanks.
Dr. Gordon, can you name the eight studies you were referring to?
9:15 p.m.
Doctor, Dense Breasts Canada
There were, in fact, 11 randomized controlled trials. The first one was done in 1963. It was in New York, and it was called the HIP, which stood for their health insurance plan. Then there were several in Sweden. There were Malmö 1 and Malmö 2, Kopparberg and Östergötland, and then Edinburgh had a trial. Two of them were the CNBSS trials. CNBSS 1 was for women aged 40 to 49, and CNBSS 2 was for women aged 50 to 59. They were completely different trials with different methods. Then there was Stockholm, Gothenburg and Finland. Of all the randomized trials, the Canadians were the only ones that didn't show reduced deaths in the mammogram arm.
9:15 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Just to get to the bottom of this, I have a couple of things. Is there evidence to show that, by delaying screening until 50, this has cost Canadian women's lives, by not being screened earlier at 40?
9:15 p.m.
Doctor, Dense Breasts Canada
Absolutely. Dr. Wilkinson's data shows that, and modelling shows that upwards of 400 lives per year of women in their forties were avoidable deaths from not screening women from 40 to 49.
9:15 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
The last word is for you, Ms. Dale.
We've heard Dr. Gordon suggesting that women with dense breast tissue should be offered annual mammograms.
I understand that the Canadian task force has claimed that there is no evidence to support supplemental screening for women with dense breasts. Can you outline why you disagree with that assessment?
9:15 p.m.
Co-founder and Executive Director, Dense Breasts Canada
First of all, I'd like to say that women with dense breasts are not of average risk, and the task force has lumped them in with women with average risk. Then they are saying that there is no evidence to support supplemental screening, and we know that there is 50 years of evidence—please don't ask me to list that—and we have that evidence, and we can certainly forward that to you as well.
The task force chair has come out and said that the U.S. said there is no evidence; therefore, there is no evidence. It doesn't appear that they want to even investigate supplemental screening for women with dense breasts, but we know the benefits of supplemental screening for women with dense breasts.
9:20 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Dale.
Thank you, Mr. Davies.
There will be two more rounds of questions.
Next up is Dr. Ellis for five minutes.
9:20 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks very much, Chair.
Thanks, everyone, for being here.
Certainly we've heard a bit of the controversy as to why this is difficult. I'd like to ask each of you what your thoughts for the future might be with respect to breast screening.
Maybe, Dr. Simard, I'll start with you. What do you think is your future? If you could be brief, then we could get all four of you.
9:20 p.m.
Full Professor, Department of Molecular Medicine, Université Laval, As an Individual
Start maybe at 35 or 40 years old by having a comprehensive risk assessment. Adapt the starting age and the ending age. Adapt the modalities. That means a mammography plus MRI. I think that's the approach. That's what we call the risk-stratified screening approach.
9:20 p.m.
Conservative
9:20 p.m.
Doctor, Dense Breasts Canada
I agree that risk assessment is important. I think AI is going to play an increasing role. AI can find things in the mammograms that human eyes can't see, which can help us predict risk.
There are the usual questionnaire kinds of things about family history and so on. Everyone should have a risk assessment, ideally around 30. Average-risk women should start a screening mammography at 40 and be able to attend annually. All women should be told their breast density. Women with dense breasts should have supplemental screening.
There are new modalities coming online all the time. The newest one is called contrast-enhanced mammography. It's going be much less expensive than MRI. It's very close in sensitivity. That will make a huge difference. Only 30 places in Canada have purchased that.
9:20 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks, Dr. Gordon. I hope you don't work yourself out of a job with AI there. You never know.
9:20 p.m.
Voices
Oh, oh!
9:20 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Dr. Wilkinson, can I have your thoughts, please?
9:20 p.m.
Doctor of Medicine, As an Individual
I agree with Dr. Gordon.
I think we need risk assessment. The Mirai is the new technology looking at using AI to predict, based on a women's baseline mammogram, what her future risk would be and to help establish a screening interval.
What I hear mostly here is that there are so many new technologies coming up and things changing that we need experts who know all this stuff on the bodies that are making these decisions.
9:20 p.m.
Conservative
9:20 p.m.
Senior Scientist, As an Individual
The future of screening...? That's a good question.
I have a paper coming out in the early 2024 in JAMA Oncology that evaluates screening. I think that will change everything. It's embargoed, so I can't tell you more.
9:20 p.m.
Voices
Oh, oh!
9:20 p.m.
Senior Scientist, As an Individual
We hear about experts a lot here today. I would never claim to be an expert. I think it's important that other people give you that designation. It's not something we self-proclaim. I may say that I won the McLaughlin Medal this year from the Royal Society for the top medical scientist in Canada. I can say I won the Killam Prize for the top medical scientist in Canada in 2016. I can say I won the Lifetime Achievement Award from the Canadian Society for Epidemiology and Biostatistics in 2019. It's up to the committee to decide who's.... There are always people who have contrasting opinions. I hear them every day. I just want to make you guys aware that people have different levels of expertise.
9:20 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks, Dr. Narod. I think it's important to talk about the scientific method, and differences of opinion, of course, are important.
Ms. Dale, often, we think about absolutes. As a former family doctor, I would say that our job is to educate—in this case, women—about the risks and benefits and help them make good decisions. As a patient, you might want to have some comments around that, if you would, please.
9:20 p.m.
Co-founder and Executive Director, Dense Breasts Canada
Yes, there are tremendous gaps in education for women but also for family physicians as well. That's in part due to misinformation and disinformation that is being spread. We are doing our best to dispel that information, but a lot of it really comes from the task force. That's where everything stems from.
You're asking about the future, but we're very much focused on today. We can't think about the future when we have so many women dying today, especially with rising incidence amongst women aged 30 to 39. It's risen about 18% since 1984, so we need to find solutions for women today.
9:25 p.m.
Doctor of Medicine, As an Individual
Could I speak to the education of family doctors?
I would just like to make it clear that the task force is a venerable institution, and there is an institutional bias that is created. I was the chair of the cancer care committee for the College of Family Physicians. I approached the college to ask if I could do some education for family doctors on breast cancer risk for women in their forties, after completing our research. I was told that I could not do that, because it was not in line with what the guidelines were saying.
I submitted a commentary to Canadian Family Physician about this research and impacts, again, to educate family physicians. This commentary was not even sent for peer review, and I've had many articles published with them. Because what I'm saying is different from what the guidelines are quoting, it's not something that can be put out there to educate family doctors.
9:25 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you.
The last round of questions will come from Dr. Hanley, please, for five minutes.