Status of Women Committee on Oct. 9th, 2024

[Jennie Dale]

The only way you can know your breast density is from a mammogram, so it would apply to women 40 and up. Women in the majority of the country are being told their breast density now. It's only in Newfoundland that they aren't.

Every woman can find out their category—A, B, C or D—and if they're category C or D, they need to have a conversation with their family doctor. They need to be informed, they need to be assertive and they need to state that they need more than a mammogram; they need a requisition for additional screening. Again, they need to know their risk. Maybe they need an MRI instead of an ultrasound. They need to speak up for themselves.

Many family doctors are not educated on breast density. They're not getting education in medical school on breast density and breast cancer. They're getting very limited education, so a woman has to be her own advocate. She has to be informed.

[Sonia Sidhu, Liberal, Brampton South, ON]

This raises another question. Do you think doctors need more education on this? You said they need to refer women with dense breasts, and mostly they do not know that. Do you think education should be added to some modules so they can look into that?

[Jennie Dale]

Absolutely. There is a huge education gap. This is the biggest obstacle we face. If our doctors were more educated, we would have fewer later-stage diagnoses because more women would be sent.

Right now, doctors are negating the issue with breast density because they are not informed. You have patients who are more informed than their own doctors, and you have a power imbalance. It's difficult for a patient to speak up when a doctor says they don't have to worry about their breast density. It's difficult for a patient to push back on that.

[Sonia Sidhu, Liberal, Brampton South, ON]

Ms. Holland, did your doctor ask for any other tests, like the BRCA1 or BRCA2? It's a genetic test for mutation. Did your doctor ask for that?

[Carolyn Holland]

No. My experience with my diagnosis was that my doctor never raised anything about breast cancer or screening, not when I turned 40 or when I was older, between 40 and 43. My family doctor took my history. I do not have first-degree relatives with it, but there is breast cancer in my family. That didn't seem to figure into anything. The other side of my family history is completely unknown, and that being the case, it was very hard for anybody to assess my risk.

I know that genetic testing, obviously, is very expensive. It's my understanding that unless there is a cluster of cases in the immediate family, you probably wouldn't be sent. Ultimately, once I had my diagnosis, I was sent for genetic testing and I do not carry the mutation. Mine is one of the 85% of all breast cancers where there is no family history. On the IBIS risk calculator that Jennie spoke to, I would have scored low.

It's about the mammogram. Had I had access and been able to self-refer at 40, I would have caught this. I'm proactive with my health. I would have caught it at 40 or whenever it came up, and it wouldn't have been as advanced.

To Jennie's point, I understand family doctors have to be jacks of all trades, but when faced with patients questioning, asking or wanting to know more, there's gatekeeping and a refusal to refer. Whether that is a matter of finances, I don't know the answer, but I don't think they're doing a service to patients by gatekeeping care.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Madam Chair, do I have more time?

[The Chair, Conservative, Shelby Kramp-Neuman]

That's five minutes, so we'll move on to the next questioner.

[Sonia Sidhu, Liberal, Brampton South, ON]

Okay, thank you.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you.

Members, I have been quite liberal and generous with the time. At this point, I will be a bit tighter on time to get a full third round in.

We're going to start—

[Anna Roberts, Conservative, King—Vaughan, ON]

Isn't this the fourth round?

[Leah Gazan, NDP, Winnipeg Centre, MB]

Do I get 10 minutes?

[Voices]

Oh, oh!

[The Chair, Conservative, Shelby Kramp-Neuman]

We're starting the third round. We'll have Michelle next.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Thank you so much.

Thanks again, ladies, for being here.

We're talking about breast cancer screening. There are some shocking stats we've heard today. It is my understanding that everyone testifying here would be in agreement with moving the screening age from 50 years old to 40. Is that correct?

I got a nod from everyone here.

Ms. Dale, you said self-referral would be your even bigger ask for the younger age as well. Is that correct?

[Jennie Dale]

Yes, and we do have self-referral. It was announced and implemented pretty much across the country, aside from Quebec, which has it under review right now.

Ontario just began yesterday. Because of this move, 845 cancers are going to be found in the 40 to 49 age group, so it's wonderful to see the country moving forward.

The problem is that the task force still has a huge influence on doctors. That's what they are following, so they may not suggest to women that they can self-refer. How are women going to find out they can self-refer if doctors are still following the task force and may try to dissuade them? This was in the testimony already. We still have the obstacle of the task force even though the provinces are moving forward.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

That's an interesting point you brought up.

You are all amazing. You all had powerful testimony.

Kimberley, we heard directly here today that you were trying to self-refer. You were asking repeatedly, and it still didn't punch through our paternalistic approach to medicine. That has to be put on the record.

There was another point you brought up, Kimberley, that I think is really important. We have a bill in the House right now that aims to put the kibosh on natural health products. I don't believe anybody in the natural health product industry was consulted by anybody with breast cancer on that. Obviously natural health products were a big piece of your treatment and recovery.

[Kimberley Wahamaa-Deschenes]

Yes, absolutely, and they still are. I was on tamoxifen for four years and I was bleeding down there, so I stopped because I could have died from uterine cancer. I made that choice, and my doctor was not very happy about it.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

That's another lesson. I think we could all go out for a coffee after this and have some big conversations. It sure would be nice if naturopaths and doctors would communicate, because there is a lot of value in health professionals who think outside the box, as we have to live and travel with what's happening in our health world and in our bodies.

I just want to leave it with Ms. Holland.

What we just heard from Jennie is very powerful. The task force has influence, and the members on the board are saying 50, but I don't see any survivors on the task force. That is a very critical piece. I think this is at the status of women committee right now because of this panel of experts. This is what I always ask my kids: Who are the experts and where is the data coming from?

I'll give you the floor to put on the record what you'd like to say about the task force.

[Carolyn Holland]

I very much appreciate it. Thank you.

You got to the core of it: Who are the experts and where is the data coming from?

As Jennie mentioned earlier, the experts making guidelines for breast cancer—and also, as we've heard, for postpartum depression, prostate cancer, lung cancer and cervical cancer—are family doctors. There is a gastroenterologist. There are nurse practitioners, and there's an ER doctor. These are not subject matter experts. We always hear from them that they're experts in methodology, but they have no understanding of the information, of the evidence or of the data they're getting because it is not their area of practice. We wouldn't allow someone to practice outside their area, yet here we are with a task force made up of folks who aren't in their area of practice.

I think it's a breach of the public's trust when they are getting information they believe.... If you asked any Canadian who is making the breast screening guidelines, I'm sure they would say that it was an oncologist, a radiologist or someone who knows cancer. It is none of those people.

These are very astute questions to ask. Who is providing this information and where is it coming from? We've heard about 60-year-old studies and have heard about flawed, corrupted studies. This is the data being used.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Thank you so much for that.

I just want to say that it would be nice to have an economist on the task force to speak about the financial impact of not investing in prevention.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you, Michelle.

Lisa, you have five minutes.

[Lisa Hepfner, Liberal, Hamilton Mountain, ON]

Thank you, Chair.

I will echo my colleagues and thank you all very much for attending today, for your very important testimony, for being so honest and straightforward and for bearing your souls. That's really important, and it's valuable that you're here today.

I will go to Jennie Dale.

Did I overhear that you're also a physician?

[Jennie Dale]

No. I'm a breast cancer survivor, going on 10 years.

[Lisa Hepfner, Liberal, Hamilton Mountain, ON]

I thought I heard somebody call you Dr. Dale, and I didn't want to be remiss and give you—

[Jennie Dale]

I just want to thank you for having four patients here to allow our voices to be heard.