Honourable members of the Standing Committee on the Status of Women, thank you for reconvening this important study.
I'm Dr. Shiela Appavoo, a general radiologist with an interest in breast imaging and three decades of experience in breast cancer screening and diagnosis. I also chair the Coalition for Responsible Healthcare Guidelines.
Today I want to focus on breast screening guidelines, as well as other guidelines that affect women, specifically those from the Canadian task force on preventive health care, operating under the Public Health Agency of Canada. You have heard and will hear a lot about breast cancer science and patient experience, but I would like to talk about the guidelines and the guideline development process itself, as well as the Public Health Agency's current external expert review of the Canadian task force on preventive health care.
As you've heard, there is strong criticism of the current Canadian task force breast cancer screening draft, which again recommends against screening women aged 40 to 49 and thus falls behind recommendations from the U.S. task force, the Canadian Cancer Society and almost all the provinces.
The problem with the Canadian task force is fundamental and extends beyond breast cancer screening. Content experts have raised issues with task force guidelines in areas that affect women, such as lung cancer, cervical cancer, colorectal cancer, perinatal mental health such as postpartum depression, vision screening and pediatric developmental delay. Aside from the breast cancer guideline, none of these guidelines have been updated dating back to 2013; thus they pose risks for Canadian women and their families. This risks avoidable late-stage diagnosis of significant and life-altering diseases.
Among other issues you will likely hear today, the task force demonstrated bias in its predetermination of the results of the breast screening guideline revision. The working group chair stated in May 2023 that they didn't believe changes to the guidelines were needed from the 2018 guideline. This was weeks before the evidence review was even initiated.
The task force also biases and manipulates knowledge translation. For example, it allows information to be expressed to patients and primary care providers only on its own terms. In its communications and in the way evidence is considered, the task force consistently underestimates screening benefits while amplifying its portrayal of harms.
As an example, its “1,000-women” chart, which is offered as a decision tool, underestimates the benefits of screening and fails to address crucial questions such as the reduction of morbidity or non-death harms when a woman screens versus not screening, as Dr. Gordon mentioned. Modern studies and computer modelling estimate a very meaningful value of around a 40% mortality benefit from screening, which the task force has arbitrarily chosen not to communicate. What the task force provides is not knowledge translation, but knowledge restriction.
Although the task force supposedly operates at arm's length from the Public Health Agency of Canada, it is funded and supported by the Public Health Agency. There's considerable interactivity between the agency and the task force, yet the Public Health Agency has been given the task of carrying out an external expert review, which is now under way.
While the panel members are distinguished and appropriately include representation from primary care and population medicine, they lack disease-specific specialists. This is exactly the approach for which specialists have criticized the task force. When I asked the Public Health Agency to include representation from specialists who look after patients with the actual disease processes, I was told they had made a deliberate choice in their panel composition. This suggests that the exclusion of topic experts was fully intentional.
The so-called external review of the task force is being led by the same body that funds it. Part of the evaluation is being performed at the University of Calgary, which houses the task force.
How can these bodies, whose reputations are tied to the task force, be truly objective? This is not an unbiased or external review at all. I urge the committee to recognize the fundamental flaws, bias and lack of accountability in both the task force and the Public Health Agency of Canada's review of the task force.
The breast cancer screening guidelines, as you've heard, are deeply problematic, as are multiple other guidelines. It's essential to address these broader guideline issues affecting women and their families across multiple health topics. A good start would be to put a moratorium on the current review of the task force and to place the review in the hands of a truly external and objective body and university. We must advocate for an honest and external review of the task force and the dismantling and rebuilding of the task force to ensure a proper structure and oversight. In this way, we can arrive at safe, appropriate and modern guidelines in many fields that affect women and their families.
Thank you.