Hello, everyone.
We thank committee members for the invitation to be part of this important discussion.
We're coming to you from Tiohtià:ke, part of the unceded indigenous lands of the Kanien’kehá:ka Nation.
It's important for us to use gender-inclusive language in our work, as breast cancer affects people based on their physiology and not their gender. We use the term “women and AFAB people”. AFAB is an acronym for “assigned female at birth”, which includes non-binary and transmasculine people who have the same risk of breast cancer as cis women do, and for us, “women” also includes transwomen, who can also be at an increased risk with gender-affirming hormone therapy.
Breast Cancer Action Quebec is an intersectional feminist organization that has been working for breast cancer prevention for over 30 years, providing education programs and fighting for better chemical regulations to reduce toxic substances in our environment and in the products that increase breast cancer risk.
Among our many different programs, we give breast cancer education workshops with women from communities often not reached by public health campaigns. We are committed to working with marginalized communities to listen to them and to empower them with the tools to take their health in hand.
Marginalized populations have very different needs and experiences regarding breast cancer, which include barriers to the existing screening program. This should be a central issue when considering expanding the breast cancer screening program to start at 40. These groups are not well served by the current screening program, and in most cases this is a reflection of the deep inequities in our health care system, which will not be solved by simply extending the program to younger populations.
Health care funding is severely limited. Shouldn't we be putting money into increasing breast cancer education and participation in the current program first, especially considering that the 50 to 74 age bracket is at the highest risk? If the program is widened to the general population, starting at 40, won't these populations face the same exclusions and barriers to participation?
Specifically, women and AFAB people with disabilities, particularly regarding mobility, have major problems with the most basic physical access to mammography screening machines and even to clinics. Disability groups have organized major campaigns to change this, with little success. This injustice has been an issue for over 30 years.
Gender-diverse people face a lack of information on basic questions of breast cancer risk, for example, how hormone therapy raises breast cancer risk for transwomen and how it may reduce it for transmen. Fully respectful health care practices are also far too rare.
Indigenous women and AFAB people are facing increasing rates of breast cancer along with all of the issues they face regarding the lack of equitable, respectful and culturally sensitive treatment in the health care system.
Black women and AFAB people are facing very specific problems regarding breast cancer, with many people being diagnosed at younger ages with more aggressive forms of the disease that are often less responsive to treatment. Also, they may participate less in existing screening programs. Lowering the screening age will not address racial disparities. In addition, Black women are facing very similar trends regarding uterine cancer, so far more work from the ground up needs to be done.
In Canada, we don’t collect race-based health data, which is a major problem and the source of many injustices. Much of the research on Black women and breast cancer has come from the U.S and the U.K., but this body of research has shown that the category of “women” cannot be treated as if they all experience breast cancer in the same way, which tends to mean the same way as white, cis, well-educated women. Gender differentiated data could also help us better serve the gender-diverse population.
The problems that all of these groups face regarding screening raises vital questions. As we all know, health care funding is severely limited. Breast cancer risk, diagnosis and treatments play out differently for different populations, so responses need to be tailored depending on these realities.
In addition, we'd like to call your attention to the lack of diversity in these two FEWO sessions among survivors, groups and experts, including the specialties and the populations they study and work with. Surely we all agree that Canadians deserve the whole picture on this important issue.
Thank you again for the opportunity for us to share our questions with you.