Evidence of meeting #125 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 risk.
A recording is available from Parliament.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
To reiterate, it's not just you. You've spoken about this with other breast cancer survivors.
Patient Advocate, Breast Cancer Canada
Yes, many. I was given a card when I had radiation. If I had to cross the border, there was something I could show in case the radiation went off at the border. I know it sounds insane, but it's true. I had a lot of radiation. I didn't travel during that time in my treatment, so I didn't have that problem, but I was given a card by my doctor in case I had an issue because of radiation.
I don't know why this is not already a thing, because it happens all the time to women, not just in Canada.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Thank you, Kim.
I'll turn to Dr. Appavoo.
In your opening statement, I think we all agree that we were shocked by the findings of the task force. The health minister ordered a review of that task force, but I think you raised some concerns about the review of the task force. Can you reiterate those and maybe give us some more to work on moving forward?
Radiologist, As an Individual
Sure. You know, it's called an external experts review, and the experts are external, but the review isn't external. The body that funds the task force is running the review. There's a massive conflict of interest there. I mean, who wants to look bad?
The Public Health Agency of Canada did an audit of the task force in 2022, and it didn't address fundamental problems like the lack of experts. It really was not satisfactory. We can see they've chosen deliberately to exclude any representation from the specialists who are involved in actual treatment of these diseases.
The university evaluation is from the University of Calgary, which houses the task force. Again, the university is not going to want to look bad. They should have an external university doing the review.
Somebody like the chief science adviser should be supervising this, overseeing it, or perhaps, although it may be out of their purview, someone like or analogous to the Integrity Commissioner. This should really be an external review. This is putting the fox in charge of the chickens.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Thank you.
Dr. Gordon, you also raised this. You said content experts are being deliberately excluded. I'm getting that you think they should be included in any task force.
Clinical Professor of Radiology, University of British Columbia, As an Individual
Yes. Thank you.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Excellent. Thank you, Lisa.
Next, Andréanne, you have two and a half minutes.
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you very much, Madam Chair.
Ms. Gioia, there's one aspect that hasn't been addressed here today. In fact, it's been touched upon, because we all know women, in our circles, affected by increasingly aggressive cancers at young ages. I'd like you to talk to us about environmental factors, because that's what your group is focusing on.
How might we explain some of the observations made about these more virulent cases affecting young women?
Research and Advocacy Advisor, Breast Cancer Action Quebec
For Action cancer du sein du Québec, exposure to endocrine disruptors that mimic hormones, especially estrogen, is a major problem. It's a broad field of research. Numerous researchers in various fields have demonstrated that it's linked to an increased risk among young women and black women. In fact, the products made for them contain more toxic substances.
Increased risk is an issue that really needs to be rigorously addressed. We wonder why there is this increase in breast cancer, but also other types of cancer, such as uterine cancer, in very young women. It's still quite rare, but the increase is striking nonetheless. So it's important.
Thank you for the question.
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you.
I have about 30 seconds remaining.
To conclude today's debate, at least for me, I'll turn to Dr. Appavoo.
You said that lowering the screening age was a step in the right direction, but that it still wasn't low enough. You'd like screening to start at the age of 40.
Can you explain why you've drawn that conclusion?
Radiologist, As an Individual
Screening should be initiated at age 40. It should be annual from 40-50, and preferably during the premenopausal years, while the hormone levels are higher. That is for women at average risk. For women at an elevated risk of getting it—especially if they have a young relative, particularly a first degree relative, like a mother or sister, who had breast cancer in the premenopausal years—they should start screening about 10 years earlier than the age of diagnosis of their first degree relative. If their mother had breast cancer at age 45, they should actually be getting into screening at age 35. Again, for those over the age of 74, it depends on the health of the woman, but 70 is the new 50. We're still young in our seventies, so as long as you're young, that's good.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you.
Lastly, we have Leah Gazan, for two and a half minutes.
NDP
Leah Gazan NDP Winnipeg Centre, MB
Thank you so much, Chair.
As we've gone through the study, I just find everything shocking and horrifying. All the information around the task force is so disturbing. I wish I had more time.
My last question is for you, Dr. Appavoo.
I know your group is calling for an accountability structure to oversee the task force. That seems really necessary, especially with everything we're learning. You're talking about ensuring the folks who oversee it are experts in the field, so they can oversee the guidelines that are being put in place.
Who would be on it? Who would make that choice about who would oversee it?
Radiologist, As an Individual
I think the panels themselves should include and potentially be chaired or co-chaired by content experts. That's actually probably an assumption most people have until they learn otherwise. Most people assume the panel of experts writing the guidelines includes experts in the sciences that are specific to the topics. For example, a breast screening guideline should be chaired by somebody who has breast cancer expertise as well as family medicine, and should include methodologies and statistics.
Overall, right now, there's no accountability for the task force or its guidelines. For example, the cervix guideline that was done in 2013 was very regressive. Gynecologists already knew HPV screening was the way of the future. They recommended against it. There is absolutely no way to change that guideline. That guideline still stands. It was outdated in 2013, when it was published.
It's 2024, and it's still there. Why? There's nobody to say, “This needs to go”, “This needs to be revised now”, or, “Let's replace it with a different guideline, perhaps from a different jurisdiction, such as a province or a different country.” There's just nothing. We're just stymied when it comes to trying to fix or change any of the task force guidelines. That is directly due to a lack of accountability. That's why I say, “This task force needs to be replaced.” Maybe I'm wrong, but I don't see a way forward to getting accountability unless the entire structure is changed.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you, Leah.
You had five seconds, so I stole it. Oh, oh!
Conservative
The Chair Conservative Shelby Kramp-Neuman
On behalf of the committee, I would certainly like to thank all of the witnesses for their testimony today.
Is the committee in agreement to adjourn the meeting?