Thank you for that. I think it's a great question.
I am based up in Prince George, which is where the northern medical program is. It's a very similar model to that of NOSM and came around the same time. The purpose is to develop a health care resource with respect to physicians who want to be in the north, who want to be in rural communities and who are perhaps better trained. At the University of British Columbia, we have mandatory cultural safety training for every health care provider student across disciplines, not just medicine but also pharmacy, dentistry, midwifery, social work, nursing, dietetics, speech and audiology—across the board. That helps, but I think we need to keep the focus on screening mammography.
First of all, I have never met a physician who did not start screening mammography in the forties, even after it was really hammered down that you start in the fifties. I do not know someone who, after seeing the end result of an undetected malignancy that was not detected with a screening mammogram, did not choose to pursue that.
In the data we have seen, over 30% of women in British Columbia choose the route of talking to their family doctor and getting a screening mammogram at the age of 40. Less than 20% of first nations women have done that. I think part of that is about the barriers that have been well described by Dr. Letendre and others. It's sneaking in anyway, but it's really a disparity about women, even without the firm guideline that women who are not first nations—because the data is specifically on first nations in the study I've done—should access screening mammography in their forties.
I think there's a mixed message, and it's unfair to health care providers. When there are recommendations and guidelines to start at the age of 50 but consider starting at the age of 40—some provinces say 45—it is stressful. It is hard to explain. When you hit age 40, you ask what screening is and why you do screening. It's hard to access, and you're dealing with other issues with respect to racism. There are mixed messages. In Ontario they do this; in B.C. they do that. I think we need to get a clear message.