House of Commons Hansard #94 of the 41st Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was drugs.

Topics

The House proceeded to the consideration of Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, as reported (without amendment) from the committee.

Speaker's Ruling
Breast Density Awareness Act
Private Members' Business

7:05 a.m.

Conservative

The Speaker Andrew Scheer

There is one motion in amendment standing on the notice paper for the report stage of Bill C-314, standing in the name of the hon. member for Vancouver Centre. At first glance, it appears that this motion could have been presented in committee.

However, in submitting her motion for consideration at report stage, the member for Vancouver Centre provided the Chair with a written explanation in which she outlined her efforts to propose a similar amendment during the clause-by-clause study of the bill, and where she explained that her amendment was based on the testimony of witnesses who had appeared earlier in the meeting. As the committee desired to proceed with the clause-by-clause study of the bill immediately after hearing from the bill's sponsor and other witnesses, she did not have time to avail herself of the drafting services of the parliamentary counsel assigned to the bill.

Upon presentation of her amendment, the member was cautioned by the chair of the committee that there was some concern over certain legal terminology her amendment contained that might have had the undesired effect of infringing on the financial initiative of the Crown. In this case, there was not sufficient time for the chair of the committee to carry out the necessary consultations and provide a definitive ruling on admissibility. As a potential remedy to this unusual situation, the chair of the committee suggested to the member that she might wish to submit her amendment at the report stage instead.

Having received the committee's consent to withdraw the amendment, the member for Vancouver Centre explained that she was able to consult with parliamentary counsel and the legislative clerk assigned to the bill. She was thus able to prepare a motion for the report stage which she feels, and I agree, does not appear to infringe on the financial initiative of the Crown. Therefore, due to the exceptional circumstances outlined above, the Chair has selected for debate the motion submitted by the member for Vancouver Centre.

I shall now propose Motion No. 1 to the House.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:05 a.m.

Liberal

Hedy Fry Vancouver Centre, BC

moved:

Motion No. 1

That Bill C-314, in Clause 2, be amended by adding after line 20 on page 3 the following:

“(d) ensuring, through the Canadian Breast Cancer Screening Initiative, the collection, processing and distribution of information on best practices for the screening and detection of cancer in persons with dense breast tissue.”

Mr. Speaker, this is a very simple amendment. It says that there is already a Canadian breast cancer screening initiative. This vehicle, without any extra cost or work whatsoever, can conduct the collection, processing and distribution of information on best practices for the screening and detection of cancer in persons with dense breast tissue.

This is necessary because we listened to many witnesses who said that there are some places where this is being done well in Canada. There are other places that are doing some fairly remarkable innovative work in collecting this information. Witnesses felt it would be quick, easy and very valuable if other provinces and areas could use some of those best practices. Those provinces and areas would not have to reinvent the wheel because in many practices currently there is excellent work being done. It has been done for long enough now that there is evaluation that says this works very well.

There have been suggestions from the Canadian Cancer Society and cancer associations that in places like British Columbia the outcomes from breast cancer screening, treatment and surgery are by far the best in the country, by a really large percentage. We need to look at some of the areas which are doing good work, borrow it and use it without having to spend a lot of time reinventing the wheel, as I said before. This would be very beneficial.

This is an excellent amendment that would really enhance the bill to a great extent.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:05 a.m.

Conservative

Patrick Brown Barrie, ON

Mr. Speaker, Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, is a piece of legislation that I have drafted because I truly want to make a difference. I want to ensure more women are aware of the impact of dense breast tissue on the analysis of a mammogram.

The bill would encourage the use of existing initiatives to increase awareness among women about the implication of dense breast tissue for breast cancer screening, and to assist women and their health care providers in making well-informed decisions regarding screening. It would recognize the work done by the provinces and territories and by many organizations in working towards these important goals. It outlines partnerships that our government has developed to enhance understanding of and to disseminate information about dense breast tissue during screening. I want to thank members from all parties for their support of this bill. I know full well that we are all anxious to ensure the bill passes as quickly as possible.

I would like to thank the hon. member for Vancouver Centre for her support and interest in this bill. She has expressed a desire to ensure best practices are disseminated. She has pointed out that Bill C-314 refers to sharing, through the Canadian breast cancer screening initiative, information related to the identification of dense breast tissue during screening and any follow-up procedures.

Indeed, the Canadian breast cancer screening initiative already helps us look at the best ways to raise awareness of dense breast tissue. The initiative also helps provide screening performance information and support evidence-based decisions.

Launched in the early 1990s, the initiative fully respects the role that provincial and territorial programs play in the early detection of breast cancer in Canadian women and the importance of sharing information and exemplary practices. In fact, it enables provinces and territories to continually share information on their screening programs, and discuss what they are learning.

To ensure strong collaboration and to work in a collective fashion to assess breast cancer screening programs, the government established the federal, provincial and territorial national committee for the Canadian breast cancer screening initiative. The committee is instrumental in providing us with the opportunity to work with provincial and territorial governments to measure screening program performance throughout the country and to develop better screening approaches.

This committee also includes non-governmental organizations, medical professionals and stakeholders. This allows for more opportunities for dissemination of practices, as well as for sharing different views. The initiative is aimed at evaluating and improving the quality of organized breast cancer screening programs. By facilitating information sharing about breast cancer screening across Canada through governments, practitioners and stakeholders, it can achieve this goal.

The bill clearly outlines the need for the Government of Canada to “encourage the use of existing programs and other initiatives that are currently supported by” the entities that have a role in breast cancer screening, be it prevention, detection, treatment, monitoring, research or the provision of information. Collaboration amongst these entities is instrumental.

Members will note that there is a great deal of good work under way through the Canadian breast cancer screening initiative. Jurisdictions are working together, sharing best practices and discussing questions that are important to them.

The amendment brought forward by the hon. member is consistent with the goals and approach of the initiative. The national committee has well-established partnerships to undertake identification and distribution of information on best practices. The committee can direct analysis on breast cancer screening, including best practices for dense breast tissue.

The dissemination of information and facilitation of use of best practices in screening in assessment are key objectives of the initiative. Provinces and territories can use this information for their respective breast cancer screening programs. The proposed amendment speaks to the need for collecting and processing information on best practices for breast cancer screening, and more specifically dense breast tissue. This is a fundamental part of the initiative. It is already enabling us, along with our provincial and territorial colleagues, to look at the best ways to raise awareness of dense breast tissue.

The Public Health Agency of Canada, through the Canadian breast cancer screening database, collects, synthesizes and distributes information on the breast density of women who are screened. It provides this information to provincial and territorial breast screening programs to support the development of best practices.

The concerns with the amendment are with regard to the word “ensuring” used in the proposed amendment. The work of the Canadian breast cancer screening initiative is not controlled by the Public Health Agency of Canada, and as such should not be ensuring the collection, processing and distribution of information or ensuring the identifying, synthesizing and distributing of information.

Therefore, while l appreciate the intention of the hon. member for Vancouver Centre, I do not see the need for this amendment. As we all want to get the bill through, I ask my fellow colleagues to continue to show support for the passage of the bill. Greater awareness and information about dense breast tissue will enable us to make a difference. It would help women and their doctors make well-informed decisions regarding breast cancer screening.

Again, I want to thank the member for Vancouver Centre for bringing this issue up. I hope all my fellow colleagues can continue to support the bill.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

March 12th, 2012 / 7:10 a.m.

NDP

Rosane Doré Lefebvre Alfred-Pellan, QC

Mr. Speaker, I am very pleased to rise in the House today to debate Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue. As a young woman, I am aware that I am at risk of developing breast cancer. In fact, we all are, because breast cancer can affect anyone, both men and women, young and old.

According to the statistics, 23,400 Canadian women and 190 Canadian men were diagnosed with breast cancer in 2011. Age is an important factor. It is a fact that older women are at greater risk. In 2011, an estimated 80% of cases were diagnosed in women over the age of 50. Young women are also at risk. It is estimated that 3,500 new cases, or 14%, were reported in women between the ages of 30 and 49 years, and 965 cases, or 4% of cases diagnosed, were women 40 and under.

According to the Canadian Cancer Society, breast cancer starts in the cells of the breast. The breast tissue covers an area larger than just the breast. It extends up to the collarbone and from the armpit across to the breastbone in the centre of the chest. Each breast is made of mammary glands, milk ducts and fatty tissue. The breasts also contain lymph vessels and lymph nodes, which are part of the lymphatic system. The lymphatic system helps fight infections. Lymph vessels move lymph fluid to the lymph nodes. Lymph nodes trap bacteria, cancer cells and other harmful substances. There are groups of lymph nodes near the breast under the arm, near the collarbone and in the chest behind the breastbone. Cancer cells may start within the ducts or in the lobules. Ductal carcinoma is the most common type of breast cancer.

As a woman, I know the importance of mammography, which is a low-dose x-ray of the breast. Mammography pictures, or mammograms, show detailed images and views of the breast from different angles. The breast is placed between two plastic plates. The plates are then pressed together to flatten the breast. Compressing the breast tissue helps make the images clearer. Better quality mammography and increased participation in organized breast screening programs have led to more breast cancers being detected earlier, which means successful treatment is more likely. Unfortunately, this test does not always detect cancer, especially among women with dense breast tissue. In such cases, doctors may opt for scintimammography or an MRI. A biopsy is the only way to make a definitive diagnosis of cancer.

Breast density is a radiological concept, but it has a major impact on the accuracy of mammogram interpretation. Dense breast tissue is a concern for all radiologists, as well as epidemiologists and gynecologists. A dense breast appears white on a mammogram because it contains little fat.

Breast tissue is quite variable. Changes in breast tissue are hormone driven and occur throughout an individual's lifetime. For example, young women typically have denser breasts than older women because breast tissue becomes less dense as women age. However, even though older women's breasts tend to contain more fat, women of any age can have dense breast tissue.

Bill C-314 requires the Government of Canada to encourage the use of existing initiatives to increase awareness among women about the implications of heterogeneous or dense breast tissue for breast cancer screening, and to assist women and health care providers in making well-informed decisions regarding screening.

Although the purpose of this bill is to improve breast cancer screening for women with dense breast tissue, we believe that it should go further still. Why not institute accountability measures to shorten waiting lists and ensure that women have access to timely screening?

Any bill designed to improve breast cancer screening should include federal funding for national breast cancer screening programs for all women, which should be systematic, free and available without a doctor's referral, beginning at age 40.

Health care workers and women who are concerned about breast cancer need more than just encouragement in order to raise awareness and promote best practices.

The government should put in place standards. Under these standards, all provincial programs would start screening women for breast cancer from age 40. The standards should include the regular and optimal use of digital mammography machines such as MRIs and ultrasounds for screening purposes. Lastly, screening standards should focus on the particular challenges of screening for breast cancer among women with dense or heterogeneous breast tissue.

The Quebec breast cancer screening program is a good example of a screening program with very good results. Screening using a mammogram targets women aged 50 to 69 and is carried out, systematically, every two years. According to data from Quebec's health and social services department, the breast cancer mortality rate for women who are systematically screened dropped by at least 25% between 1996 and 2006.

It is high time that the federal government showed leadership by adopting a funding plan and implementing a real national strategy to improve breast cancer screening in Canada. That also means honouring the commitments made as part of the 2003 and 2004 health accords, including the commitment to reduce waiting times and increase the number of doctors and nurses to ensure that women at risk have access to primary care or specialists as quickly as possible.

Experts and organizations fighting breast cancer are asking for more and agree that this project does not go far enough.

The Canadian Breast Cancer Network does not believe that this bill will improve screening procedures for those women most at risk of developing breast cancer. Breast cancer survivors direct the network. It is a national link between all the groups and individuals concerned about breast cancer, and its members, partners and founders include the Canadian Cancer Society, the Canadian Breast Cancer Foundation and the Breast Cancer Society of Canada.

The Canadian Cancer Society supports a bill that would improve cancer screening measures, particularly for patients with dense breast tissue. However, the society believes that this bill will not produce concrete results for patients living with breast cancer and their families.

Lastly, Quebec's association of hematologists and oncologists says that while it is important to increase breast cancer screening, we cannot forget about other kinds of cancers. Improvements need to be made in the prevention of and screening for all cancers. We must not concentrate all our efforts on one single category of women or type of cancer.

I wonder when this government will start to take this issue really seriously? The Conservative government introduced a bill that will in no way improve the lives of Canadian women. The government must start thinking more seriously about this issue in order to prevent even more women from developing this destructive disease.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:20 a.m.

NDP

Christine Moore Abitibi—Témiscamingue, QC

Mr. Speaker, Bill C-314 seeks to improve breast cancer screening measures for women with dense breast tissue.

One woman in nine is expected to develop breast cancer during her lifetime, and one in 29 will die of it. The current mortality rate is 21%. Risk factors can be both genetic and environmental, and breast tissue density is one of those factors, hence this bill.

Women with high breast tissue density face two challenges: the probability of developing breast cancer is higher and screening is more difficult because the X-rays are harder to read. It is therefore important to improve care for women with dense breast tissue because of the increased risks to their health.

This bill seeks to do that and:

...requires the Government of Canada to encourage the use of existing initiatives in order to increase awareness among women about the implications of heterogeneous or dense breast tissue for breast cancer screening, and to assist women and health care providers in making well-informed decisions regarding screening.

Still today in Canada, not all women are fully informed about breast cancer. As a former nurse, I know that not all women—far from it—have access to a family doctor and therefore to the chance to discuss the risks with a professional. Sometimes people in remote areas do not have the same access to health care as others. Sometimes women end up not having access to full and accurate information about breast cancer, its risks and the importance of screening. And the doctor ends up not having access to the patient's complete medical file because she has several different files. These women see a doctor when they go to emergency. In the long term, there is no continuity of care because doctor visits are always one-offs.

Women may be seen by their family doctor, and now by specialized nurse practitioners who may also work in this area. Nurse practitioners will ask questions, analyze risk factors, conduct assessments, teach women to perform breast self exams and help them do so. These concrete measures can help these women. If a woman does not have access to a family doctor or nurse practitioner, she will not know that she may have access to screening programs and, consequently, will not take advantage of them.

I believe that it is important to talk about this. Breast cancer will result in the death of 14 women a day in Canada in 2012. It is a very important issue. Screening and awareness of the risk factors are also major issues. Early diagnosis and treatment greatly increase women's chances of survival.

Women with dense breast tissue should be made aware of it and should undergo more tests before being given a diagnosis because cancer is more difficult to detect in x-rays of dense breast tissue. The more tests, the great the difficulty. Consequently it is important to promote detection screening to these women. It is also important to promote and to circulate this information among health professionals so that they can screen women.

We often see people die from cancer because of this. We must not take it lightly.

The Canadian Cancer Society's website talks about the determinants of survival. It points out the factors related to the cancer control infrastructure, such as the availability and quality of early detection, diagnosis and treatment.

Depending on where a woman lives and the quality of infrastructure available, and depending on the timeliness of detection, she will have a greater or lesser chance of dying of cancer.

This is not an equitable situation. In my opinion, access to health infrastructure should not be one of the determinants of breast cancer survival.

The fact that such is the case in Canada in 2012 does not make any sense. And this should also not be the case for any other illness. For example, to date, Nunavut does not have a formal screening program.

We therefore really need to do more than encourage the government to get the message out and to facilitate screening. Clearly, we need more concrete action. We need better access to health care and infrastructure; we need more family doctors, more nurses and more nurse practitioners; and we need improved prevention measures. We must decrease wait times—which have reached record highs—for tests and treatments. We must improve access to medical specialists who are better able to diagnose and treat these patients. We must work with the provinces to come up with a national strategy to combat breast cancer that is fair to all women, regardless of their geographic area or their income.

We have no choice. We must really discuss this with the provinces. We need real leadership on this issue. For example, Canada should abide by the 2003 and 2004 health accords, which were meant to improve the accessibility, the quality and the viability of the public health care system.

In order to prevent all these bills on health from being just words written completely in vain that look good on paper but do not contain any concrete measures, we should ensure that they include measures such as federal funding to create systematic breast cancer screening programs for all women across the country. These programs should be made available free of charge, on a voluntary basis, to women aged 40 and over. Right now, the systematic program that exists in Quebec is free for women over the age of 50.

I would like to take a few minutes to talk to you about my cousin Linda, who passed away from breast cancer when I was in Vancouver in June. Her daughter had just had her first baby when Linda learned that she had breast cancer. She was only 42 years old when she died. I believe that this is a concrete example of why systematic screening programs should be made available free of charge to women as early as age 40, not age 50. This is a good example, and I thought it was important to talk about what happened to my cousin. I was close to her, and 42 is very young. I thought it was important for members to be aware of this.

Such bills should also include standards requiring that existing provincial programs begin screening women at age 40. Early detection is essential and should be a priority. We know that. I do not know if people understand this, but the earlier in a person's life breast cancer—or any type of cancer—shows up, the more likely it is to be aggressive, because an immune reaction takes place. The stronger the immune system's reaction, the more aggressive the cancer can be. That is why very early detection is important, as I just explained.

Similarly, any health-related bills should include standards for existing screening programs to optimize and standardize the use of digital mammography equipment such as magnetic resonance imaging and ultrasound units. Women should have access to these devices, which, once again, improve detection rates, particularly for women with risk factors such as high breast density.

Health-related bills like this one must go farther: instead of offering vague suggestions, they have to propose practical measures. This must be done together with the provinces and territories, of course, because health is under provincial jurisdiction. It is important to truly work with the provinces to develop an action plan. If we do that, we can hope to save lives. If health-related bills are too vague, they are not useful; they are nothing but nice ideas on paper that do not really change anything for the better.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Conservative

The Acting Speaker Barry Devolin

Is the House ready for the question?

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Some hon. members

Question.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Conservative

The Acting Speaker Barry Devolin

The question is on the motion. Is it the pleasure of the House to adopt the motion?

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Some hon. members

Agreed.

No.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Conservative

The Acting Speaker Barry Devolin

All those in favour of the motion will please say yea.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Some hon. members

Yea.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Conservative

The Acting Speaker Barry Devolin

All those opposed will please say nay.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Some hon. members

Nay.

Motions in amendment
Breast Density Awareness Act
Private Members' Business

7:30 a.m.

Conservative

The Acting Speaker Barry Devolin

In my opinion the nays have it.

And five or more members having risen:

Pursuant to Standing Order 98, the division stands deferred until Wednesday, March 14, 2012, immediately before the time provided for private members' business.