Status of Women Committee on June 11th, 2024

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Dr. Rushton.

[Dr. Moira Rushton]

In discussion with one of my colleagues, part of the issue with a lot of these studies is that the end point perhaps is not the right end point we need to look at. The end point is often a hard end point of survival, instead of looking at the stage migration that we achieve with early detection.

I would disagree with the chief surgeon from Manitoba who indicated that the treatment of stage 1 and 2 breast cancer is essentially the same. Historically, that may have been true, but every year we're achieving advances in systemic therapy of breast cancer, where that's no longer the case. Even in the worst actor of triple negative breast cancer, where even a small subcentimetre node-negative tumour gets chemotherapy, one that's larger than two centimetres or has lymph node involvement will have immunotherapy and a more aggressive chemotherapy. Systemic therapy is really working to de-escalate treatment where we can in earlier-stage disease, but also very much escalate for stage 3 disease across the board.

Stage does matter, and I think end points matter. The problem with the evidence review and the lack of expertise is that there is no one there to put it into the context of what it means to treat breast cancer today.

[The Chair, Conservative, Shelby Kramp-Neuman]

Emmanuella, Dr. Hebbard would like to contribute as well.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

I'm sorry. I have another question.

I actually took a look at the composition of the task force. It appears that there are quite a few women. It seems like it's almost equal in women and men. However, there is only one Asian woman and one Asian man. Besides that, everybody is white.

Do you think that had any effect on what those recommendations looked like?

[Dr. Shiela Appavoo]

I can answer that.

I don't think there were actually any women of colour on the working group that actually addressed breast cancer. I don't think that necessarily influenced what they said. I will grant that they weren't making racist recommendations because no people of colour were in the room. However, I do think that it's symbolic of a disregard for racial equity.

One of the things that I think is also indicative of that is their use of GRADE to elevate the ancient RCTs above the observational studies. Ninety-eight per cent of those RCTs were done from the sixties to the eighties on white women. They put that evidence as the top level of evidence, and everything else, which may have been much more diverse, was given a lower importance, so there is a systemic form of racism there.

I think the fact that there were no women of colour on the working group is possibly a symptom of the same disease.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you very much.

I don't have much time, but I would like any stats that you can send to the committee on dense breasts, any facts that we can include afterwards in our report.

By what date do they have to submit?

[Clare Annett, Committee Researcher]

It's tomorrow.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

They're due by tomorrow, so if at some point today you could send in some statistics on dense breasts, which you mentioned, Dr. McKerlie, and anything else that you have, that would help us send the right information to the task force.

This is what's going to happen with this study. It's going to end up being sent there so that they can consider this. Please do send it in.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you, Emmanuella.

Next, Andréanne, you have two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

Before asking my question, I would like to check one thing. You all seem to have studied the subject extensively. Can you tell me, by raising your hand, whether some of you were consulted by the working group?

Ms. Sonea, were you consulted?

[Helena Sonea, Director, Advocacy, Canadian Cancer Society]

Yes.

[La présidente, Conservative, Shelby Kramp-Neuman]

Andréanne, I think Jean Seely has her hand up as well online—just so that you are aware.

[Andréanne Larouche, Bloc, Shefford, QC]

Perfect, thank you.

I would like to know, in the case of the people who were consulted by the working group, what they had the opportunity to tell it. I would ask that they give me a summary, since I do not have much time.

We could start with Ms. Sonea and then hear Ms. Seely, who is joining us by video conference.

[Helena Sonea]

Thank you very much for the question.

We were consulted along the way. For us, it was really important to ground this entire experience in what patients are experiencing, making sure that, as part of their considerations as they were building out their guidelines, the patient experience was front and centre in their considerations and making sure that we were being holistic in that approach.

[Dr. Jean Seely]

I was one of the expert advisers on the evidence review, and the advice we provided was rejected by the task force on multiple occasions. Anyone who was able to be an adviser to the working group had to sign a non-disclosure. They could not disclose what their input would be. It was something that I did not do for that reason.

I can tell you that, on numerous occasions on the evidence review panel, we could see the lack of understanding of the screening and of the understanding of the studies we were talking about, so it was really not well regarded and not well taken into consideration.

[Andréanne Larouche, Bloc, Shefford, QC]

Forgive me, I am a bit in shock. You were consulted and you made recommendations, but you were disregarded and you were made to sign a non-disclosure agreement.

Can you tell me, in two or three seconds, what the reason for that was?

[Dominique Vien, Conservative, Bellechasse—Les Etchemins—Lévis, QC]

And yet it is a public issue. That is unbelievable.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you, Andréanne.

Leah, you have two and a half minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

I agree with my colleague Andréanne Larouche. It is totally shocking, this whole notion. It's like this hysterical woman's syndrome. We know that the health care system has historically reeked of sexism, which is why I ask the question.

I certainly don't think that representation doesn't exclude expertise, but in having other folks making decisions about my body as a woman, I'd like to see some women around the table and certainly women around the table who reflect my background and ethnicity.

In saying that, I want to ask Dr. Seely a very basic yes-or-no question, and then I want to ask you another question. In Nunavut, do you think it's critical that they immediately implement a breast screening program? Please answer yes or no.

[Dr. Jean Seely]

Yes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Okay, you would recommend that.

[Dr. Jean Seely]

Yes. In fact, I do interpret those mammograms, and I've been working to try to implement this in Nunavut. We're working toward that.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Okay. Thank you.

You also spoke about data, that there's not a lot of data on Black people, indigenous people and people of colour. Would you recommend a major federal investment to do more research geared towards breast cancer as it impacts Black people, indigenous people and people of colour?

[Dr. Jean Seely]

Absolutely. There is an urgent need to collect these data and to add this to how we track breast cancer and other cancers in Canada so that we know who is getting breast cancer and at what stage.

[Leah Gazan, NDP, Winnipeg Centre, MB]

I have only 25 seconds left.

Dr. Appavoo, you mentioned that you have a list of recommendations for the task force. Could you please submit those recommendations to the committee?