Health committee  First of all, public education is very important. We are not spending enough dollars on informing people. We have a huge population now that is very diverse and we are not addressing that. The most important thing is the guidelines. The guidelines have to endorse that we need to do this.

Health committee  Yes.

Health committee  No, I don't think this information is available to any of us from the outside. I don't have any information. I'll just address another thing that was brought up, which is that mammographies don't pay that well. It is a misconception that reading more mammograms is an easy job. For example, a mammography would pay 10 times less than what a CT scan would pay.

Health committee  They invited some advisers—we heard from two of them today—for the evidence review. Other advisers were working directly with the task force. All of these people need to be talked with. Find out if the decisions that were made—the draft recommendations—were a unanimous decision.

Health committee  May I add to that?

Health committee  I want to echo Martin's sentiments that overdiagnosis is a word that is very difficult to understand. The role of screening is to find the cancer. How to treat the cancer is a different aspect of the cancer. To determine which cancer will be biologically aggressive and will grow and kill the woman versus which cancer will not grow but will allow the woman to die of some other cause....

Health committee  That's correct.

Health committee  Different organizations tend to have a bit of variation as to whether to start at 40 or 45. Even some organizations in the U.S., such as the ACS, recommend age 45. We have some provinces in Canada that recommend 45 and above too, so there's a bit of variation. However, overall, if you look at all the evidence that is currently available, it is a best practice to start screening at 40, and that's what we are pushing for.

Health committee  We see that all the time. There are people who come for screening and a very common comment is “These people are healthier than me”. As long as a woman is healthy and active and has at least a seven-plus-year life expectancy, they should continue to screen. That's what we are all recommending as part of our organizations.

Health committee  At the current time, there is a lot of discussion about risk assessment. It's been generally recommended, even by the NCCN guidelines, that women between 25 and 30 years of age can get a basic risk assessment profile. They are not yet at the age where systematic screening is offered, but they should at least get a risk assessment performed so that, in case there's a flag that they're high risk, appropriate steps can be taken.

Health committee  Thank you. Honourable health committee members, I am grateful to have this opportunity today to talk to you all about breast cancer screening, a topic that is very close to my heart. I am an academic breast imaging radiologist working at the Princess Margaret Cancer Centre in Toronto and am currently serving as the president of the Canadian Society of Breast Imaging.