Health committee  Thank you for that question. I would love to hear from my co-panellists on this as well. Yes, there have been significant reductions to research funding. I think if we're really going to stay competitive with research on an international level, then we need to restore this funding for all cancer types.

Health committee  Yes, I'm happy to send it along. We have research looking at the gender pay gap between male and female surgeons across Ontario, and also referral patterns, which can be partly attributable for these differences in pay. I'm happy to share those papers with you.

Health committee  I agree. Particularly on cases where there are very identifiable risk factors and on those cancers, such as endometrial and cervical, where we are seeing, unfortunately, an increase in incidence, that's where our attention should be.

Health committee  I actually don't believe that it is currently available in Atlantic Canada, but it should be.

Health committee  Sure. Building on some research that we had done previously, a group recently looked at procedures across Canada and the remuneration for procedures that are more commonly performed on male patients compared to female patients. These would be things like a hysterectomy compared to the removal of a prostate, for example.

Health committee  Specific to robotic surgery, it's a technology that's widely available in the U.S., but there have been barriers to bringing it to Canada, mainly related to cost. I do think that we need to be somewhat judicious with the use of robotics in Canada. I'm not recommending that it be used for every single patient.

Health committee  Thank you for that question. In terms of early diagnosis, I think it's really around access to endometrial biopsy. We need public awareness first. Patients need to know that they should go in and see their health care provider if they are having menstrual abnormalities. In terms of access to biopsy, it's not a complicated procedure to do in the office, but I do recognize that a lot of primary care providers are not comfortable providing this or experience other financial barriers, perhaps, to providing this test.

Health committee  Thanks for that question. They are few and far between right now. I believe Alberta was the first province to have access to robotic surgery. It's in B.C. and a few centres in Ontario, and I believe it is starting to expand more across Ontario ever since Ontario Health started to fund robotic surgery.

Health committee  Unfortunately, there has been a lot of work demonstrating that procedures performed on female patients are not remunerated at the same level as procedures performed on male patients, even for relatively similar procedures. There are a lot of factors that go into this. One of them is that most gynecologists are women, so as our specialty has become more female-dominated, we have not, unfortunately, been remunerated at the same rate as have male surgeons in other specialties.

Health committee  I think, as a starting point, you should look at the procedures in the schedule of benefits across provinces and compare them to comparable procedures on male patients and look at pay equity with respect to those procedures. There is a lot of consistent research now showing that this issue spans provinces.

Health committee  Thank you very much. With regard to a national health education program, I believe it was brought up as part of this women's health study relating to endometriosis and pelvic pain. Unfortunately, right now a lot of young girls have either painful, heavy or irregular periods, and they don't realize that it's something that can be treated to improve their quality of life.

Health committee  Yes. As I mentioned, for endometrial cancer, we are seeing a shift to younger and younger women being diagnosed. Relating back to issues around access, I think access to hormonal treatments that could be preventative, especially in patients you can identify are at risk.... Women with polycystic ovary syndrome, for example, are at a higher risk, and hormonal treatment could help mitigate that.

Health committee  Yes. I think that earlier this week the committee heard from Dr. Shannon Salvador, the president-elect for GOC. I do think that research in general for women's cancers in Canada is lagging behind and is under-resourced. Speaking to endometrial cancer specifically, often in younger women this is actually the first obesity-related diagnosis they will receive.

Health committee  When we are doing these surgeries we actually have to tilt patients' heads down in order to access their pelvis. The anesthesiologist is trying to ventilate the patients lungs, we're trying to expand their belly with gas so that we can see into their pelvis. When someone has obesity this can add a whole lot of extra weight or pressure on what the anesthesiologist is trying to do.

Health committee  Thank you very much. I'd like to thank the members of the House of Commons Standing Committee on Health for the opportunity to speak today about women and cancer for the women's health study. I'm here to advocate for the prevention of endometrial cancer, which is the most common type of cancer of the uterus, to suggest simple strategies that can be instituted by the government for early diagnosis, and to ensure equitable access to treatment for all Canadian women with endometrial cancer.