Good morning. Thank you.
I'd like to thank the members of the Standing Committee on the Status of Women for this incredible opportunity to speak about the current Canadian breast screening guidelines.
My name is Dr. Ify McKerlie. I've been a general radiologist with a focus on breast imaging for over 20 years. I co-chair the patient engagement group of the Canadian Society of Breast Imaging. In my practice over the years, it has become increasingly obvious that patients who are affected by breast cancer are getting younger and younger. In addition, the increased incidence of breast cancer has also been shown in recent Canadian research.
My daily practice includes diagnosing and performing biopsies on these patients and, as such, I'm often the first point of contact and the deliverer of bad news. Breast cancer in younger women tends to grow faster and is more aggressive.
The task force has recently released its recommendations for breast cancer screening. It is important to acknowledge that the task force members do not specialize in the field of medicine—breast cancer screening—for which they have set the guidelines. They have mistakenly placed higher emphasis on the potential harm that early screening may cause rather than the life-saving benefits.
Breast cancer is a disease that has a far-reaching impact. The brutal harm of a late-stage diagnosis is significantly more severe than the potential harm of undergoing additional imaging. The outdated study from the 1980s, which the task force continues to use to make its guidelines, comprises a population that is 98% white women.
Forty years later, however, Canada is a much more racially diverse country. Over 9.5 million Canadians were identified as a member of a visible minority group in the 2021 Canadian census, making up 26.5% of the total population.
In the U.S., it was noted that in Black, Hispanic and Asian women, breast cancer peaks at an earlier age of 40 when compared to white women. Recent Canadian analysis shows that Caucasian women are the only group whose peak incidence is greater than 50. The task force was aware of this recent yet-to-be-published paper from Statistics Canada, but did not lower the screening age.
In the recently released guidelines, the task force notes that the lifetime risk of breast cancer in these populations is lower than the risk in white populations. They go on further to note that non-white populations in the 40 to 49 age group are diagnosed more with breast cancer, have a higher proportion of aggressive subtypes of cancer, are less likely to have hormonally sensitive cancers and are less likely to have stage 1.
Black women have an even more sobering outlook, with a 42% higher mortality than white women, more aggressive cancers and worse outcomes stage for stage. For the 40 to 49 age group, the task force notes:
There are data showing variability in incidence, mortality, subtype and stage at diagnosis (e.g., higher mortality in Black women....
Despite listing all the disadvantages facing racialized women, it put a strong emphasis on informed patient choice, which would require an educated discussion with a family physician. The task force promotes a one-size-fits-all approach, which counters the observed variability in values and preferences. If a woman chooses to be screened, it still recommends screening every two to three years.
When the U.S. guidelines were announced, the U.S. task force stated that “New and more inclusive science” had led it to call for screening at 40. In Canada, where is the use of new and inclusive science? With knowledge comes responsibility, so knowing the above—acknowledging higher mortality in Black women in the 40 to 49 age group—and not acting on it is simply unethical and discriminatory.
The task force also discriminated against women with dense breasts by not recommending supplemental screening. Breast density is highest in Asian, Black and Hispanic women.
It's 2024. We must include the 40 to 49 age group in the screening population, particularly given the incidence in racialized women and higher mortality in Black women, as well as the high risk to women with dense breasts. Lives depend on it.
In the absence of proper governance and an accountability structure for the task force and indeed for any organization, there is chaos. Women in their forties are not acceptable losses.
Thank you.