Thank you very much for that.
Evidence of meeting #131 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 #131 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.
Prof. Juliet Daniel
I would also like to ask the chair what they would say to someone like me, who was diagnosed at the age of 45.
I found the lump because my mother passed away of ovarian cancer when I was 22. That is what inspired me to become a cancer researcher. I was very aware of what I needed to look for and what I needed to do. My family doctor and I were incredibly diligent in assessing my health on an annual basis. I had my annual physical in October 2008. Three months later, I found the lump in my breast—
Conservative
Prof. Juliet Daniel
It went from being a very small tumour to a very big tumour in three months. Because I'm a scientist, I was able to ask for a mammogram, etc. The average person doesn't have that scientific background and wouldn't know how to advocate for herself.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you very much for sharing your story and your expertise.
Next, I would like to give the floor to MP Damoff for six minutes.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
Thank you, Chair.
Thank you to the witnesses for being here today.
I've had the privilege of visiting Dr. Daniel's lab. I hope, Dr. Caron, that I can get out to yours in Prince George as well.
I would say that you are two of the leading experts in Canada, if not in the world, on the experience of indigenous and Black women with breast cancer. I'm wondering if the task force consulted with either of you when it was determining its guidelines.
We'll start with you, Dr. Daniel.
Prof. Juliet Daniel
To be honest, I don't even remember. I've been consulted on so many things over the past two years that I actually don't remember. I don't specifically remember being consulted. I know I was on a panel with several people regarding breast cancer in general, but I cannot remember if it was the task force.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
That's okay.
Dr. Caron, did they reach out to you at all?
Professor, As an Individual
I really appreciate your asking that. No, they did not. They did not reach out to me. I'm not aware if they reached out to my colleagues who work with me in this area either.
I just wanted to acknowledge Dr. Daniel's personal story and the overlap in terms of the peoples in this country who are missing out. I think the task force really focuses on the majority, which makes the majority of people feel safe, content and represented, but it doesn't change the harm that's being done.
I agree wholeheartedly that a social determinant of health is indeed racism, but I also want to point out what Dr. Daniel described and say that I think a social determinant of health is also access to research. The reason that screening mammography is firmly recommended at 40 or younger—really, younger—for women with genetic abnormalities that actually increase their risk of breast cancer is that the research has been done to show that there are genetic abnormalities in those populations that put them at a massive risk of breast cancer.
I would say, in regard to Dr. Daniel's population, whom she stands up so wholeheartedly for and is a voice for—a cry in the woods—overall, I think we need to start to recognize that just because there is an absence of data does not mean that there's an absence of risk. It means that there is a lot of work to do so that we can stop being what I used to refer to as “the asterisk nation”.
An example is the triple-negative data, absolutely. There was a well-known risk years ago with respect to African-American populations in the United States, but there was no data in Canada around the massive increased risk in that population. Interestingly enough, when it came to the “North American Indians”, which was the terminology used in those studies, there was no data even available. We could not even comment on it.
The absence of data, the paucity of data, is not something to rest on and say, “Whew, it doesn't seem like there's an increased risk.” I think it needs to be acknowledged and put forward, and then we need to ask ourselves what we are doing in creating guidelines when we don't even have adequate information to base these guidelines on for these populations that the Canadian government is responsible for hearing.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
Thank you. I actually have a quick question for the chair.
I know Dr. Daniel has a manuscript she could submit as a brief, Chair. I'm wondering what the deadline is for briefs.
Maybe while you look at that—I don't want to use all my time while you look—the guidelines talk about people who are at higher risk, and you both talked about how Black women and indigenous women are at higher risk. I think, Dr. Caron, you touched on this as well.
Do they actually have any idea they're at higher risk? Even white women might have the triple X gene. How do they know unless they've been tested? Maybe they have a diligent family physician who follows the genetics of breast cancer, but is it a legitimate claim from the task force to say that people who are at higher risk can access screening at 40?
I'll start with you, Dr. Daniel. I have about a minute and a bit left.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
No. Do they even know they're at risk? Would they even have any concept that they were at risk that would lead them to go to their doctor and say, “I'm high risk. I need a mammogram”?
Prof. Juliet Daniel
In partnership with The Olive Branch of Hope, this is what we've been doing now for about eight years. We've been going to Black communities across Ontario, and doing some virtual events in Nova Scotia and other places of Canada, to basically educate and inform Black women about triple-negative breast cancer.
For the record, I would like to state that when I first applied for funding in Canada to study triple-negative breast cancer in Black women—I believe that was in 2013, and I didn't get funded—one reviewer said that my study of Black women with triple-negative breast cancer was not relevant to the Canadian context. Receiving that as a Black researcher and Black breast cancer survivor and being told that studying a very aggressive breast cancer subtype in Black women in Canada was not relevant to the Canadian context was a serious affront to me and every Black person in Canada. That hurt to the core.
Part of our mission became to ensure that we educated every Black woman about her risk. We have them fill out family history charts. To Dr. Caron's point, not everyone is aware of their family history. Again, there's a stigma. Many of us were told this person died from old age. In the Caribbean, people won't even say the word “cancer”. They say, “Oh, they had the C-word.”
We have to be aware of these cultural differences and nuances. Again, that's why, as I said, the manuscript we're writing is called “one size does not fit all”, because we have to be aware of this.
Conservative
The Chair Conservative Shelby Kramp-Neuman
That's excellent. Thank you very much.
At this point, MP LaRouche, you have the floor for six minutes.
Liberal
Pam Damoff Liberal Oakville North—Burlington, ON
I'm sorry, Madam Chair. Will you give us the date for the brief?
Conservative
The Chair Conservative Shelby Kramp-Neuman
MP LaRouche, wait just one minute.
The date for the briefing has passed. It was October 21 for briefing documents with recommendations. If, indeed, you'd like to submit or have someone submit reference documents without recommendations, they can still be received, but the date was October 21.
Conservative
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you very much, Madam Chair.
I also want to thank the witnesses very much for their contribution to this important study.
During the break week, one of my activities was to attend a breakfast conference organized by the Haute-Yamaska Chamber of Commerce and Industry. It was very interesting. The conference focused on what you do when cancer strikes in a business. It was organized by the Quebec Cancer Foundation. The guest speaker was Ms. Danièle Henkel, a businesswoman who was diagnosed with breast cancer.
It was interesting, but, based on what I heard in discussions after the event, beyond the taboos that remain in business and the difficulty for women to announce this diagnosis, there is unanimous agreement that screening should begin at 40.
Since this is what I understood from their opening remarks, all the witnesses can answer the question.
I hear that there are many concerns, but if screening is extended to people from age 40 when resources are already insufficient, how will we ensure that services aren't stretched thin and that no one is penalized? How do you picture that? We're talking about screening starting at age 40, but we have to ensure that resources are also increased to provide the necessary services and that no one will feel hindered by a lack of access to resources, specifically.
Almost all of you also raised access to resources in your opening remarks.
Ms. Daniel, Ms. Sheppard, Ms. Kewayosh and others, you can answer those questions.
Director, Indigenous Cancer Care Unit and Indigenous Health Equity and Coordination, Ontario Health
I'll go first, if everyone is okay with that.
In Ontario, we have expanded the Ontario breast screening program to women age 40. We wouldn't do that unless we had the capacity to invite women age 40 and up to be screened. In terms of the challenge, it's the follow-up. Many indigenous women, especially those from remote communities in the northwest, have difficulties with follow-up care. Some have even said no to follow-up care because it means leaving communities where they are the main provider of care and nurturing at home.
I'm going to invite Amanda Sheppard to speak to that as well.
Conservative
The Chair Conservative Shelby Kramp-Neuman
I'm sorry to interrupt you, Dr. Sheppard.
Ms. Kewayosh, the next time you have the floor, can you be mindful to push your boom mic a little bit away from your mouth? There was a little bit of static.
Dr. Sheppard, please go ahead.
Dr. Amanda Sheppard Senior Scientist, Ontario Health
Thanks for that.
I'll just add that there has been research in the Ontario context, and we do know that access to mammography is challenging. We know that fewer first nations women who live on reserves receive mammograms, particularly in remote communities.
I think that this is also a call for non-insured health benefits to ensure that there is funding. As we're talking about access, adequate funding is needed for flights and supports to get women to mammograms. That point hasn't been raised yet, so I want to mention it.
I also want to reiterate a point that Alethea shared earlier, which is that we know that when first nations women are diagnosed early—so, stage 1—there's poor survival. I think that's a really important call for early screening and close attention to follow-up care.
Thanks.
Professor, As an Individual
Madam Chair, may I please speak to that question?
Professor, As an Individual
I think it's a great question. Given time constraints to point out a few things, again, words mean a lot. There is a difference between access to screening mammography and utilization of screening mammography, and they come from very different cost expenditures, efforts, roles and responsibilities.
In British Columbia, we are trying our best to address both, increasing access not only in terms of geography but also by doing screening mammography with mobile units that go into rural, remote, indigenous and northern communities in the province. That is greatly increasing access.
Utilization means that a woman is aware of it, trusts it and chooses to use that resource. That means dealing with entities such as health literacy and cultural safety.
When it comes to cost, it becomes very challenging. It's above my pay grade to look at what a human life is worth, but we also have to remember that screening mammography not only detects cancer early but also has a preventive aspect.
Many of the patients I see who have had an abnormal mammogram are referred to a surgeon. I proceed to do the next steps. Often it is something such as DCIS, ductal carcinoma in situ. It is in situ and early, technically before stage 1. It can prevent invasive carcinoma from developing, or it can even be more up stage as ADH, LDH or LCIS.
The bottom line is that there are pathologic findings that you can find that are not invasive breast cancer but that change the risk profile of a woman so that she knows that she should get annual mammograms after that, do breast self-exams and do those annual physical checkups with her family physician to prevent breast cancer. Preventing breast cancer decreases the need for surgeries, chemotherapy, hormone therapy, radiation and all of the health care required for the complications and the care.
Finally, when it comes to women in their 40s, we have to remember that these women are caring for their children and are often caring for their parents. They are the crux of society. We must protect them.
I hope I look like I'm in my 40s; I'm not. There is no kind of self-benefit from this, apart from the fact that I do have people I love in my life whom I want to protect. I strongly, strongly think that it is worth a screening mammogram in their 40s and that screening is appropriate to the risk of this common malignancy.