Status of Women Committee on June 11th, 2024

[Dr. Moira Rushton]

Absolutely.

I do think that this discussion around screening and health screening is an opportunity for us in Canada to think about more meaningful health care reform. We can think of what the evidence-based ways are that we can help save lives and about how we can skip that step outside of a primary care provider, because our family physicians are burning out. They do not have the capacity for us to be putting more on their plates by saying, “Now please have detailed risk-benefit ratios.”

With regard to government organizations, I'd really like to see the government, public health and provincial health providers providing screening programs that patients can self-refer to, much like what is about to start in Ontario in the fall, so that they can make that decision and then follow up with their family provider to review the results.

Trying to make family doctors continually be the gatekeepers to all medical care in Canada fails so many because, even in Ottawa, about 30% of people don't have a family doctor.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you very much.

At this point, we'll move on to Sonia.

You have six minutes for the Liberal Party. Thank you.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the witnesses for being with us.

My first question is for the representative from the Canadian Cancer Society and then all the witnesses who want to reply can contribute to that. I would like to know about the differences across provinces and territories in their outreach approaches to testing women and the treatment of breast cancer.

[Ciana Van Dusen]

We know that the recommendations are as such. They're guidelines. The provinces have the ability to make informed decisions for their populations, and they are doing so across Canada.

In the last few months, we've seen various provinces make the decision to expand access, whether self-referral or systematic screening. It is important to note that there is a difference there and that self-referral does still require women to know that they have access, that they have a right to it and that they can go and get it, as well as a certain amount of education and resilience in pursuing that, as opposed to a systematic approach where the invitation comes to you and it's a lot more streamlined and clear.

Those are some differences as far as how we carry out access to breast cancer screening, but both are certainly steps in the right direction. I'm not sure if there was a second part to your question as far as differences are concerned.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you. Would anyone else like to contribute on that?

Go ahead.

[Dr. Jean Seely]

I can tell you that the Canadian practice has been a patchwork of guidelines. Some provinces have been screening women in their forties by allowing self-referral since the program started, like in British Columbia, Nova Scotia and Prince Edward Island. Others have come on board. Currently, as of this date today, that's all the provinces and territories except Nunavut, which does not have a screening program, and Quebec, which is looking at the evidence for screening women in their forties. Manitoba is the only one that has not adopted this policy for self-referral for women in their forties. Alberta starts at 45. The other provinces all start at age 40.

We have had the opportunity to study this differential. What we've shown, in this large study done with Statistics Canada, is that the women who have been diagnosed through screening in their forties in these provinces that have been screening have a significantly higher rate of early-stage breast cancer, and the provinces that do not include those women in their forties have significantly higher rates of those more advanced cancers at stage 2, stage 3 and stage 4. There's also a differential in approach to density.

This is the opportunity we have for the guidelines to make a more standardized approach, and one of the reasons we're so disappointed with the draft guideline.

Thank you.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Dr. Seely.

As a follow-up—

[The Chair, Conservative, Shelby Kramp-Neuman]

Sonia, I believe Dr. Turner wants to contribute to that as well.

[Dr. Donna Turner]

Yes. Thank you, Madam Chair.

I just wanted to note that in some provinces, for example in Manitoba, the breast screening programs work very hard to connect with communities of various racialized populations and indigenous populations, in particular in a province like Manitoba.

I think it's really important to note that one of the things we have not done well in Canada is capture information on race and ethnicity or, in fact, in terms of gender identity. This is an area where we see that there is a great possibility for advancement.

In Manitoba, our breast cancer screening program is asking women to self-identify in terms of their race, ethnicity and indigeneity, following a practice that has been developed in Manitoba with communities and in partnership with communities and health care leadership. It's really an important step forward in our getting more information on what we can do for women who are in potentially equity-denied populations.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Dr. Turner.

You raise a very good point regarding the data collection for racialized or indigenous populations. Do all provinces collect the data? What could you tell us about data collection specifically for racialized women? The Cancer Society or anybody can answer.

[Dr. Jean Seely]

Perhaps I can answer that because I was involved in a large study with Statistics Canada.

Unfortunately, the data for race and ethnicity is not collected and not correlated with the method of detection of breast cancer, so we had to do a very circuitous registry adjustment and correlate it with the census data to be able to provide that race and ethnicity data. This is really a significant gap, and we need to be able to collect these kinds of data to be able to show the impact of screening in these women of different races and ethnicities.

Our data does show that there is very significant harm being done to the women of races and ethnicities other than white, and that includes indigenous women and women of all ethnicities in Canada, with a higher rate of advanced-stage breast cancer.

This is a call for increasing the data collection in different provinces and territories to be able to capture this more readily and to demonstrate the impact of screening and diagnosis.

[The Chair, Conservative, Shelby Kramp-Neuman]

Sonia, I see that there are several others who want to contribute to this conversation, but your time is up.

Perhaps those who have their hands up can find the room to provide an answer in some of the following questions.

Next, I'd like to invite Andréanne Larouche.

It is six minutes for the Bloc Québécois.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

Thanks to the witnesses for being with us today.

Breast cancer is devastating for women and for entire families. We all know women who have died or are still suffering the consequences. That is the case for me. So I want to thank all the witnesses for participating in this study, in memory of all the women who have died and in solidarity with all the women who hope to continue living.

My first question will be for Ms. Van Dusen and Mr. Raynaud, from the Canadian Cancer Society.

What I am hearing today is that more and more studies are showing the importance of prevention. I would like to hear your views on the guidelines that serve as a manual on the subject of screening for people starting at age 40.

Quebec may not have guidelines about this yet. However, the Institut national d'excellence en santé et en services sociaux is working on revising Quebec's rules on the subject, so something is happening in this regard.

There are also examples at the international level. No one would want to turn back the clock when it comes to the guidelines for people starting at age 40.

[Ciana Van Dusen]

There is a growing amount of evidence, reports, data and methodologies across various areas that are demonstrating both the advantages in terms of the lived experiences of these people diagnosed with cancer but also the advantages to our system of catching cancer early when it's most treatable and less expensive.

I think that when we look to the United States, their guidelines having changed most recently, it is a good indicator. We have race-based data internationally that we have not previously seen or had access to, and we know that we have a very diverse population in Canada whose needs we need to meet.

Also, I will just mention that there are women of that age group—50 to 74—who currently have access and are not being screened. It's really important that as we consider expanding access, we're not leaving these people further behind and are supporting this expanded access that women should have with resources, whether that's health resources, human resources, technological resources or financial resources, so that we're delivering this in the way that is intended.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Raynaud, do you have anything to add?

[David Raynaud]

We are talking about prevention and early detection, which are two different things. As we said in our opening statement, we can also do things upstream from cancer by trying to promote healthy lifestyles, for example. That said, early detection is definitely a key factor, not only for increasing survival rates, but also for reducing the impact of treatments and for the secondary effects. We have seen this in some of the accounts we have heard. Having better early detection means that the burden of treatments on patients and the secondary effects can be limited. This is also a way of reducing costs to the health care system, because there could be lighter treatments.

That is what I wanted to add, to supplement my colleague's answer.

[Andréanne Larouche, Bloc, Shefford, QC]

Well said. In fact, Ms. Farber's poignant testimony, which we heard first, was to the same effect.

Mr. Raynaud and Ms. Van Dusen, I would like to continue my questions for you.

We are talking about the guidelines for screening starting at age 40. It is all very well for the federal government to establish these guidelines, but ultimately, that will serve no purpose if it does not then provide its share of investments. I am talking about transfer payments here. It has not invested enough in the health care system over the last few years and we are now seeing the tangible consequences. It has allowed the systems in Quebec and in the provinces to grow poorer. It has made cuts to health transfers over the years. It has not met the expectations of Quebec and the provinces in this regard.

As you said, a standard is one thing, but Quebec and the provinces, which control their own systems, then need to have the resources. I am talking here about financial resources, technological resources and human resources.

It is important to reinvest in the health care system to avoid it falling victim to an era of austerity and to have the financial resources to provide appropriate care and treatment.

[Ciana Van Dusen]

Do you have your hand up?

[Dr. Shiela Appavoo]

I may attempt to answer that. Recent studies that I think were done by Dr. Seely and colleagues have shown that, based on screening annually from 40 to 74 modelling and modern treatment costs—which are very expensive—Canada would save about $460 million per year in treatment costs. I think investing in screening will pay off in spades for the government. They need to take the plunge and make the investment up front, and I think they will reap the rewards in the next few years after that.

[Andréanne Larouche, Bloc, Shefford, QC]

I have only a few seconds left, so thank you.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you. Unfortunately, that's your time. Well, you have about three seconds.

[Andréanne Larouche, Bloc, Shefford, QC]

To summarize, not only is more money needed, but prevention would also save money and allow more to be invested in treatments for the victims.

[The Chair, Conservative, Shelby Kramp-Neuman]

Next up we have Leah from the NDP.

You have six minutes as well. Thank you.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much. I want to thank all the witnesses. The testimony is just magnificent. If we can keep our responses brief, I have an agenda.

One of the comments that was really shocking to me is that people making decisions can't have skin in the game. I actually disagree.

My first question is for Ms. Farber. I'm wondering if you could provide a key recommendation to our committee to improve the health care system based on your experience. If you had one key recommendation, what would it be?

[Shira Farber]

As it pertains to screening, because that's why we're here today discussing these guidelines, I firmly believe that Canadian women should be allowed to self-refer and be included in a screening program starting at the age of 40. I also believe that women over the age of 74 who want to participate should be able to continue to do so. There are a lot of women in their later seventies who are in great health and would like to have the right to detect their breast cancer early too.

I believe that women who have breast density should know that. I think that's a major risk factor. I didn't know that I had dense breasts until my pathology results came back. How would I ever know that was a risk for me if I had never had a mammogram before my cancer diagnosis?

In my opinion, that's what will empower women and allow them to have these discussions with their family doctors—for those of us who are lucky enough to have family doctors, because, as we know, there are a lot of Canadians without family doctors right now.