Health committee  At the gynecologic cancer initiative in British Columbia, where we're working across disease sites and across institutions and across disciplines to address all gynecologic cancers—because we can learn from each other, as I think you've seen here today—we have a goal to reduce death and suffering from gynecologic cancer by 50% by 2034.

Health committee  Yes.

Health committee  Yes, for the control group, we included basically the surgeries that women would have gotten prior to the recommendation that salpingectomy be included. Those were women who had hysterectomies alone, so their Fallopian tubes got left behind, or women who had tubal ligations, so their Fallopian tubes were tied rather than removed.

Health committee  Yes. In our colorectal surgery trial, the colorectal surgeons see that the average additional time in the OR has been four and a half minutes to remove the Fallopian tubes, so it's not difficult and it doesn't take long.

Health committee  That was a study we did that looked at hysterectomies and tubal sterilizations across Canada. What we found was that between 2017 and 2020, 80,000 Canadians received a tubal ligation or a hysterectomy without a salpingectomy, so they missed the opportunity to have their Fallopian tubes removed.

Health committee  You know, I think there was some hesitancy. There were some concerns around possible additional complications. I think the research has really addressed those concerns and shown that complications are not a risk. I do think there were some surgeons who were waiting to see the evidence of effectiveness.

Health committee  No.

Health committee  There should be a really easy answer to this question. Unfortunately, there's not, and that's partly because we're still in fairly early stages of the research. As you may be aware, the average age of diagnosis for ovarian cancer is 61. We actually do these opportunistic salpingectomies on people who on average are in their early forties.

Health committee  I agree with Jessica. As I mentioned in my speaking notes, Canada has really led the world in a lot of gynecologic cancer research and a lot of effective prevention and diagnostics. Endometrial cancer molecular classification started here. Opportunistic salpingectomy started here.

Health committee  I'm not an expert on how the federal government could communicate, but I think we have seen examples in the past of the federal government helping to get messages about health and wellness effectively out to all Canadians. I think that it would be incredibly powerful to use that as a way to get messages out about gynecologic cancer to ensure that Canadians are aware of prevention opportunities like opportunistic salpingectomy and that all Canadians are aware that HPV-based self-screening is available to them.

Health committee  I think there is a lot of really important research happening with respect to BRCA and detecting those mutations earlier. I know there are people who are part of the Gynecologic Cancer Initiative in B.C. who are looking at population-based testing. We absolutely need to identify BRCA mutations as early as we possibly can in order to offer those people the prevention that we know works in both preventing breast cancers and preventing ovarian cancers.

Health committee  Can I add one thing to that? Jessica did a wonderful job, but one thing I also wanted to mention is that we are now moving the research as well to try to target people who are at higher-than-average lifetime risk for ovarian cancer who might want to come in for a Fallopian tube removal surgery in order to prevent it.

Health committee  Yes, and I think the research that we've done nationally looking at differences and variation in uptake of opportunistic salpingectomy is really clear. If there were national standards and opportunistic salpingectomy was being done at the same rate in other provinces in Canada that it's being done in B.C....

Health committee  I would think that Tania would probably have much better information about the specific projects than I do.

Health committee  I think you've heard from some of the other witnesses as well about these inequities. Unfortunately, we do often see in research that where a woman lives dictates far too much in terms of what she gets with respect to cancer care. This goes from prevention all the way to the molecular testing that Dr.