Thank you very much.

Honourable members of the Standing Committee on the Status of Women, thank you for convening this important study with such urgency. I spoke yesterday at HESA, so any resemblance between today's statement and my statement from yesterday is purely coincidental.

I'm Dr. Shiela Appavoo. I'm a general radiologist with an interest in breast imaging. I founded and co-chair, along with Dr. McKerlie, the Canadian Society of Breast Imaging 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 guideline issued by the Canadian Task Force on Preventive Health Care regarding breast cancer screening that is recommending against screening women 40 to 49. This guideline stands 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 The Nurse Practitioner Association of Canada has also recently withdrawn their endorsement of the similar 2018 task force guideline.

The decision to not screen women 40 to 49 is biased. The May 30 news that the task force had again refused to recommend screening for women 40 to 49 was not a surprise to those of us following along with the guideline development process. This result was predetermined. The task force leadership indicated in the media in early May 2023, immediately following the release of the U.S. task force guideline draft, 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, benign biopsies and callbacks for additional imaging, and they minimize the benefits of early detection. In their calculations they do not include important morbidity benefits of screening, such as decreased rates of mastectomy, chemotherapy or lymphedema, a permanent, disabling and disfiguring form of arm swelling caused by aggressive lymph node surgery needed for later-stage cancers.

The task force’s focus on the harms of screening, particularly the anxiety of recall, is paternalistic. The paternalism of making decisions for women because of their concern about the possible reaction of anxiety to a recall is disturbing. It’s tantamount to saying, “Don’t worry your pretty little head about breast cancer.”

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 breast cancer screening recommendation that the task force has made since 2011, Canada’s national guideline is falling farther and farther behind the provinces, other countries and expert recommendations. Unfortunately, these guideline problems are not isolated to breast screening and are a pattern seen in multiple other guidelines, including those that directly affect women’s health.

Please bear with me as I veer slightly off the topic of breast cancer, as this is important for context. The task force’s pregnancy and postpartum depression, lung cancer and cervical cancer screening guidelines are similarly dismal. All of these affect women.

The cervical cancer guideline has not yet been updated since 2013, despite multiple landmark studies that should have prompted a revision. It does not recommend HPV screening, although this was recommended nationally and instituted in such countries as the U.K., Australia, Norway and the Netherlands dating back to 2017. While Australia is on its way to being the first country to eliminate cervical cancer through vaccination and HPV screening, women in Canada have been getting invasive cervical cancer—avoidably—for the greater part of a decade because of this weak task force leadership.

We must not allow these guidelines to stand as they are. We must have a breast screening guideline that is informed by the latest evidence and not by paternalism, one that truly serves the best interests of Canadians. With respect, looking at its record, we must dismantle and rebuild the Canadian Task Force on Preventive Health Care to safeguard Canadians in the future.

Thank you for your attention to this critical issue.