Maybe I can take this—
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.
Physician, Canadian Task Force on Preventive Health Care
Maybe I can take this—
NDP
Leah Gazan NDP Winnipeg Centre, MB
Sorry; I'm going to finish.
This is very troubling, because you spoke about how you were trying to reflect the values and preferences of your subjects in the recommendations, yet you don't know the sample. Is that what I'm hearing?
Physician, Canadian Task Force on Preventive Health Care
What you're hearing is that there's no evidence for those people.
What we're trying to get across is that we need—
NDP
Leah Gazan NDP Winnipeg Centre, MB
I'm going to stop you there. There's no evidence on these people, so your recommendations, then, did not take into account Black people, indigenous people and people of colour.
Physician, Canadian Task Force on Preventive Health Care
I would respectfully, Madam Chair, say to just go and look at our tools. It is mentioned. We have a mention of the increased deaths in Black women. It is mentioned. It's all there. What we know is there.
Conservative
The Chair Conservative Shelby Kramp-Neuman
Thank you very much.
At this point, Laila, you have the floor for five minutes, please.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, Madam Chair.
I want to thank you guys for taking the time to come here.
I think it's pretty clear at this point that Canadians don't trust what you've put out. Canadian women shouldn't trust what you've put out. In fact, most provinces have decided that your guidelines aren't worthwhile and have changed their guidelines on their own.
The biggest comparison to our country is the United States, and they've lowered it to 40. You've completely ignored anything they might have decided as to why they've done that.
Here you've been continually trying to say that the harms from breast cancer screening outweigh some women living. This is incredibly concerning. Effectively, the harms that you've been able to describe to us at this committee are anxiety. Frankly, women can handle anxiety.
I've had to live most of my life—in fact, my entire adult life—without my mom because my mom got breast cancer and died at 49 years old before cancer screening would have allowed her to potentially catch that cancer. She might be here today had she found her cancer before it was at stage 4, when virtually every option was closed to her. She lived 11 months after she was diagnosed with stage 4 breast cancer.
I will not accept that anxiety and false positives are somehow the same as women dying.
Just based on rough math, one person will die. That means 400 additional deaths. Your study is saying it's okay because only 400 women will die. I don't know if anyone around this table is okay with an extra 400 women dying because the stress and anxiety are too much.
What do you have to say to these women and the families of these women who are having to now live with that?
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, I will start answering that, and then Dr. Reynolds will continue.
Our recommendation doesn't say that harms outweigh the benefits or benefits outweigh the harms. Our recommendation says that women can be and should be empowered to have the information about the benefits and harms to take the decision that aligns with their values.
Dr. Reynolds, do you want to add to that?
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Your data also says that you don't think women between the ages of 40 and 50 should get screening, because you've decided that the benefits don't outweigh the harms, and therefore this is the conversation we're having around this table. We've had the same conversation around the health committee table. We're now having it at the status of women committee table.
We're wondering how we've had witness after witness—experts—come in here and say that this is not working, and yet you are standing with this. The health minister went to extraordinary lengths and even wrote saying that he was disappointed with your findings, and you're standing here before our committee saying that this is all okay and you stand by your findings. How do you stand by your findings?
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, our role is to look at the evidence and to put all the evidence together to come up with a recommendation. That's our first role, and that's what we have done.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
We very clearly heard that the evidence is sorely lacking. Women's health does not get the appropriate amount of research compared to other types of health. Of course, there might not be enough evidence.
When the United States has decided that it's worth lowering cancer screening down to 40 and most provinces have decided that it's worth it, why are you so intent on standing by clearly flawed evidence, rather than potentially thinking that women's lives are worth it?
Physician, Canadian Task Force on Preventive Health Care
Dr. Thériault, maybe I can step in.
Physician, Canadian Task Force on Preventive Health Care
Yes, go ahead, Dr. Reynolds.
Physician, Canadian Task Force on Preventive Health Care
These recommendations are conditional. They're conditional on the values and preferences of individuals.
We are not saying,“Don't. Everyone, do not.” We are saying not to do systematic screening for ages 40 to 49; we are saying to inform women about the benefits and harms and let them decide.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
You are also saying that women under 50 shouldn't get screened, which means people like my mom die. That's the reality. That is the absolute reality.
Because she was under 50, my mom was not eligible to get a mammogram until she found a lump. My mom has been dead for nearly 15 years. That's the reality. That is what we're dealing with right now.
Physician, Canadian Task Force on Preventive Health Care
I hear your pain. It's obvious. I hear your pain at this moment.
If you read our recommendation—
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
It is beyond pain.
You are not taking into account anything to do with the women who have had to go through additional chemo, radiation, surgery and all the rest of it. You are not taking into account any of the additional harms that come with later-stage diagnosis.
I'm sorry. I'm not just angry about my mom; I'm angry about every single woman whose life is impacted because this screening guideline has failed. This is flawed. I'm angry because there are families who have lost loved ones because you refuse to accept that your evidence is flawed and perhaps your answer needs to change.
You came to this committee, continued down that path and doubled down. Do you know what? Everyone around this room does not like what you've said and we do not agree with what you've said.
Conservative
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Madam Chair.
This committee heard from doctors Jean Seely and Anna Wilkinson that screening women from age 40 would save our health system over $400 million every year. It is a big amount. It is a big burden on the health care system.
Did the task force consider these savings in its analysis of the benefits of the screening?
Physician, Canadian Task Force on Preventive Health Care
The method of the task force is really to look at the benefits and harms for the individual person. We have a section in which we do look at implementation and cost-effectiveness, but it's not the basis on which we make our recommendations.
That is....
Yes, go ahead.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Dr. Reynolds, several witnesses have told us that your task force ignored and dismissed input from experts.
One of them, Jennie Dale, said that “experts were excluded from voting on the guidelines” and that the task force publicly “cast doubt” on those experts' integrity.
What do you have to say about this?
Physician, Canadian Task Force on Preventive Health Care
Through Madam Chair, I think it came to me, Dr. Thériault. I will be pleased to pass any additional questions or issues to you.
We included experts on the working group. We included experts—a radiologist, a radiation oncologist, a medical oncologist and a breast surgeon—on the working group from start to finish. They were intimately involved with the guideline, along with our patient partners, throughout the process.
The idea that we did not include experts in this guideline is false, plain and simple. It's false.
Liberal
Sonia Sidhu Liberal Brampton South, ON
We heard repeatedly in this committee about breast density as a risk factor of cancer, yet the task force gives women with a high breast density the same recommendation when it comes to screening as women at lower risk in their age bracket.
Why didn't the task force highlight the difference and the benefit of screening?
Physician, Canadian Task Force on Preventive Health Care
Madam Chair, referring to our tools, you can see that we did highlight the potential higher benefit for women with dense breasts. It is in our tool. We said there were 1.9 deaths averted instead of one, based on one study of higher risk.
The other thing is that we looked at whether we should screen women with dense breasts differently. We looked for studies that said whether we should add ultrasound or MRI. As the U.S. found in May 2023, there is no such study to inform patient-oriented outcomes.