Health committee  What the U.S. did differently from Canada was that they took greater weight of the data showing an increasing incidence in younger women and the incidence of breast cancer in racialized women. But the Americans didn't get it perfect either. They're only saying to screen every two years.

Health committee  I'll be quick. Yes, what Dr. Nadler says is true, but we do know that the size and the nodal status still matter even for aggressive tumours. In fact, sometimes it matters even more. As I said, the five-year survival rate for stage one triple-negative cancer is 96%. Stage 3 is 47%.

Health committee  Let me just define this for the others. An interval cancer is one that turns up after a woman's last mammogram was read as negative. It's usually found as a lump. Interval cancers are more often the aggressive ones, the HER2-positive and so on. They are the rapidly growing cancers.

Health committee  First of all, I need to explain that it is well known that a percentage of women, perhaps around 10% plus or minus are going to be recalled. It is known that women are much less anxious if they're prepared ahead of time and if they're told that this could happen. It's most likely to happen on their first screening mammogram, because there are no priors to compare to.

Health committee  Every province does its own thing. Our screening program in British Columbia was the first in Canada in 1988. When we started, all women got a letter of invitation on their 40th birthday, and women were allowed to attend annually starting at 40 and going all the way through. It has gradually deteriorated over the years.

Health committee  Are you addressing me?

Health committee  If I understand your question, you're asking why breast cancer is getting more common in younger women. I don't think anybody knows the answer. One that was proposed that seems to make sense to me was, especially during the pandemic, there was greater consumption of alcohol. We know that alcohol is a carcinogen and is related to breast cancer risk as well as risks of other cancers.

Health committee  There is confusion between overdiagnosis and what a false positive is. The term “false positive” is incorrectly used by the task force. It's pejorative to refer to something abnormal on a mammogram that needs additional tests as a false positive. Yes, 95% of those turn out to be negative and the patient is reassured that everything is fine.

Health committee  First of all, the mortality reduction possible with screening depends on what kinds of studies you look at. There's one kind of research called a randomized trial, where you have a control group and a study group. Then there's observational data. Screening has been under way in Canada since 1988.

Health committee  They're at risk because their cancers aren't found earlier because they're not screened starting at age 40. They deserve the same opportunity of early detection as Caucasian women. Everybody should be screened at age 40, but absolutely, racialized women deserve their cancers to be found as early as Caucasian women's.

Health committee  You're quite right. Overdiagnosis is only important if it leads to overtreatment. Overdiagnosis actually applies to real cancers. These are not false positive. These are cancers that have been diagnosed on a biopsy. From that point, the patient is referred for care to a surgeon, to an oncologist or to a radiation therapist.

Health committee  Thank you. The first point I want to make is about family history, as you've heard a couple of times. It's very important that everyone understand that—sit down for this one—85% of women who get breast cancer have no family history. Women are at increased risk if they do, but that's not the only risk factor.

Health committee  Yes, I believe women are capable. It's patronizing for the task force to make a decision for women. If given the correct information, which is not currently in the decision tool, and given it in multiple different ways, women can make the decision for themselves. The task force plays down the benefits by using absolute numbers.

Health committee  With early diagnosis, women can have better treatment that's effective. They can have a lumpectomy, for example, instead of losing a breast with a mastectomy. The way they do the lymph node staging is also less aggressive. It's called a sentinel node biopsy. Compared to the traditional method, which left about a third of women with permanent swelling in their hand and arm, with the less aggressive sentinel node biopsy, the likelihood of lymphedema is as low as 2%.

Health committee  Thank you. Honourable health committee members, the Canadian task force understates the benefits of screening, but they are obsessed with what they call the harms. They recommend against screening women in their forties, even though women aged 40 to 49 are 44% less likely to die of breast cancer if they have mammograms.