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.
Physician, Canadian Task Force on Preventive Health Care
Yes, go ahead.
We did have this information prior to their publication, and it did go into our deliberation.
NDP
Leah Gazan NDP Winnipeg Centre, MB
For example, “In the U.S., it was noted that in Black, Hispanic and Asian women, breast cancer peaks at an earlier age of 40 when compared to white women. Recent Canadian analysis shows that Caucasian women are the only group whose peak incidence is greater than 50.”
That was by Dr. McKerlie. Is her information inaccurate? It conflicts with what you're sharing here today.
Physician, Canadian Task Force on Preventive Health Care
I could share the data. I mean, you have to....
We have read the study, and what we find is that the median age of breast cancer diagnosis for Black women is 56, compared to 63 for white women.
NDP
Leah Gazan NDP Winnipeg Centre, MB
She goes on to say that, “The task force was aware of this recent yet-to-be-published paper from Statistics Canada” in terms of this research, “but did not lower the screening age.”
You were aware of this research for Black, indigenous, Hispanic and Asian women. What was your reason, being aware of the research, not to lower the screening age? You were aware of it.
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, I will try to just repeat it. Maybe Dr. Reynolds can do a better job at this.
We were aware of this information, and as I said, most racial groups in Canada have either no significant difference in incidence of breast cancer from white women or a lower incidence, except for women who identify as multi-ethnic, Filipina and Arab, but this does not translate in increased mortality. What we know about increased mortality is that for Black women in their 40s, there is one more per 1,000 women.
As I said, we in the task force will all ensure that this information is even more prominent in our documentation. It's already there. We're going to make sure it's even more prominent in our documentation.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you.
We would like to begin the second round.
Anna, you have the floor for five minutes.
Conservative
Anna Roberts Conservative King—Vaughan, ON
Thank you, Madam Chair.
I'm getting a little concerned about some of the comments that we've heard here.
I want to recognize Carolyn Holland in the room, who's a survivor.
As my first question, do experts vote on the guidelines? If they don't, why not?
Physician, Canadian Task Force on Preventive Health Care
Dr. Reynolds, do you want to take this?
November 18th, 2024 / 12:35 p.m.
Physician, Canadian Task Force on Preventive Health Care
Certainly.
The task force follows internationally accepted standards for our methods. When we're looking at experts in their roles, the recommendations are to have them as non-voting members. The reason for that is that what they see and how they see it is very different. They see people with disease, as opposed to family physicians and primary care. We see the entire population.
Specialists or experts tend to recommend interventions at a much higher rate and more frequently than independent panels. The evidence definitely supports that.
As a result, our experts are non-voting members, as per standard guidelines—
Conservative
Anna Roberts Conservative King—Vaughan, ON
I'm sorry to interrupt; I have limited time.
I just want to say that Carolyn was diagnosed at the age of 40, I believe. She's here today because of the early diagnosis.
We heard earlier from a witness, Dr. Daniel, who said that Black and indigenous communities struggle with getting a diagnosis. There was an indigenous woman who was diagnosed. She found a lump at age 22, and was put off. She was told to go home and take some T3, because it was just pain. At age 24, she went back, and sure enough, it was breast cancer.
Here's my question. I come from a financial background, and if someone came to me for a mortgage because I was an expert in that field, I would be better equipped to diagnose and understand what their needs are.
I go to my family doctor. I recently had knee surgery, and she had to direct me to a specialist. Why do we not have specialists on this task force who understand that women's lives are vital and important to the community?
Physician, Canadian Task Force on Preventive Health Care
Through you, Madam Chair, thank you.
The task force, as you know, provides recommendations for a broad array of topics, with breast cancer being one of them. In guideline development, it is recommended that those to whom the guideline is directed—for us, it's primary care—be the constituents of that panel. The experts have a perspective that differs from primary care. Theirs is completely valid in their realm of practice, and our perspectives are equally valid in our practice.
Conservative
Anna Roberts Conservative King—Vaughan, ON
I'm going to state something from one of our witnesses earlier. We had testimony that the Canadian task force argues that screening at 40 causes unnecessary stress that comes from callbacks. However, in the case of a life-threatening, ulterior diagnosis that affects your physical, mental and emotional health, while it was stressful waiting for the results from the biopsy, it would have been even more stressful and downright dangerous to delay screening and a possible diagnosis.
I'm sorry to disagree with you both, but I think women's lives are important and I think we need to revamp this task force to ensure that we have individuals on the task force who understand that I'm a woman and I can handle it. I can handle that news. I don't mind being called back if it means I'm going to be alive to tell my children and grandchildren that I survived breast cancer.
I'm not trying to put you guys down. I don't know where you're getting your research, but all of the evidence points to what the witnesses we've had said about how breast cancer must be diagnosed early in order to save lives.
If there's history in the family of breast cancer, why are we waiting?
Physician, Canadian Task Force on Preventive Health Care
If I may....
I'm sorry. Go ahead, Dr. Thériault.
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, am I allowed to answer this?
Physician, Canadian Task Force on Preventive Health Care
As I said, we're both clinicians. We have dealt with numbers of cases of different kinds of cancer, so we feel this.
The message we put forward is that breast cancer screening is a personal decision, and it is based on values and preferences. There are benefits. I will say that out of 1,000 women aged 40 to 49 who are screened for a decade, one will avoid a breast cancer death because of it, but there is also additional testing showing no cancer and there's overdiagnosing—
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you very much.
Unfortunately, I have to cut you off there. Thank you very much.
Next I'd like to welcome MP Hepfner. You have the floor for five minutes.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Thank you, Chair.
Thank you, Doctors, for being here to answer our questions today. I know you've been under some intense scrutiny as part of your role with this task force.
I was also going to ask about the lack of subject matter expertise on the panel, because we heard from a lot of witnesses who came to us that you didn't have any experts in radiology, oncology or other areas, specifically of breast cancer, on the panel. You've answered that partially. If you have more to add, please do.
In particular, I spoke with one radiologist who specializes in breast cancer. She said she had an opportunity to review the findings of the panel, but if she was going to do so, she would have had to add her name to the document, and then she would not have been able to take her name off the document if she had disagreed with the findings. She said subject matter experts were staying away from consulting with the task force because they couldn't have a say on whether they agreed with its findings or not.
What's your response to that?
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, there's a lot to answer in that, but I've already explained that we had four experts in the working group from the beginning to the end. They were oncologists, radiation oncologists, radiologists and breast surgeons.
You can find on our website all the comments that have been made on our systematic review and our answers to them. There are not many groups that do that and are transparent like this, putting forward publicly all that we've received and all the answers we've given to these comments. We will continue to be transparent.
For the other part of the question, I don't know if Dr. Reynolds wants to comment.
Physician, Canadian Task Force on Preventive Health Care
Transparency is so important. We want to have clinical experts and subject matter experts to be able to provide their input, but they also have to be transparent about it. We say putting their names on it does not mean that they agree with the recommendations, but we have to be transparent that they provided input into it. Otherwise, we would be hiding something, and we're not doing that; we're a transparent organization.
These are principles of good guideline development that are consistent with our best practice methods.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Thank you.
I also spoke with a group of experts in cervical cancer, and I believe there are screening guidelines coming up for them. Are you the same group? Will you change any of your task force or any of your methodology, given the history for breast cancer, when it comes to cervical cancer?
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, the task force does make recommendations on different screenings, and yes, cervical cancer screening is one of the topics.
It is ongoing. We have experts involved in the process. As we do all the time, we send all of our documents—such as the protocols, the systematic reviews and the guidelines—to interest holders. All of these people can participate and give comments, and we will answer these comments and make that public, yes.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Okay. Thank you.
Dr. Thériault, I think one of the reasons this issue got so heated early on, before you even came out with the recommendations, is that you were getting into social media fights with survivors and other experts. How is that helpful?
Physician, Canadian Task Force on Preventive Health Care
You could read all my posts....
I don't know how to answer that, Madam Chair. I'm sorry I didn't address you first.
You can read all my posts. I don't think I got into any fights, but I would have put forward little things. For example, they would say that breast cancer screening in your forties would reduce breast cancer death by 50%. I would put forward that, while this is what we depicted, from two deaths out of a thousand to one out of a thousand, that's 50% less. This is the extent to which I intervened—to give some factual data that is easier to understand for patients.
Liberal
Lisa Hepfner Liberal Hamilton Mountain, ON
Okay. thank you.
When you talk about breast cancer screening being a personal choice for women, do you think that's taking into account the barriers that many women face, such as not having a family doctor, not having access to your family history, not necessarily knowing or growing up with the notion that you have to check yourself?