Thank you for the opportunity to testify on this critical issue.
I'm a breast radiologist in Vancouver, and I've been in practice for over 40 years. I watched the previous session, in which you heard compelling testimony from women harmed by the task force, and just now with Ms. McIntyre, with some needing both breasts to be removed, having hair loss from chemo, having to take time off work or worse, having to work through treatment.
Cancers in younger women grow and spread faster, so it's especially important that we find them earlier. The years of life saved by screening are greater for women in their forties than in any other decade, yet the task force still recommends that screening start at age 50, perpetuating avoidable deaths and suffering. Women in provinces that start screening at 40 are more likely to be diagnosed at an early stage. They're less likely to need chemotherapy, and they can have less aggressive surgery. That's why all women should be offered screening starting at 40.
Canadian data showed that since the task force first recommended not screening women in their forties back in 2011, the stage of breast cancers has increased, and the number of women whose cancer has spread has gone up by 10%. The task force ignored this research when making its current guidelines.
Currently, 9 out of 12 jurisdictions have lowered the screening age to 40 or have pledged to lower it. Alberta and Northwest Territories screen at 45. We are waiting for action only from Quebec, and that review is due in December. Even with all this progress, many women are still unaware that they can self-refer. Family doctors who trust the task force are not telling women about screening, and if they do, it's often to discourage it. That comes back to a power imbalance.
Dr. Michelle Nadler testified to HESA that “the task force doesn't mind” if women screen “as long as [they're] informed”. There's a strong emphasis that women must speak to their family doctor before self-referring, but the decision aid tool, which you heard about from Dr. Wilkinson, that the task force sends to family doctors is a one-size-fits-all. It does not allow for individual variation like ethnicity, family history and breast density. The only benefit it shows is averted deaths. It doesn't include the potential to avoid harsh therapy. It overstates the risks of mammograms to doctors, and it wants women to decline screening as a result.
Both women and health care professionals need education. When I lecture to health practitioners, they're shocked to hear that the task force members are mostly family doctors and that content experts are deliberately excluded. Canadians assume guidelines are made by experts. This is a breach of public trust.
All women should have a risk assessment by age 30. The task force guidelines are intended for women who are not at increased risk. However, women with a first-degree relative with breast cancer are at increased risk, as are women with dense breasts and women who've had cancer. The task force guidelines do not apply to those groups, but family doctors don't know that, and some use those guidelines for these women as well.
That said, I'd like to emphasize that 85% of women who get breast cancer have no increased risk, no family history. That's why we need to screen all average-risk women, starting at age 40. Women with additional risk factors may need to start younger or to be screened more often or to be offered supplemental tests like ultrasound or MRI, but average-risk women need to be screened. Women should receive an invitation letter on their fortieth birthday, informing them that they can now have screening mammograms. Currently, only Alberta sends invitations at age 45. Women in their forties are the sandwich generation. They're caring for young children at home and for aging parents, and they're working and contributing to the economy. They are not acceptable losses. All women in Canada deserve the opportunity for early detection.
The task force should be disbanded. We cannot wait for an expert and external review in the spring in the hopes that action will one day be taken for a newer, better, accountable task force. Women are dying needlessly now. We need the guidelines suspended now. In the interim, provincial guidelines can be used. Ontario began self-referral at 40 on October 8, and it has predicted that 845 additional cancers will be found this year. Those cancers would have been found eventually, but now they can be found at an earlier stage. A new model for the task force should incorporate experts and patients. There's no time to wait. We need to act now.
Thank you.