Thank you.
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.
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.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you, Michelle.
Next we have Sonia for five minutes.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Madam Chair. I'll be sharing my time with Pam.
Thank you to all the witnesses for being here and for your knowledgeable testimony.
Dr. Gordon, we heard last time from Ms. Jennie Dale, the co-founder of Dense Breasts Canada, that family doctors are often not educated on breast density and the associated risks. Do doctors need more education? If they do, what kind of education would it be? What guidelines should be there?
Clinical Professor of Radiology, University of British Columbia, As an Individual
Family doctors and the public absolutely need more education on dense breasts.
You heard from one of the presenters today that she found out only after she already had her cancer diagnosis. Women with dense breasts are at a greater risk of getting breast cancer, and they're at risk of their cancer not being seen even if they do have a mammogram.
Family doctors definitely need to be educated. It should be part of the curriculum in medical school and in the residency for family practitioners. The task force is in denial over the risks associated with dense breasts, but, as I said, they're mainly family doctors, so they need to be educated as well. They need to listen to the experts. They need to let the experts vote on their panels so that women won't fall through the cracks.
October 21st, 2024 / 12:35 p.m.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
Thank you.
Thanks to all of our witnesses for being here today. I've met with many of you previously.
I'm not a regular member of this committee, but I would suggest that the committee think about adding another meeting to hear from those who specialize in the treatment and research of Black women, indigenous women and those with a disability.
I tried submitting Dr. Juliet Daniel as a witness, and I was told that you weren't accepting any more witnesses. I did ask her to submit a brief, but it was on pretty short notice.
One of the things we're tasked with is coming up with recommendations.
Dr. Wilkinson, I know you've spoken about HPV screening and lung cancer screening. In Ontario we started vaccinating for HPV in 2008. The guidelines were put in place in 2013. I would expect that research has come a long way since 2013. Do you think that any task force should be shortening the timeline when they look at these guidelines? It seems like waiting 10 years or more to update them is too long.
Medical Doctor, As an Individual
Yes, I think we should be updating guidelines every five years or so. It's becoming more and more complicated, because, traditionally, we've relied on these randomized controlled trials to dictate what we're doing, and we're more and more in an era where those may not be available for some of the basic questions, so we have to think about when to stale-date trials.
We asked for a pause in this breast cancer screening guideline process to have only trials after 2000 considered. We had the pause, but there was no change, so these guidelines that you see still have evidence from 1963, from the 1970s and from the 1980s. Everything about breast cancer has changed since then, like the imaging we use and the fact that we didn't know about molecular subtypes. We didn't even have tamoxifen or lumpectomy until the mid-eighties, so these trials were done before those basic things. We really need to think about the validity of the evidence we're using if it's older.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
We're also seeing more younger women getting breast cancer now than we did in the 1960s, when it was much more in older women. We're just finding it more.
The other thing I wanted to ask you about is the Canadian Cancer Society having withdrawn its support for many of the guidelines that the task force has put out. You talked about subject matter experts being consulted but not being voting members. If the task force stayed in place, what could we recommend in terms of people who have expertise providing input and perhaps voting? How do you see that working?
Medical Doctor, As an Individual
As a family physician, one of the major difficulties I find is that there are multiple guidelines on each topic. The Canadian Association of Radiologists has a breast screening guideline that's different from the task force guideline, and that's so across all subject matters. It's confusing for family physicians. Which guideline do you follow?
We should, as a nation, be bringing those people into the fold. It shouldn't be the specialist versus primary care. Let's have a collaborative guideline so that, for the issue of breast cancer screening in Canada, we pull in all of the expertise from all of these specialists, and we have one way forward.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you very much.
Thank you, Pam.
Thank you, Sonia.
Laila, you have five minutes.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
I want to thank everyone for this study here today. It's wonderful to have breast cancer be prominently studied here in the month of October.
We did study this at the health committee, and we had some amazing testimony, but I want to go further on this.
Dr. Paula Gordon, can you tell us how you would advise a woman who might be on the fence about whether they should talk to their doctor? What advice would you give a woman today?
Clinical Professor of Radiology, University of British Columbia, As an Individual
That's a really good question, because we know that family doctors are provided with a decision tool that understates the benefits and exaggerates the harms. It's almost designed to discourage women from having screening.
My advice would be to go have your mammogram at age 40. Yes, it's going to be a little uncomfortable. Don't book the test for when you're premenstrual, because that's when breasts are the most tender. Let's make it the best we can for your first time. Maybe even take a Tylenol an hour before the test. That'll give you some very important information right off the bat. You'll find out whether you have dense breasts, and hopefully you'll get an all-clear.
Another important piece of advice I would give women is that when you get that report and it tells you your breast density, if you're category C or D, which means you have dense breasts, you should, at the very least, do breast self-examination, because we know mammograms can miss cancers and we want women to find them as early as possible. If at all possible, try to get a supplemental test like ultrasound if you're at average risk. If you're at very high risk, have an MRI. Go online and look at the IBIS risk assessment tool. It's just a few questions, and it will tell you what your lifetime risk and risk over the next 10 years are of getting breast cancer. If you have higher than a 20% or 25% lifetime risk, you're at high risk, and you should be talking to your doctor about getting referred to a high-risk screening program.
All women should have a risk assessment by about age 30, and women should be encouraged to do breast self-examination so they get to know what their normal is and have a better chance of finding cancer as early as possible.
Thank you.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
Yes, we do know that early detection does truly save lives.
I'm going to open this up to Dr. Appavoo.
What advice do you have for women? We know that this task force has failed women, so what advice could you give to women today who are possibly on the fence?
Radiologist, As an Individual
Do you mean regarding breast cancer screening?
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I mean regarding breast cancer screening. Right now we can skip past them. We have a captive audience.
What advice do you want women to have?
Radiologist, As an Individual
Do that risk assessment between the ages of 25 and 30 so that you know before it's too late if you are at a higher likelihood of getting cancer, even in your thirties. As we've heard today, there are a significant number of women who do get breast cancer in their thirties, so find out your risk before you find out the wrong way.
As Dr. Gordon says, women 40 to 49, or basically in premenopausal women after 40, should be screening every year, because in those years the hormones are at a higher level. Breast cancer is sort of fed by the hormones in a lot of cases and grows faster and more aggressively. We know from studies that there's a lower chance of getting a late-stage cancer if you screen every year instead of every other year.
The other thing is—I'm going to wander slightly off topic—women aged 74 and above are a bit ignored. As Dr. Wilkinson said, with those studies in the 1960s to the 1980s, the lifespan for women was about 76 years in 1970, and the studies stopped at age 74. Well, lifespan for women now is around 83 years, so stopping at 74 makes sense if you only look at these ancient studies. It doesn't make sense in 2024.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Dr. Wilkinson, the last minute goes to you.
What advice would you give to Canadian women here today?
Medical Doctor, As an Individual
Screening is a very personal decision. You can make your own decision as a woman about whether that's something you want to do or not.
I agree. Know your risk and know it early. When you're 40, that's when you can start thinking about mammograms. The rates of cancer are not really high enough in the twenties and thirties to think about broadly screening, but if we had clear guidance from the task force, we'd probably have high-risk programs across the country. Right now we have them only in Ontario and Nova Scotia, so there's very limited access to that for women who realize they're high risk.
Conservative
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Thank you, Chair.
I want to echo my colleagues and thank all of you for being here. This has been really valuable testimony today.
I want to start with Ms. Kim MacDonald and a different type of screening that affects women who have experienced breast cancer. We were talking about it this morning. It's airport screening.
Even just today, you've had experiences as a breast cancer survivor in the airport. As we're coming up with recommendations, I'm hoping you can add this to the conversation.
Patient Advocate, Breast Cancer Canada
Yes, I would love this to be added to the conversation. This is something that breast cancer survivors talk about with each other. When you go through airport security, if you have prosthetic breasts or a bra that has some kind of light prosthetics in it, you are stopped. You are screened. You are patted down. You are treated like a criminal. This happens to me often, or I'll just go flat because it's easier and I know that I won't be patted down.
It's like you're being humiliated every time you travel. Also, you're telling a perfect stranger that you had breast cancer and you had a mastectomy. I told this woman at the airport that this is why I was being flagged. She said, “Okay, but I still need to do everything. Do you want to go to a room?” I said, “No, I don't have time to go to a room. Just pat me down right now. I'm not doing anything illegal.”
Time and again, women who have had breast cancer and mastectomies are stopped and treated as if they're smuggling something in, just because they're wearing prosthetic breasts. My suggestion would be that we have a card or something that gets us out of the humiliation, like people who may have an artificial limb or a plate when they get stopped. It's very personal. It's very embarrassing, and it happens all the time. It happens to me almost every time if I wear anything underneath my shirt.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
My next question was going to be about any potential solutions. You kind of touched on that. Do you know of any other sorts of examples, such as cards, that we could put forward?
Patient Advocate, Breast Cancer Canada
I don't know specifically. I just know that other people who have issues because of health who go through airport security can get a pass without being patted down. I think a card might be the best solution to get women who've had breast cancer past that.