Members of the Standing Committee on the Status of Women, thank you for the opportunity to comment on the draft task force breast cancer screening guidelines. As a breast imaging specialist, I diagnose women along their entire cancer journey. I detect breast cancer from screening, or I diagnose it after a woman presents with a palpable lump. I perform breast biopsies, and I localize breast cancers for the surgeons. I interpret the imaging of women diagnosed with late-stage or recurrent breast cancer. I speak to women at all stages of breast cancer.

Screen-detected cancers found before symptoms occur have a very different diagnosis than one found because of symptoms at stages 2 or 3, or already metastatic at stage 4. The task force falsely states that an additional imaging test is a harm comparable to a delayed diagnosis of a late-stage breast cancer. My patients attest that the severity of the harm of a delayed diagnosis vastly exceeds any stress associated with an additional imaging test.

The recent draft guidelines released by the task force for breast cancer screening have sparked significant concern within the medical community, and as an expert included on the evidence review panel, I found their recommendations profoundly disappointing. These guidelines ignore robust recent evidence that supports the initiation of screening at age 40, a standard now adopted by the U.S. task force and by numerous other countries worldwide.

The task force recommendations are anchored in studies that date back 40 to 60 years using obsolete technologies such as screen-film mammography. This reliance on outdated data overlooks monumental advances in breast cancer treatment, including hormone receptor-positive treatments, less invasive surgical options like lumpectomy, sentinel lymph node biopsy and all the modern immunologic and chemotherapeutic agents that have completely revolutionized breast cancer management.

The task force approach diminishes the importance of recent observational trials that involve millions of women comparing screening to no screening using updated diagnosis and treatment. This includes a large Canadian study of over 2.7 million women screened over 20 years showing a 44% reduction in breast cancer mortality in women who began screening in their forties. Similar studies in Sweden show an even greater benefit, with reduction in mortality of 50% to 60%.

Breast cancer is a devastating diagnosis, but the harms are mostly preventable when it is detected early. The survival rates are starkly different across the stages. It's nearly 100% five-year survival for stage 1 detected by screening compared to only 22% five-year survival for stage 4 when the disease has spread and become incurable. Further, the treatments are much less intensive and less costly when treated early. Stage 1 costs an average of $36,000 Canadian to treat as compared to stage 4, which can exceed half a million dollars per patient diagnosed. These statistics underscore the critical importance of early detection, which the task force draft guidelines fail to adequately prioritize.

The task force disregarded data that showed that women of race and ethnicity other than white are more likely to be diagnosed with breast cancer in their forties. This one-size-fits-all approach to recommending screening starting only at age 50 discriminates against these women and contributes to their twice higher rates of advanced breast cancer due to delays in diagnosis and lack of access to screening mammography programs.

The task force also acknowledged that women with dense breasts were twice as likely to develop breast cancer than women with non-dense breasts, but it failed to recognize the reduced sensitivity of mammography in these women, which drops from as high as 90% in women with non-dense breasts to a low of 60% in those with the densest breasts. The task force ignored very high-quality randomized trials that showed that adding screening with MRI reduced interval cancers, those that are found by symptoms after a normal mammogram, by 80% with MRI and by 50% in those screened with supplemental breast ultrasound. These interval cancers have been shown in evidence-based medicine to be acceptable surrogates for breast cancer mortality, which may take 10 to 20 years or more to demonstrate. They failed to acknowledge the importance of supplemental screening in these women and, again, are not following international standards.

We must demand that our health policies be reflective of the latest scientific evidence and best practices in medicine. As a medical community, we owe it to every woman in Canada to advocate for guidelines that are not only scientifically sound, but also reflective of modern medical technology and treatment advances.

Let us stand together to call for an immediate review and revision of the task force guidelines to truly reflect what is best for women's health today.

Thank you very much.