Evidence of meeting #124 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 evidence.
A recording is available from Parliament.
Liberal
Emmanuella Lambropoulos Liberal Saint-Laurent, QC
Thank you very much. I know my time is up, but I appreciate your answers.
Conservative
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you, Madam Chair.
Ms. White, Ms. Holland, Ms. Wahamaa‑Deschenes and Ms. Dale, thank you for your presentations.
Today's topic is somewhat distressing. We all have a woman in our lives who's had breast cancer and, in some cases, has passed away—my friend, for instance. Also top of mind are all those women battling cancer right now, one I know personally.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Andréanne, I'm sorry to interrupt you. We have two different people interpreting right now. We'll just pause for a moment.
Andréanne, do you think you could speak in French for a couple of seconds to see if there's double interpretation?
Bloc
Andréanne Larouche Bloc Shefford, QC
I'll say a few words to see whether it's working.
Is the interpretation coming through?
Conservative
The Chair Conservative Shelby Kramp-Neuman
That's better.
I'll just make sure the witnesses are able to hear.
I've pressed pause on your time, Andréanne.
Please continue.
Bloc
Andréanne Larouche Bloc Shefford, QC
Top of mind are all those women who are battling breast cancer as we speak, including a young mother I know. She was diagnosed in her early forties, when she was pregnant, so she had to give birth while dealing with all that stress. This is an upsetting topic for all those women.
I recently attended an event in my riding put on by the Fondation Louis‑Philippe Janvier, which provides support to young adults dealing with cancer. I want to recognize the foundation's work, because it and other such organizations don't get enough help. This came up a bit in the discussion with Ms. Ferreri as well as in your opening remarks.
Something else that comes to mind is the whole debate around providing 50 weeks of EI sickness benefits to ensure that adults dealing with an illness are properly supported and can recover with dignity. Right now, people can't recover from illnesses in 15 or even 26 weeks. Who can reasonably imagine not having that financial burden on their shoulders?
Two weeks ago, I took part in the marche du Grand défoulement in support of the Quebec Cancer Foundation, which also has to try to make up for the fact that the government isn't capable of providing adequate support to young adults suffering from cancer. They have homes to pay for and children to support. Both of those organizations hosted events recently, and I wanted to highlight the work they do.
I've heard all kinds of stories, so I add that to the information and considerations before the committee.
My first questions pertains to a topic we've already talked about, the task force that was formed. Ms. Ferreri asked whether it was a matter of money, and Ms. Lambropoulos asked some questions. There was talk of a lack of evidence. What is that about?
I'll put that to you, Ms. Seely, since you mentioned it in your opening statement and you have to leave at 5:30.
You said you found what has come out of the task force with respect to evidence concerning. Can you tell us more about that? Other than the fact that the task force apparently just relied on what the U.S. said and doesn't have enough evidence, and beyond the cost issue, can you tell us what concerns you about the task force?
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
With evidence, if you use a very strict formulary called a grade format, you can look at thousands of studies, but the highest level of evidence there, which will supersede any other evidence, is a randomized controlled trial. I mentioned earlier that we cannot repeat the studies that have been done for over 40 to 60 years to prove that mammography works. The task force insisted on using the randomized controlled trials evidence, so regardless of all the other studies that came after those old trials, it will always be the best level of evidence if that's the constraint made on the system approach. That has meant underestimating the benefit of screening mammography by almost half.
The reason for the underestimation in those randomized controlled trials is that they used outdated equipment. We don't use the same kind anymore. They also had other significant problems. The Canadian national breast cancer screening trials recruited into the screening arm women who had advanced breast cancers. They also moved patients from one arm to the other.
This constraint meant that, regardless of the outcome, it was predetermined by the task force's selection of randomized controlled trials. With all the evidence, the U.S. did not do that and only used evidence from 2016 on, so we know this was not necessary. The task force was very much insistent that we use that kind of evidence.
As Jennie mentioned earlier, we know that the people on this task force already had a very strong bias against screening mammography. They don't believe it works. They believe treatment is the solution, and it is all that is needed for breast cancer. They have no expertise in diagnosing women like Carolyn and other women who present with advanced breast cancer. There is an incredible, terrible toll it takes on them when they undergo this kind of treatment, with chemotherapy that can be more than 12 months long and all of the downstream negative side effects of chemotherapy. The members themselves, who were selected for that kind of bias, imposed these constraints, which meant that, regardless of what all the experts were saying, they did not listen to them. The experts showed that there were so many changes since those randomized controlled trials that they should not use them.
I don't know whether that answers the question fully, but that's the best explanation I can tell you as to why this was the outcome.
Bloc
Andréanne Larouche Bloc Shefford, QC
I have just 30 seconds left. I lost track because of the interruption.
Ms. Dale, you also talked about the task force in your opening remarks. In 30 seconds, do you have anything you want to add to what Ms. Seely said?
Co-founder and Executive Director, Dense Breasts Canada
The task force lacks accountability. It lacks transparency, as Dr. Seely said, and it has an extreme anti-screening bias. As for composition, there are no experts in breast cancer screening on the task force. There is an ER doctor, a pediatrician and a gastroenterologist making guidelines for Canadians. This is not just an issue that impacts breast cancer; it is an issue that impacts every guideline the task force is making. We need expert input, and the task force lacks that.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you, Ms. Dale and Andréanne.
Leah, you have six minutes.
NDP
Leah Gazan NDP Winnipeg Centre, MB
Thank you so much.
I want to start out by thanking all the witnesses.
Your stories, Madam White, Madam Holland and Madam Wahamaa-Deschenes, speak to the fact that this is bigger than a physical illness. People need to look at the long-term emotional and physical impacts of cancer on the survivor but also on families. I'm sorry that in your cases that was not respected.
If I have time, I want to ask Dr. Seely some questions, because she's leaving.
Dr. Seely, you have come before to committee to present evidence. We had a witness by the name of Dr. Ify McKerlie, and she stated in a former committee meeting:
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.
She went on to say, “The task force was aware of this recent, yet-to-be published paper from Statistics Canada, but did not lower the screening age”, which was shocking to me.
She added that not only were the studies that were prioritized during the development of draft recommendations out of date, but that they also used a sample population composed of 98% white women. She added, “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.”
Do you feel that there needs to be more research done to look at screening ages for populations based on genetic research?
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
Dr. McKerlie was quoting our study, which has just been accepted for publication.
In Canada, all women except white women have their peak diagnosis of breast cancer under the age of 50. White women have their peak age of diagnosis at 60. In those old, randomized controlled trials that I mentioned, 98% of the women were white. Women who are not white are more likely to get breast cancer under the age of 50. This is the biggest reason the U.S. lowered the screening age to 40.
In Canada, if we remove the barrier of age 50 and allow women to self-refer at age 40 and older, we will allow women of all races and ethnicities to participate in screening if they choose to screen. Right now, we only allow that for women 50 years and older.
This is absolutely discriminating against non-white women, and it is why we're seeing that non-white women are three times more likely to be diagnosed with advanced stage breast cancer in Canada than white women. It's so critical that we address this inequity. Simply lowering the screening age to 40 will allow us to remove that major barrier, because a lot of these women don't have a family physician and cannot get a referral to get a screening mammogram even if they are allowed to.
NDP
Leah Gazan NDP Winnipeg Centre, MB
Thank you so much, Dr. Seely.
I want to move to Jennie Dale to build on this, as we're talking about discrimination in the health care system.
One of the things Dr. Seely mentioned was access to doctors and services. I'm wondering, Madam Dale, if you can speak about the health care inequities in patients who live in remote and northern communities. How are they affected in their ability to access screening compared to those in larger cities?
Co-founder and Executive Director, Dense Breasts Canada
I'm sorry, but I cannot speak directly to remote communities. I can just speak to the inequity of women needing a requisition in their forties who don't have anyone to ask for that requisition.
Women are being denied the chance to get screenings. All I can speak to is the shortage of family doctors, the inability to get a requisition and why we need self-referral to eliminate the inequity.
NDP
Leah Gazan NDP Winnipeg Centre, MB
Thank you so much.
I'm going to move to you, Madam Holland. I believe it was you who spoke about how, when they have cancer, women often have to continue working or the patient has to continue on with surviving and doing things to survive.
Do you think the government needs to look at putting in long-term support programs for survivors of cancer—in this case breast cancer—including mental health supports and programs like that?
Conservative
The Chair Conservative Shelby Kramp-Neuman
Leah, unfortunately, your time is up.
I'm going to allow about 25 seconds to answer, because it was a really good question.
I know our next speaker wants to pose one question to you, Ms. Seely, as I know that you need to leave at 5:30. If you can be patient, in just about 30 seconds we'll get moving.
Ms. Holland, if you could, answer in about 25 seconds or less.
Dense Breasts Canada
I can pass the question to Kimberley, the other witness. I was fortunate. I had sick leave at my job and had access to long-term disability, whereas I know Kimberley was in a position where she had to continue working.
Founder, Trust Your Bust, As an Individual
I was an events manager. I took one day of vacation for my chemo and went back to work after the weekend. I worked throughout all my treatments. I worked every day through radiation. I had third-degree burns. I finished 30 radiation treatments and went to my remote camp. I wrapped a big bandage around it. You just keep going, so yes, there should be some type of benefit.
One thing that my—
Conservative
The Chair Conservative Shelby Kramp-Neuman
If I may, I need to leave it there, but perhaps the title of the report could be “Just Keep Going”.
Dominique, you have five minutes.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Thank you, Madam Chair.
I want to start by thanking each and every one of you for being here this afternoon. I'll go straight to Dr. Seely since she has to leave soon.
Dr. Seely, there is somewhat of a myth out there that overdiagnosis is dangerous or harmful. I'd like to hear your view on that.
There's a second question I'd like your insight on. Let's say women 40 plus in the country could register to have a mammogram if they wanted to. How many lives do you think could be saved, if you were to extrapolate?
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
Let me answer the second question. I think we have very good evidence—with modelling in Canada—showing that if we started screening women at age 40, we would save at least 400 women's lives every year. If you can imagine two jet airplanes filled with women, that's how many lives we would save by starting screening at age 40, and that's even an underestimation.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Tell me, Dr. Seely, is overdiagnosis harmful? Is that true or a myth?
Professor of Radiology, Faculty of Medicine, University of Ottawa, As an Individual
I can talk about overdiagnosis. It's the diagnosis of a cancer that would not lead to the patient's death. We refer to overdiagnosis in the case of a woman who is going to die from other causes. The likelihood of a woman in her forties dying from her breast cancer is more than 90%. Overdiagnosis is much more of an issue for older women who are likely to die from other causes, whether cardiovascular or neurological.
Conservative
Dominique Vien Conservative Bellechasse—Les Etchemins—Lévis, QC
Thank you, Dr. Seely.
Now I'll turn to Ms. White.
Ms. White, we were all quite moved by your story earlier. Women carry an enormous mental load. When it comes to a woman's health, there is no one better—