Thank you, Chair, for the opportunity to be here today.

As Dr. Turner mentioned, I am the head of surgical oncology, and my clinical practice is dedicated to the treatment of breast cancer and gastrointestinal cancers.

Particularly with breast cancer, the number of scientific studies is immense and varied. It is important that we don't make health policy decisions based on personal bias or even on a well-meaning desire to make a difference. You need experts who are impartial. They need to not have skin in the game. The statistics that go into these recommendations are complex, and you need experts to interpret the data correctly.

There is a misconception that mammography will prevent cancer or significantly de-escalate the treatment required. This is actually the exception rather than the rule. Breast cancer is not a single disease. We tailor breast cancer treatments based on protein profiles, which is the largest determinant of their treatment. Based on cancer subtype, there are some five-millimetre cancers that will get chemo, and some five-centimetre cancers that will not.

In the modern era of breast screening, this largely impacts how many women are diagnosed with stage 1 versus stage 2 cancers, with stage 3 and 4 cancers largely unaffected by screening programs. The treatment of stage 1 and 2 breast cancer is largely the same.

I believe the harms of screening are real. We know younger women are more likely to have an abnormal screen, which results in multiple follow-up tests and biopsies. Women commonly report this process as highly distressing. In some women, it is so distressing that they never go for screening again and miss out on future benefits.

However, on a health care system level, an increase in mammograms is a large financial and human resources problem, but the outflow of follow-up testing and biopsies is the greater problem and risks creating new and very significant delays in the diagnosis and treatment of those who actually have cancer.

What would be the most impactful to the breast cancer landscape in Canada? We need to increase screening in our current age groups, include women who are remote and those who have social disadvantages and belong to minority groups. In my practice, I see women who die of colorectal cancer at a young age, and people with cervical cancer and many other diseases. I personally see the lack of access to primary care driving more deaths in young women and young men due to this health care crisis.

We also have too few studies on breast cancer prevention, and there really needs to be a renewed focus on this.

In conclusion, I thank the committee and all the people here today who have a passion to improve the future of this disease, even if we see a different way forward.

My final comment is that I'm a 47-year-old mother, breast cancer surgeon and health care leader, and I have not personally had a mammogram, because I do actually believe in the work of the Canadian task force.

Thank you very much.