Status of Women Committee on Oct. 21st, 2024

[Jennifer Beeman]

I can take that question, as we're working together.

One of the big issues is how differently breast cancer plays out for different populations. It was interesting to hear the presentation from the Quebec Breast Cancer Foundation towards a more targeted approach, because that's where our understanding is going as well, specifically because different ethnic backgrounds play into breast cancer risk. It was already known that it was the case for Ashkenazi Jewish women. Now there's such a big, urgent health care “crisis”, I'd call it, regarding Black women and breast cancer. They really need to be around this table.

There are Black women breast cancer researchers who are calling it urgent that we get race-based data and to better understand it. Black women have historically been marginalized in many different ways, including with clinical trials. The percentage of Black women who've been part of clinical trials has been less than 1%. Researchers theorize that it's one of the reasons that it's becoming very clear that certain therapies don't work for them the way they work for white women.

There are layers to this issue. Breast cancer is a harrowing disease. We know that as well as anyone else here. It's wretched. Seeing anyone die from this is terrible. Overdiagnosis, where we turn healthy women into breast cancer patients, is an equally important problem that needs to be taken very seriously. No one who's been through breast cancer would want that. We need to start targeting.

As we said, race is a question that we need data on. It's the same thing for indigenous women. We need a lot more data on what's happening for indigenous women as well. Research out of Alberta indicates that their breast cancer incidence is going up. Do they respond to therapies late? Obviously, there are diagnoses at later stages. Do they respond to the same therapies? Then there are the historical problems in terms of how they are treated within the health care system.

There are layers to the problem and they require many perspectives. They require these women, and groups that work with them, to be around the table as well.

Thank you.

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

Thank you very much for that response.

Dr. Gordon, you said that the majority of provinces at this point are lowering the age to 40. Quebec is the only province that we're still waiting on. They are still at 50. I'm wondering if you know what their argument is for staying there for so long. I don't know if the task force's guidelines have anything to do with that. Generally, the way Quebec tends to go is not necessarily based on federal guidelines.

I'm wondering if you can give any insight there.

[Dr. Paula Gordon]

With Quebec, the previous speaker, Ms. Beeman, brought up the issue of overdiagnosis. Let me explain to the attendees what that really is.

Overdiagnosis is the theoretical possibility that somebody could be diagnosed with breast cancer, a real breast cancer, and treated for it, but that they would die of something else before the breast cancer would have surfaced, so they never really needed to find out that they had breast cancer. The extreme example is a woman who has breast cancer and finishes her treatment, and six months later, she has a massive heart attack and dies. Another example is that she's diagnosed with another cancer that's very aggressive. Let's say she gets a pancreatic cancer, and she dies even before her breast cancer would have killed her. Overdiagnosis is real, but at the time a woman is diagnosed with breast cancer, if you don't have a crystal ball, you don't know what's happening to that woman six months or a year later, except overdiagnosis is vanishingly rare in younger women. Women in their forties are much less likely to have significant heart disease. They're less likely to develop other cancers, so overdiagnosis is not a reason to not offer breast cancer screening to women in their forties.

The task force is using it the wrong way, and perhaps Quebec is as well. Depending on what evidence committees are willing to look at, like the task force, they can choose to exaggerate the harms and understate the benefits. We have Canadian data showing that women in their forties who have mammograms are 44% less likely to die of breast cancer than women who don't.

If I can just take a moment to address another comment from Ms. Beeman and her colleague, who brought up the issue of representation among the experts, the other panellists might not be aware that in your previous session, Dr. Ify McKerlie, who is a Black physician and a breast cancer specialist, did give testimony. I'm sorry that there are no other non-white experts.... Well, Dr. Appavoo, do you count as non-white? I don't see colour anymore—

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

Thank you so much.

I appreciate your comments.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you very much.

Unfortunately, Emmanuella, your time is exhausted.

Next, I would like to welcome Andréanne Larouche.

You have six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you for your virtual and in‑person testimony this evening.

I took many notes. I fail to understand why governments haven't recognized the value of prevention, rather than waiting and needing to provide care later.

Screening doesn't start at the age of 40. Is this because of concerns about lacking the resources, given the costs involved? The figures provided vividly demonstrate how much prevention, by treating cancers at much earlier stages, affects both women's lives and the economy.

Can you hear me, Ms. Wilkinson?

[The Chair, Conservative, Shelby Kramp-Neuman]

To whom are you asking the question?

[Andréanne Larouche, Bloc, Shefford, QC]

Can you hear me now in French?

[The Chair, Conservative, Shelby Kramp-Neuman]

Do you have the interpretation on, Dr. Wilkinson? Are you able to hear?

[Dr. Anna Wilkinson]

We're not able to hear the interpretation.

[Andréanne Larouche, Bloc, Shefford, QC]

May I start again, Madam Chair?

[The Chair, Conservative, Shelby Kramp-Neuman]

The clerk will help you.

We'll suspend for a minute while this is being sorted out.

[The Chair, Conservative, Shelby Kramp-Neuman]

Andréanne, we are ready to go. Please go ahead.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

As I was saying, I want to thank the witnesses participating in the meeting in person or online for their important testimony.

I'm particularly struck by how this issue sometimes seems to come down to economics. Is the idea of not screening for breast cancer before the age of 50 driven by a fear of lacking the financial, material and human resources needed to detect the cancer? Is it really a matter of cost?

In this study, the figures show just how much a cancer detected later or at a much more advanced stage leads to higher costs and, above all, more serious consequences for the person living with the diagnosis. The person must undergo much more extensive treatment. This affects both their personal and economic lives. I think that this is a terrible shame. At the same time, I hope that there will be more talk of prevention and detection. I hope that we can also focus on this area as part of our study.

I'll turn to you first, Ms. Ippersiel.

You talked about the PERSPECTIVE project. I think that it's worth looking beyond age. There's the age 40 factor. We've heard evidence confirming the benefits of cancer detection before the age of 50 and the need to change screening guidelines to include women in their 40s. That's my understanding of your remarks. However, we must also take into account the improvements in research technology to focus even more on much higher‑risk groups, with a view to developing more appropriate and personalized treatments. Cancer research is increasingly moving towards more personalized diagnoses and treatments to better reflect each individual's reality, experiences, disease stage, time of disease detection and prognosis.

I want to hear your comments on the PERSPECTIVE research project that you talked about.

As part of this study of the PERSPECTIVE project, I want to know what aspects we should keep in mind. This project mustn't be forgotten in our report.

[Karine-Iseult Ippersiel]

The PERSPECTIVE project has been running for 10 years. The project involves researchers—including professor Jacques Simard from Laval University in Quebec City—at the Centre hospitalier de l'Université Laval, or CHUL, in Quebec City.

Basically, they combined a saliva test with a questionnaire on all the risk factors that I spoke about earlier. The result is a risk score based on the polygenic breast cancer risk score unique to each individual. After screening, based on this risk score, a filter could be created to prioritize the people who face the highest risk of breast cancer in society. This would help avoid discrimination and the decision to focus on people in their 40s or 50s. It could cover everyone aged 30 to 74.

They surveyed people who participated in clinical research. Of these people, 89% said that, if they knew that they had a higher risk score, they would pursue a more stringent and frequent screening program based on their risk level. In contrast, a person who doesn't have as high a risk level could wait until they reach the risk level of the general public before entering the system. Knowing this risk would make it possible to really prioritize high‑risk individuals and make better use of resources that, as you say, are minimal in the field.

[Andréanne Larouche, Bloc, Shefford, QC]

Ms. Beeman, on that note, you said that it's also necessary to take a closer look at racial disparities. Why are there so many differences among various communities? What steps can be taken to ensure that screening incorporates these factors?

I would like to hear your thoughts regarding Ms. Ippersiel's comments on the PERSPECTIVE project and on the need to focus on other risk factors.

[Jennifer Beeman]

Our approach to ethnic origin or race really falls along the same lines. We're seeing this in women of African descent. Researchers are beginning to identify a genetic predisposition to breast cancer, as is the case for women of Ashkenazi Jewish descent. This could be a risk factor. As Ms. Ippersiel explained, there really is a movement to take much more targeted approaches to breast cancer screening. Breast cancer has a whole range of risk factors. This could mean starting screening earlier. A number of specialists are coming to a useful consensus.

I also encourage you to look at the analysis of the Toronto‑based Rethink Breast Cancer. This group works with women and people under the age of 50 who have breast cancer, people who have metastatic cancer and marginalized groups. Its position is extremely sound. This organization isn't in favour of screening for breast cancer starting at age 40. Instead, it advocates for a more targeted approach to screening, based on a range of risk factors.

The perspectives are somewhat limited in the information sessions. A wider range of people are asking perfectly legitimate questions about the benefits of expanding breast cancer screening to include women aged 40 to 49, in comparison with other approaches. It's challenging. We aren't experts. However, we should listen to a range of experts on this topic.

Ethnic origin—for example in the case of first nations women, black women and perhaps other groups—may involve specific risk factors for these women.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you very much for that.

Leah, you have six minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you, Chair.

My first question is for Milena Gioia.

I really appreciated your testimony talking about the importance of inclusive care. You spoke specifically to the AFAB community. Why is it important to provide gender-affirming care in the treatment of breast cancer?

[Milena Gioia]

Thank you so much for the question.

It's really about ensuring that everybody is included in our measures to challenge and to prevent breast cancer, to detect it. If we don't include.... What's happening right now is that gender-diverse people, so non-binary and transpeople, aren't targeted by the current awareness campaigns. All this pink stuff around breast cancer is not very.... Transmen don't feel called to participate in this whole aspect of it. They don't necessarily know that they are at risk for breast cancer even after having top surgery, like gender-affirming double mastectomy, let's say.

[Leah Gazan, NDP, Winnipeg Centre, MB]

I have limited time. I ask that question for a very specific reason. There has been push-back provincially to get rid of gender-affirming care. My concern is if we continue to push back against gender-affirming care in certain provinces, how is that going to impact the safety of the trans community, particularly around breast cancers?

[Milena Gioia]

Are you talking about gender-affirming care in general?

[Leah Gazan, NDP, Winnipeg Centre, MB]

I'm talking about gender-affirming care, but in this specific instance, it is related to breast cancers.

[Milena Gioia]

It would affect mental health. Suicide rates would go up. I think that maybe matters. I'm not sure if I understand the question about how gender-affirming care would affect—

[Leah Gazan, NDP, Winnipeg Centre, MB]

Let me clarify the question.

If it's difficult to access gender-affirming care.... My assumption is that people would be less likely to get medical help, particularly around breast cancers, if they don't feel they can get health care that respects gender diversity.