Thank you for having me.

Honourable members of the health committee, thank you for convening this important study with such urgency.

I'm Dr. Sheila Appavoo, a general radiologist with an interest in breast imaging. I chair the Canadian Society of Breast Imaging's patient engagement working group. I also founded and chair the Coalition for Responsible Healthcare Guidelines.

I speak today about my serious concerns about the recent draft guidelines issued by the Canadian Task Force on Preventive Health Care regarding breast cancer screening, which recommend against screening women aged 40 to 49.

These guidelines stand in stark contrast to those provided by the U.S. task force, the Canadian Cancer Society and the majority of Canadian provinces, all of which have recognized the need to lower the screening age to 40. The Nurse Practitioner Association of Canada has also recently withdrawn its endorsement of the similar 2018 task force guidelines.

The task force decision not to routinely screen women aged 40 to 49 is biased. This stance was seemingly predetermined. The task force leadership indicated in the media in early May 2023 that there was no need to change the Canadian guidelines. This was before the evidence review began. Lo and behold, this prophecy was fulfilled almost exactly a year later.

How does the task force come to such different conclusions from the rest of the modern world? Without the context provided by the fulsome guidance of experienced content experts, they amplify harms, such as overdiagnosis and callbacks for additional imaging, and they minimize the benefits of early detection. One rarely hears the task force discussions mentioning the lives saved or mastectomies prevented by screening.

The U.S. task force has acknowledged and acted on the increasing incidence of breast cancer and racial disparities. Canadian research has found similar trends here at home, and the Canadian task force even acknowledges higher mortality in Black women in their forties, but fails them in its guidelines by begging off on a lack of evidence and abandoning common sense and the precautionary principle.

In every racial group except white women, breast cancer starts to peak in the forties, yet the task force makes little attempt to accommodate these groups. While acknowledging the influence of race, ethnicity, family history and breast density, the task force has minimized these important individualizing issues.

One of the misconceptions of the task force is that improved life expectancy is attributable to better treatment, with an implication that treatment is a substitute for early detection. This is problematic. Women with an early-stage diagnosis are far more likely to live out their full lifespan with less of the aggressive treatment, existential dread and generational trauma of a woman and her family dealing with a late-stage cancer diagnosis. Simply put, women with smaller, less advanced tumours tend to live longer and better-quality lives, and screened women tend to have smaller tumours than non-screened women.

It has been mentioned by some task force members that screening should be limited to control costs. This is a false economy. Screening is an investment, considering the cost of modern treatment. Work done by researchers in Ottawa has demonstrated that by screening annually from age 40 to 74, Canada would save around $460 million annually. The cost of treatment far outweighs the cost of screening. We cannot afford not to screen.

If instituted, the consequences of these new task force guidelines will be dire. Many young women will potentially pay with their lives. Most provinces and territories have recognized this and have allowed self-referral for women aged 40 to 49. However, the recommendation of a primary care provider is still the strongest predictor of whether a woman will actually go for screening. As long as doctors are being given the task force message that women in their forties don't need screening, many of those women won't get access.

By continuing to make the same recommendation that the task force has made since 2011, Canada's national guideline is falling further and further behind the provinces, other countries and expert recommendations. This has led to patchwork access for women across the provinces. Unfortunately, these guideline problems are not isolated to breast screening; they are part of a pattern seen in multiple other guidelines during the past 15 years of the task force's existence.

We must not allow these guidelines to stand as they are. We must have guidelines that are informed by the latest evidence and that truly serve the best interests of Canadians. With respect, looking at its record, we must dismantle and rebuild this task force.

Thank you very much for your attention to this issue.