Health committee  I agree that risk assessment is important. I think AI is going to play an increasing role. AI can find things in the mammograms that human eyes can't see, which can help us predict risk. There are the usual questionnaire kinds of things about family history and so on. Everyone should have a risk assessment, ideally around 30.

Health committee  There were, in fact, 11 randomized controlled trials. The first one was done in 1963. It was in New York, and it was called the HIP, which stood for their health insurance plan. Then there were several in Sweden. There were Malmö 1 and Malmö 2, Kopparberg and Östergötland, and then Edinburgh had a trial.

Health committee  Absolutely. Dr. Wilkinson's data shows that, and modelling shows that upwards of 400 lives per year of women in their forties were avoidable deaths from not screening women from 40 to 49.

Health committee  I don't think any one country does it all right. We do see, for example, in France and Austria, women with dense breasts are automatically recalled for supplemental screening. We have that now in British Columbia. Women who have category C and D breast density, can have supplemental breast ultrasound screening covered by their provincial health insurance.

Health committee  I'm happy to supply that evidence later. We'll supply that evidence.

Health committee  That is what we're saying. In fact, there were 28 former staff who came forward with evidence of protocol deviations. That's what they're called. That wasn't the only problem with the Canadian trial. In fact, they allowed women to be participants even if they had a known breast lump.

Health committee  That sums it up.

Health committee  The problem is that we don't know at the time we diagnose a cancer whether it is overdiagnosed, because we don't know yet when that woman is going to die. Now, you could argue for example—you heard this earlier—that if a woman is in good health and she has a life expectancy of at least seven to 10 years, then we should keep screening her.

Health committee  Can I jump in and build on what—

Health committee  I'm happy to do that. First of all, even the term “false positive” is pejorative. It's really fearmongering, because we're not telling women they have cancer when they don't. What they use the term “false positive” to mean is a false alarm, where something showed up on your mammogram and at the end of the day it's probably not going to be cancer, but it deserves another look.

Health committee  She's clearly declared her bias and her conclusion. You might be interested to hear that in that article called “Debunking myths about screening”, she claimed that earlier detection does not result in better outcomes. She said that's a myth. She said it's a myth that “newer technology produces more benefit”, and that it's a myth that screening saves lives.

Health committee  Yes. That's what's prompted this conversation. Normally the task force reissues its guidelines. The last couple have been every seven years. This has to be something.... Research is being churned out very quickly, and these guidelines have to be more nimble. They have to be able to be changed more frequently when more research is done.

Health committee  As you heard from Dr. Wilkinson, the Canadian task force procedures, to this point, have focused on rating the quality of evidence, if you will, and randomized control trials are always ranked the highest. The problem is that the randomized trials were all done between the 1960s and the 1980s, at a time when mammograms where done on X-ray film that you put on the light box.

Health committee  Thank you very much. I'd like the committee to know how futuristic and wonderful Dr. Simard's work is, but it is futuristic. Certainly, Dr. Narod's discovery of the breast cancer gene was pivotal, but we're dealing with guidelines now that deal with average-risk women. Only 5% of women are high risk, and the vast majority of women who get breast cancer have no risk factors, not even a mother with breast cancer.

Health committee  Thank you. I am Dr. Paula Gordon, and I'll start. Thank you for the opportunity to be here today. I am a breast radiologist. I've been in practice for over 40 years, reading mammograms and ultrasounds, and doing needle biopsies and other breast procedures. I've volunteered with Jennie Dale and Dense Breasts Canada for seven years as their medical adviser, advocating for optimal breast cancer screening.