Evidence of meeting #115 for Status of Women in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was task.
A recording is available from Parliament.
Noon
NDP
Leah Gazan NDP Winnipeg Centre, MB
Thank you so much.
My next question is for Dr. McKerlie.
Shockingly, but not shockingly, I'm wondering if you are aware of the makeup of the task force right now. Give me a yes or a no, please.
Noon
NDP
Leah Gazan NDP Winnipeg Centre, MB
What is the number of folks on the task force who are Black, indigenous and people of colour?
12:05 p.m.
As an Individual
I am not actually sure what their ethnicities are, but I think it's very few of them.
12:05 p.m.
NDP
Leah Gazan NDP Winnipeg Centre, MB
I asked that because I think inclusion is intentional, and sometimes we don't look at specific factors if certain people are excluded from tables. I am concerned about it.
Dr. Appavoo, you spoke about paternalism and saying, “Don't worry your pretty little head” about it. Can you expand on that? What is a key recommendation you would make to address that level of paternalism that seems to be costing the lives of women and gender-diverse people?
12:05 p.m.
Chair, Coalition for Responsible Healthcare Guidelines
Thank you for asking that question.
I think there's paternalism at several levels. One of the most obvious is the idea that recalls are a harm that should be weighed against the possibility of an avoidable late-stage diagnosis, which may mean harsher treatment and potential death.
A recall is where somebody gets pulled over after their mammogram to go back for extra testing. I liken it to going through security at the airport. They put your carry-on through the X-ray, and every once in a while they'll see something in your bag, ask you to come over and check your bag. Then most of the time you're not carrying anything dangerous, and you can just go on your way.
That's very much similar to what the process is with mammography. A recall is not a harm. It's unpleasant. I do not diminish the level of anxiety and shock that there is in finding out you have to go back for another look, but it's transient. The reason people are worried is that they don't want to die of cancer, and that's what this is all for. We are trying to avoid having people die of cancer, so they get worried when we call them back, but that's part of the process. It's a lot of hard work not to die of cancer.
12:05 p.m.
Chair, Coalition for Responsible Healthcare Guidelines
My key recommendation would be to acknowledge the anxiety, but not put it into an equation where you weigh that against the potential benefits of not having late-stage treatment or potential death. It is something to acknowledge, to warn people about, but it has no business in an equation.
12:05 p.m.
As an Individual
Yes, I was thinking about that question in terms of knowing what the specialties of the people who comprise the task force are, particularly with your comment about having skin in the game and the bias for breast experts. I've always thought about that and wondered what the bias is.
We as radiologists in probably most institutions out there are known as people who are busy, and we always say no. On that skin in the game, we want what's best for our patients, and we wouldn't do anything just for.... I think I can speak for most radiologists. I'm not exactly sure what that bias is. Is it monetary? It's one thing to be sitting and making these guidelines and thinking about one in x number of people. It's another thing to be actually dealing with people individually and seeing them as people, not numbers on a paper. It's different.
12:05 p.m.
NDP
Leah Gazan NDP Winnipeg Centre, MB
Thanks very much, because I am concerned about the lack of data and the fact that the lack of data is impacting certain populations, because we don't have the research that's needed.
I'm going to Dr. Seely. It's shocking that Nunavut is the only territory that doesn't have breast screening. We know that Nunavut, in terms of access to essential services, is lacking housing. We're often turning a blind eye to the folks of Nunavut.
12:05 p.m.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Leah, you have exhausted all of your time, and then some.
12:05 p.m.
Conservative
The Chair Conservative Shelby Kramp-Neuman
She avoids looking at me.
I was a little bit generous, but we need to move on. Perhaps we can incorporate that question Leah was alluding to further on in the discussions.
At this point, I'd like to start our second round with Dominique with the Conservatives.
The floor is yours for five minutes.
June 11th, 2024 / 12:05 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Thank you, Madam Chair.
So much intelligence today! We often hear highly intelligent things from witnesses appearing before this committee, but today you are all truly very inspiring. Thank you for being here and for your testimony.
I am going to try to speak slowly so the interpreters are able to convey my thoughts to you well.
To begin, I have to tell you that I have a personal experience that I will not recount here, but my colleagues are aware of it. Among my family and friends, I also have women who had to have mastectomies in their thirties. I can confirm that you are telling the truth when you say that more and more young women are facing the problem of breast cancer. Ms. Roberts cited the example earlier where cancer is diagnosed in one breast but the other is healthy. Sometimes, the person might nonetheless decide to have the second breast removed as well. We can see how very difficult these situations are.
I was surprised by something I heard this morning and I had seen in my reading, which is the talk about harms caused by early detection. I am flabbergasted. Personally, I started having mammograms when I was a young woman, which makes for a few years now. How can anyone talk about harm in screening? Explain that to me. I do not understand how anyone can reach that conclusion.
Dr. Appavoo, what are the disadvantages or harms associated with early screening? I cannot believe that the disadvantages or harms come down to simply getting telephone calls to tell us to go and get tests done or redone. For myself, I was quite happy that they called me back and they insisted.
What, then, are these harms that the task force is taking into consideration?
12:10 p.m.
Chair, Coalition for Responsible Healthcare Guidelines
Thank you for asking that question.
Everything has pluses and minuses. There are a few downsides to screening.
One of them is that about 7% to 10% of women who get a mammogram may get called back to have a second look. About 95% of those women will get a double-check, be able to breathe a sigh of relief and go home knowing they got a little bit of extra care and attention. They're good until their next screen. Most of them will be fine.
I don't like to diminish the worry. I mean, mental health is important as well. I don't diminish it, but in comparison with a delayed diagnosis, I think it's trivial. That's my own personal opinion about that.
I would say there is a more significant harm in the form of something called overdiagnosis, which is essentially the chance that your cancer is found. You poked the bear. You went hunting for cancer and you found one, but that cancer could have sat there until you died of other causes and you would have never had to have the treatment. The treatment itself is unpleasant, to say the least.
However, the good news is that, for the youngest women, that is a very trivial likelihood. It's around 1% or less than 1%. That is because your chance outliving your cancer, basically, is based on whether or not that cancer is aggressive. Is it one that's going to grow? Also, how much lifespan do you have left?
On the one extreme end, if you do a mammogram on somebody who's 85 and she has heart disease, that's overdiagnosis, but for somebody who's 40, it's not going to—
12:10 p.m.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
I am going to have to interrupt you, because I do not have much time left and I would like to add a brief word. I apologize.
You said earlier that the working group should be dismantled and another one appointed. What are the main characteristics or the main reasons that led you to say that? Who do you think should sit on that committee?
12:10 p.m.
Chair, Coalition for Responsible Healthcare Guidelines
For the new task force, first of all, it's not for me to actually do that. I think that would be a project of its own. However, we do have some recommendations.
I think that we need to rebuild it with accountability. We need to rebuild a new task force with accountability, with transparency and with experts. The idea of bias and eliminating the need for experts is based in a logical fallacy, an ad hominem attack and an appeal to motivation, which is—I'm sure most of you have debated here at some point—really not a valid argument. Everybody has bias. There's some sort of bias in everybody and you have to work around it.
You can't throw out expertise in trying to eliminate bias.
12:10 p.m.
Conservative
12:10 p.m.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Yes, your five minutes are up. I'm sorry.
Next we have Emmanuella for five minutes.
12:10 p.m.
Liberal
Emmanuella Lambropoulos Liberal Saint-Laurent, QC
Thank you, Madam Chair.
I'd like to thank all our witnesses for being here today. All of you are great.
Dr. McKerlie, Dr. Rushton and Dr. Appavoo, I want to particularly thank you because I was the person who submitted your names. Jennie Dale from Dense Breasts Canada was the one who had sent me your names.
In honour of her and of all of the women fighting to improve the outcomes for women with dense breasts, I'd like to ask you if there's any evidence that has come out in the last decade that you think should have been considered by the task force when putting out the report.
In the report, it actually says that “for women with moderately increased risk due to high breast density...[they] did not find find any evidence on the benefits of supplemental screening”. That's not what we heard today. If anybody can explore that a little bit more and provide some more details, that would be great for a first question.
Go for it.
12:15 p.m.
As an Individual
I'll just start by saying that they did put it in the guidelines. There's been a lot of research done in the States to show that women with dense breasts have at least a four to six times higher risk of getting breast cancer.
If you add MRI to supplemental screening, I think you pick up at least 80% more cancers, where in a mammogram it would have been normal. If you add ultrasound, you'd pick up at least 50% more. There is for sure some evidence to show that supplemental screening would help pick up more cancers and that should have been factored into guidelines.
I'll stop there.