Status of Women Committee on Oct. 21st, 2024

[Dr. Shiela Appavoo]

As Dr. Gordon said, this has been done before. It can be done again. I think there are better ways to do these guidelines. As we've seen, the U.S. task force's model recommended screening women aged 40 to 49.

There are other guidelines. There are the National Comprehensive Cancer Network guideline and the provincial screening guidelines. Almost every other guideline you could throw a stick at recommends screening at 40. It's just the Canadian task force that is entrenched in this idea that women 40 to 49 shouldn't be screened, and I think that is a symptom of the more fundamental problems with the task force.

[Marc Serré, Liberal, Nickel Belt, ON]

Dr. Wilkinson, you mentioned the task force ignoring all the recommendations from the experts, but you also mentioned that they almost did this intentionally, because now there are provincial interpretations, and the guidelines are not clear.

Can you expand a bit on the recommendations to us as a federal committee here, and what to do next?

[Dr. Anna Wilkinson]

I would love to just quickly mention data, because lots of people have been referring to data. There are data in terms of evidence, but there are also data that we collect within our Canadian Cancer Registry. I think a part of the guidelines is the ability to have some quality assessment after the fact to determine what happened with these guidelines. Currently, there are significant issues with our Cancer Registry data that prevent us from assessing what's going on. A very basic outcome of this committee could be to say....

We have no data from Quebec since 2010, so I cannot tell you what's going on in the country with breast cancer, because I don't have data for a significant portion of our population. We don't have data from Nova Scotia from 2021-22. Our incidence data right now dates to 2019, and our mortality data dates to 2021.

If, for each cancer case, we collected data on the race and ethnicity of that person, on the density of their breast, on whether or not it was screen-detected and on whether or not it was a recurrence, that would allow us to properly assess what's going on.

We just finished a big study on race and ethnicity in breast cancer that will be published within the next week or so, and we had a very complex linkage of census data with registry data to try to put together what is going on in our country, when it could be so simple just to flag who gets what.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you for that.

I have 20 seconds left before the chair cuts me off, but, Dr. Gordon, Dr. Wilkinson and all members of the committee here, can you send over...? There are issues with wait times that we haven't really addressed in the committee right now. Is there a possibility of sending some recommendations along on how to address the problem, the length of time...and the wait times right now across the country?

[Dr. Anna Wilkinson]

We have a one- to two-week wait time for mammograms in Ottawa right now, in our region. We do not have a wait-time issue for mammograms, and we have accessible mammogram units for people who are in wheelchairs.

[Marc Serré, Liberal, Nickel Belt, ON]

It's not the case across the country, though.

[Dr. Anna Wilkinson]

It's not the case across the country, for sure, but I'm saying that it's a very heterogeneous problem, I think.

[Marc Serré, Liberal, Nickel Belt, ON]

Wow.

[The Chair, Conservative, Shelby Kramp-Neuman]

That's interesting. Thank you.

Andréanne, you have two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Madam Chair.

Ms. Wilkinson, what you just said about the availability of resources is interesting, so I'll continue in that vein. You seem to be saying that resources are available in the Ottawa region, and that they're even adapted to the needs of people with disabilities.

Ms. Ippersiel, I did some research on Mr. Dubé's announcement last week about a study commissioned by the Institut national d'excellence en santé et services sociaux, or INESSS, on the potential expansion of breast cancer screening starting at age 40. I've seen a lot of headlines that seem to question whether Quebec has the necessary resources. Isn't that approaching the problem from the back end? Shouldn't we make sure we have the resources first?

This affects the federal health transfers the ministry of health is calling for. When we don't get those transfers upfront, we don't get the critical and necessary investment in our health care system.

There should be no question of economic cuts or austerity. These transfers need to be made.

[Karine-Iseult Ippersiel]

Definitely. In Ottawa, Ontario, the wait is one to two weeks, if at all. Across the river, on the other hand, the wait is 26 to 33 weeks, sometimes 38.

The problem is manifold. First, there has been a shortage of 500 to 700 medical imaging technologists in Quebec since 2021. Second, since technologists earn less in the Outaouais region of Quebec than on the Ontario side, those working in Gatineau eventually go to work on the other side of the river. Early last summer, Minister Dubé responded to the situation by increasing a bonus for medical imaging technologists in the Outaouais region.

Training is another problem. If you're not able to specialize in mammography in the Outaouais region, you have to go to Montreal, a difficult situation for a mother with children. As we know, more and more medical imaging technologists are women. The situation is more complex. So it's not just about the money: It's also about the people who are going to do the work.

Yes, offering screening to women aged 40 to 50 is an excellent idea too, but unfortunately we have to ask ourselves whether we have the resources to do that, given that, for a simple mammogram, the wait for women aged 50 to 74 is 15 to 33 weeks.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you.

Leah, you have two and a half minutes.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you so much.

I was wondering, Dr. Wilkinson, if you could send the committee a brief on the recommendations that are coming out of your latest report. That would be really helpful—and maybe some other recommendations that are coming out.

[Dr. Anna Wilkinson]

Sure.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Unfortunately, I have limited time.

I wanted to ask this to Madam MacDonald and Madam McIntyre. We often talk about the physical parts of cancer, but we don't talk about cancer in terms of the emotional and financial parts of it. I think that's something that has come out in the study. That is one reason that I put forward a bill for a guaranteed livable basic income, because you just never know what's going to happen in life. People need to live with dignity, including those experiencing life-changing health incidents.

I'm wondering if both of you could very briefly just give maybe one suggestion on where the system is lacking in terms of financial or socio-emotional supports for people struggling with cancer.

We'll start with you, Madam MacDonald, and then go to you, Madam McIntyre.

[Kim MacDonald]

I'll speak to the mental health aspect of it.

I want to say that mental health is as important and impacted as much as physical health when it comes to breast cancer. I think if I were to make a recommendation, it would be that women, or anyone who's going through breast cancer, be assigned a therapist. Have it be part of the treatment, because I think it's just as important as all the doctors and specialists we see. I think it would benefit patients greatly to have a social worker or a therapist as part of the treatment.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Madam McIntyre.

[Julie McIntyre]

I was fortunate enough to be able to take a leave from work, but I know not everybody is able to do so. The financial losses can be significant. I do think that's important to consider—and that there are supports in place for people that they don't necessarily have to seek out.

When you're going through a cancer diagnosis, you are dealing with so much. For me, mentally, I was in survivor mode, looking at each treatment one step at a time, one day at a time, dealing with side effects, etc. What I've noticed is that I put the emotional aspect on hold—subconsciously, to be honest. Now that I have finished my active treatment, I'm trying to deal with lots of the emotions that will continue to affect me.

Social workers and therapists are very important. Again, we can't expect everyone to have to seek out those people. As Ms. MacDonald said, that should be available. It is available in the hospitals, but you do have to make an appointment or try to navigate the system. Some kind of health care coordinator who could help patients with that would be very helpful.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you very much for that.

Next I'd like to welcome Michelle Rempel Garner. You have five minutes.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair.

I know this topic has been studied at the health committee. I'd like to direct my questions more around a gender lens or a gender approach to some of these recommendations.

I know that the task force suggested that self-referral for women under 50 was something that could be an option. At the same time, I think it's a well-established fact that women have to advocate differently from men for their own care. Then you start getting into different issues based on different ethnicities, demographics and locations in the country.

Given that, did the task force consider the difficulties or the barriers faced by women in self-advocacy, even women in privileged positions, in making that recommendation? If not, what would you recommend to this committee as it pertains to self-referral?

I'll start with you, Dr. Appavoo.

[Dr. Shiela Appavoo]

I think the guidelines themselves are separate from provincial guidelines and rules around self-referral. For example, in some provinces, even dating years back, women were allowed to self-refer at 40. In my own province, until October 2022, women were allowed to self-refer at 50 only. In October it moved down to 45.

Those provincial clinical practice guidelines and rules are affected by the task force recommendations. I would say that there's indirectly a strong influence on provincial clinical practice guidelines and thus patient access.

I'm not sure if that answers your question.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

More clearly, or more directly, I am a woman in a position of privilege. I have never been accused of not being able to speak my mind or advocate for anything. I don't have a primary care physician. Once a month, I have to eat an entire bottle of Aleve to deal with my menstrual cramps. When I go to a doctor, they just tell me, well, maybe you're anxious. I tell them I'm incapacitated: Don't you think there's something wrong? They tell me that it could just be that I'm getting older.

This is me. I was a federal cabinet minister. If I'm being gaslit, I can't imagine how it is for somebody who does not have my experience in self-advocacy. I guess what I'm asking is whether the aspect of medical gaslighting, or that bias in taking women's health seriously, particularly in the family physician's office as the first point of referral, was taken seriously by the task force. How can we self-refer if we already have that bias that we're dealing with? What should this committee be recommending to address that gap?

Go ahead, Dr. Wilkinson.

[Dr. Anna Wilkinson]

When we did our race and ethnicity study, we gave that information to the task force. That study, which is coming out shortly, found that all races and ethnicities other than white have a much earlier peak onset. That means that 41% of cases of breast cancer in Korean women are diagnosed before the age of 50. A third of breast cancer cases are diagnosed before the age of 50 in Arab women and Black women and first nations women—you name it.

If we're talking about restricting access, if you have a task force guideline that says you have to go and have a discussion with someone, you need to have the resources to know that, first of all, and to then seek someone out and advocate for yourself. If that physician has been told that, actually, no, they shouldn't do that, then you're completely skewing this away from people who actually need access the most.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

I agree. In a different life, I did a lot of work with primary care networks in Alberta.

Would one of the recommendations that you would give to the committee be to consider that medical bias, which is quantifiably present for women? Would you recommend that this be taken into consideration when thinking about any sort of guideline that could relate to self-referral?

[Dr. Anna Wilkinson]

Absolutely.