Health committee  For those of you who aren't familiar, we started a new program in Champlain region, the Champlain screening outreach program, which allows anyone without a family doctor to access cancer screening. More than that, it also is a proactive program. We go out and we link with different community organizations.

Health committee  Could I speak to the education of family doctors? I would just like to make it clear that the task force is a venerable institution, and there is an institutional bias that is created. I was the chair of the cancer care committee for the College of Family Physicians. I approached the college to ask if I could do some education for family doctors on breast cancer risk for women in their forties, after completing our research.

Health committee  We basically looked at stage distribution at diagnosis for the women who lived in these jurisdictions that had organized programs and those that didn't. What we saw was significantly more stage 1, less stage 2, less stage 3 and less stage 4 for women in their forties if there was screening.

Health committee  We do.

Health committee  In our survival study we looked at survival, but we also looked at incidence-based mortality to make sure we weren't looking at just lead time and—

Health committee  I agree with Dr. Gordon. I think we need risk assessment. The Mirai is the new technology looking at using AI to predict, based on a women's baseline mammogram, what her future risk would be and to help establish a screening interval. What I hear mostly here is that there are so many new technologies coming up and things changing that we need experts who know all this stuff on the bodies that are making these decisions.

Health committee  Our early detection programs are in essence task force guidelines. Those guidelines tell family doctors what to be doing for their patients and what test to be ordering.

Health committee  I would say that our closest counterpart is the U.S. They seem to be more open to looking at newer data that's not standardized randomized control trials. They seem to be more proactive. We tend to be very reactive with our guidelines. I think they are more innovative in terms of looking towards changes that could be made.

Health committee  I think that openness to different methodological processes would be good. When we say early detection we're talking screening, in essence. Although, you're talking about some other.... There are many things that are coming down the pipeline. One day we may be able to do a single blood test that does a screen, but we are not there yet.

Health committee  I would think the U.S. would be up there. Some of the European countries are quite proactive in terms of breast screening. I would go with the U.S. probably.

Health committee  Absolutely. Our study showed that if you treat DCIS, which is sort of a carcinoma in situ, that's about $15,000. Stage 1 is around $20,000. By the time you get to stage 3, you're up to around $100,000, and stage 4 is over half a million dollars. If you think that the women in their forties are going to present at some point with their cancers, they're going to just present with later-stage cancers or, like we saw in our study, they're going to be fifty years olds with later-stage cancers or they are going to have more cancers in their fifties because we didn't treat the precancers in the forties.

Health committee  Are you talking about a jurisdiction in Canada?

Health committee  That's a very good question. That's the crux of the matter, I think. We need to move beyond the old data. We need to move beyond 60-year-old data. We cannot use data from before we landed on the moon to determine our breast cancer guidelines now. We are moving into uncharted territory.

Health committee  Guidelines would be a really good start. We need something. We have an opportunity, and I think the national guidelines are a federal issue, because they are impacting all the outcomes in the province. We have an opportunity to do this differently, to be creative and to think about the impact of what we're doing.

Health committee  I can only elaborate on what I've experienced. Certainly, I've not seen transparency to date. Our recommendation was to not use old data as the expert. However, during the time that we were trying to establish the evidence base, it seems that the working group was already working on evidence—although I don't know where it came from, since we had not completed our review.