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. I am greatly invested in improving patient care and experience through the health care system.

The recently issued Canadian task force recommendations, which excluded screening of eligible women between 40 and 49 years of age, came as a huge disappointment. The recommendations conflict with those of other reputable organizations, leading to confusion among health care providers and patients.

Canada's evolving ethno-racial landscape has been systematically excluded by task force recommendations, which are still predominantly based on older studies involving white women. The data is not fully representative of our population, leading to recommendations that might not be applicable, beneficial or safe for everyone. For example, Black women experience poor breast cancer survival rates, are more likely to be diagnosed with advanced-stage breast cancer and have biologically aggressive tumours, all of which occur at an earlier age than in white women.

Canadian data shows significantly higher proportions of stages 2, 3 and 4 breast cancers occurring in women in Canadian jurisdictions that do not include women in their forties in screening programs as opposed to those that do. Lower stage means less aggressive treatment, fewer side effects and increased disease-free survival. Stage matters. Modelling has shown that by not screening women in the 40 to 49 age group, we would see an additional 470-plus avoidable deaths every year. This is equivalent to allowing a passenger jet full of young Canadian women to crash every year because we refuse to screen them at the right time. This is the chilling reality of the situation.

Mammography is a compression technique. Tissues overlap, and up to 16% of women who come for their first mammogram are likely to be recalled for additional pictures or an ultrasound and sometimes end up with a biopsy with benign diagnosis. This percentage drops over subsequent years. Recalls are not harms. These are like sending your bag through airport screening. Most of the time, it goes through. However, sometimes it gets pulled out, opened, checked and given back, and occasionally a forgotten nail clipper gets thrown out. Most women are grateful that they went through the one extra step for safety.

The task force recommends shared decision-making to allow women to discuss with their primary care providers the age at which they should have a mammogram. In a country that is grappling with a severe shortage of family doctors, this is a distant dream. The power differential between the physicians following the task force guidelines and the patient is a barrier to shared decision-making.

The current tools provided by the task force are biased towards not having a mammogram. Among other recommendations, the task force recommended against supplemental screening for women with dense breasts. We know that dense breast tissue precludes finding breast cancers at an earlier stage, akin to finding a snowball in a snowstorm. This often leads to delayed diagnosis, greater stage and spread of cancer and more extensive and expensive drugs, which may lack funding. These drugs can have a devastating side effect that significantly diminishes quality of life and function.

The task force has stated that there was insufficient evidence to support supplementary screening, and they selectively chose to follow the U.S. task force on their dense breast recommendations. Meanwhile, there are decades of data that demonstrate the benefit of supplementary screening. More recently, Ontario conducted a health technology assessment and drafted a recommendation to publicly fund supplemental screening.

To conclude, we want guidelines based on new and inclusive science that are aligned with other international guidelines and that consider the changing landscape of diversity and ethnicity in Canada. Early detection with normal, personalized therapies is the best we can give women in their cancer journey.

No woman should be denied a mammogram. Self-referral should be allowed, and for those women who prefer not to have a mammogram, they should be free to opt out.

Thank you so much.