Bill C-314 (Historical)

Breast Density Awareness Act

An Act respecting the awareness of screening among women with dense breast tissue

This enactment 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.

Breast Density Awareness Act

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, I am very pleased to rise here this afternoon to speak to Bill C-314. This bill calls on 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.

On behalf of our health critic, the hon. member for Vancouver Centre, I would like to say that the Liberal Party supports this bill. All efforts to raise awareness, to provide more information and to encourage communication must be supported.

As a family doctor, it became very clear to me and also in our work at the Women's College Hospital in Toronto that the world changed when books like Our Bodies Ourselves came onto the market, and women were empowered to know more about the choices in order to ask better questions of their doctors and demand better care.

The bill, which will respect the awareness of screening among women with dense breast tissue, is just that kind of initiative. So we as Liberals support any effort to increase awareness, to fund research, and to provide information to Canadians about cancer prevention and early detection. We know that we should be doing more of this in many areas of health, including health promotion, wait times and pharmaceutical strategies.

The proposed legislation calls on the federal government to work with the provincial and territorial governments to increase awareness among women about the risk factor involved in having dense breast tissue. It asks that we use existing programs. It asks that we identify the gaps in information for women and that we improve that information that is going to Canadian women. It asks that we address the challenges in detecting breast cancer in women with dense breast tissue.

This year, 23,400 Canadian women will be diagnosed with breast cancer and 5,100 will die. As the Parliamentary Secretary to the Minister of Labour has said, all of us are touched by breast cancer in some way. My mother died of breast cancer as well. She had two different breast cancers that took her life even in what was to be a lesser kind of breast cancer: breast cancer after menopause. My sister has had breast cancer diagnosed before menopause.

As a physician, I recognize the importance of early detection and ensuring that patients have the best possible information and treatment. Any oncologist would say very clearly he or she would rather find these cancers early when indeed they can be treated. The problem is the dense breast tissue makes it difficult to identify breast cancer. There are too many stories of what was presumed to be a negative mammogram that was later on shown to have a cancer hiding in the breast tissue that was not visible to the radiologist at the time.

We are blessed now in Canada that almost 80% of mammography is done with the new digital approach which makes it much easier to detect the problems in dense breast tissue, but still we need to do more. We need to require more tests and appropriate screening. It means that we need to ensure that people reading the mammography are experienced radiologists. Now with technology, help is possible for very experienced people with tremendous expertise in mammography can read them at a distance. The new machine in Moose Factory allows the people a long way away to be the actual expert reading the exams.

We always have to balance appropriate testing without alarming the general population or Canadians with unnecessary tests that only put more pressure on the system. We believe that the federal government does have a role to play in facilitating best practices and funding research related to cancer prevention and early detection as part of the Canadian partnership against cancer.

It is interesting that the California state legislature recently passed bill SB 173 that would require mammogram providers to inform women if they have dense breast tissue and that they would benefit from more screening. But is also interesting that the California governor, Jerry Brown, vetoed the bill noting that while it was important, the bill should have used more careful language so as not to create unnecessary anxiety among women and strain the health system. This message was echoed by the California Medical Association because of its risk of leading to unnecessary MRIs and ultrasounds.

We are pleased to see that Bill C-314 calls for research, information sharing, and increased awareness for women about the problems related to screening for those with dense breast tissue, which makes it hard to identify these tumours.

For any Canadian who wants to look at the movement in the United States, it is at rudense.com. There is very interesting information. It asserts that breast density is one of the strongest predictors of the failure of mammography screening to detect cancer. There is a very interesting logo, “Are you dense? exposing the best-kept secret”. Unfortunately the best-kept secret can take people's lives.

There are things that are coming forward: ways that we could detect the breast density on a scale of 1 to 4; letting women know which category they are in; what women should expect for themselves and their families in terms of the amount of screening; and the serious conversation women need to have with their doctors.

We in the Liberal Party are very keen on the idea of national clinical practice guidelines that every Canadian can come to know and understand. Therefore, regardless of their postal code, women could be asking for the best possible care based on the evidence-based clinical practice guidelines.

It means that family doctors are brought up to speed and can actually have meaningful conversations with their patients, not only about the clinical practice guideline but whether their individual situation places them in that average clinical guideline, or whether their situation is particularly special, such that a different plan of action or care plan should be there for them.

I am very pleased and thank the member for bringing the bill forward. We look forward to further debate.

As our party's health critic, I look forward to studying the bill with the hon. member at the health committee.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Madam Speaker, I am pleased to speak in support of Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, introduced by my colleague, the hon. member for Barrie.

The bill encourages the federal government to use existing initiatives to increase women's awareness of how dense breast tissue impacts breast cancer screening. We know that breast cancer is far too common in Canada. This year, some 23,000 Canadian women will be diagnosed with breast cancer, a one in nine chance over a lifetime, and breast cancer will claim the lives of 5,100 women this year alone.

We know that breast cancer screening saves lives. We also know that women with denser breast tissue face added challenges with cancer detection through mammography. Targeting dense tissue, as the hon. member for Barrie attests, is one tangible way we can make a difference. We can play an effective role in the adoption of effective, efficient early detection practices in screening. That is why we are raising awareness and providing accurate information about screening. This helps women make better decisions, particularly if they have dense breast tissue.

Bill C-314 focuses on the efforts already under way to raise women's awareness about dense breast tissue and breast cancer screening. It also would help women and their doctors make well-informed decisions regarding their screening.

There are a number of elements in the bill that I will outline, along with current federal initiatives that support this bill. First, the bill requires our government to determine if there are breast density information gaps in relation to breast cancer screening. By knowing where these gaps are, we can plug the holes through research. In response to the first element, our government will continue supporting cancer research through the Canadian Institutes of Health Research, or CIHR. A priority of CIHR's Institute of Cancer Research is early cancer detection. It is currently exploring partnership opportunities with the Canadian Breast Cancer Foundation for early detection funding. This research will address breast cancer information gaps.

Second, the bill would require that approaches be identified as needed to improve information for women. This would be done to address the challenges of detecting cancer in women with denser tissue and to raise awareness concerning these challenges. Bill C-314 also recognizes the responsibility provinces and territories have for delivering these invaluable programs. For example, when mammography identifies dense breast tissue, these programs notify women to obtain further testing. In Ontario, Nova Scotia, Newfoundland and Labrador and the Northwest Territories an annual recall system is in place for women identified with dense breast tissue. In other jurisdictions, follow-up is determined by the radiologist.

While breast screening programs are primarily a provincial and territorial responsibility, the federal government, through existing initiatives and partnerships, supports raising awareness of breast cancer screening and breast density. In response to this bill, the government will d continue to support provinces and territories in raising awareness of breast density and its screening implications through the Canadian breast cancer screening initiative. This initiative is a partnership between the Public Health Agency of Canada and provincial and territorial programs. Through it, we are working with provincial and territorial governments to measure screening program performance nationwide. This means that all jurisdictions regularly share screening program information: lessons learned, best practices, share challenges and mutual questions of importance.

Part of the Canadian breast cancer screening initiative includes the Canadian breast cancer screening database, a national repository on breast cancer screening. Provinces and territories contribute to that database, which is then used to monitor and evaluate screening programs across Canada.

Bill C-314 would require the existing Canadian breast cancer screening initiative to share information on dense tissue in relation to cancer screening and any follow-up procedures. The initiative makes a tool available to assist in decision making pertaining to breast cancer screening. In the future, the tool will include breast density information. Sharing information about ways to improve these programs ensures women receive the full benefits of early detection.

I am pleased to note that our government will also begin discussions through the federal-provincial-territorial national committee for the Canadian breast cancer screening initiative regarding identification protocols for dense breast tissue. Through the committee, participating provincial and territorial screening programs are encouraged to share best practices on raising awareness of dense breast tissue.

The committee also provides opportunities for provincial and territorial governments to collaborate on screening recommendations and approaches. The Canadian breast cancer screening initiative will also continue providing information on breast cancer screening through its biennial report. This information will help to enhance organized screening across Canada.

Moreover, our government continues to take action through the Canadian Partnership Against Cancer, which leads the implementation of the Canadian strategy for cancer control. This made-in-Canada approach, consistent with the bill, has a key role in accelerating effective cancer prevention and control strategies. It also works with and engages the cancer community to provide Canadians with information on screening.

Of interest, the partnership hosts a web based resource called, “Cancer View Canada”. This portal provides information to Canadians on cancer issues, including screening, and it draws on the expertise of partners.

Renewed investments in the partnership, which was announced last March by our Prime Minister, allows the partnership to continue its important work. As members will see, there is much work already started that supports Bill C-314.

The bill also recognizes the important role of the Canadian Cancer Society, the Canadian Breast Cancer Foundation and the Canadian Women's Health Network in providing reliable information to support women's decision making.

The federal government works collaboratively with various stakeholders and will continue raising awareness through these existing initiatives. Canadians do not have to wait to learn about these issues from their doctors. We have a responsibility to provide this current evidence in the most efficient and effective way possible, especially when the lives of Canadians may be at stake.

Through further awareness, Canadian women and their families can become more informed and they will make better decisions. They will also learn about breast density and its implications for screening.

I encourage all my fellow parliamentarians to support this very important bill. It would increase awareness for women regarding dense breast tissue. It is important knowledge to have, not only for them but in the interest of their loved ones. It could even save a life.

I thank the hon. member for Barrie for his concern about this issue and his willingness to ensure we are better educated about our health.

[Rathika Sitsabaiesan, NDP, Scarborough—Rouge River, ON]

Madam Speaker, as a woman who, like most Canadians, has had friends and family struggle against cancer, I am proud to be given the opportunity to rise today in the House and state without reservation that I will use my mandate to search for practical and effective ways to fight cancer.

Canadians need first rate prevention strategies that include increased access to doctors, increased access to specialists, better screening, earlier screening, first rate equipment, dedicated funding and better access to necessary medications and progressive research. Access, equipment and funding are the silver bullets that make the most difference in the lives of cancer patients.

As I read the bill before us, I was searching for these targets but, I am saddened to say, I found none. It is not that Canada does not need a bill to help fight against breast cancer, it is that we need a better bill. There are real ways that the government can make a difference and Bill C-314 shirks that responsibility.

First, education and awareness are not enough to combat health care problems. I have seen again and again over the past six months how keen the government is to throw huge amounts of money at educational and awareness campaigns while ignoring the tangible systemic problems that need to be addressed.

Awareness is a first step, and I would never degrade the necessity of education, but what is a woman who discovers that she is at risk for breast cancer to do when she does not have access to a family doctor?

I come from Scarborough—Rouge River, an urban riding in the greater Toronto area. One would think that being in an urban centre, people would not have a problem in terms of access to doctors. However, from the day I was elected, I have heard constantly from my constituents that they do not have family doctors and cannot afford the time and money required to travel to a place where they can see a doctor or a specialist. With the state of public transit being what it is for my constituents, I cannot say that I blame them. I takes two hours one way to go downtown. Would hon. members travel hours and hours on public transit to go to the doctor's office? I know I would not.

Unless the government is willing to back this awareness campaign with federal money aimed at providing women with dense breast tissue direct access to doctors and state of the art screening equipment, such as a digital MRI mammogram machine, then all the education and awareness in the world will not really help these women.

I have witnessed this trend again and again. A federal program will take one shallow step toward addressing the real problem and that is where it stops.

This is a game of optics. The Conservatives want to give the appearance that they are taking action on health care issues, without actually doing anything.

The women of Nunavut do not have a breast cancer screening program at all. This is urgent. This is something that we can do that will have real effect on women's lives.

If the government is serious about preventing breast cancer, then the bill in our hands today would be, among other things, a comprehensive proposal to work with our provincial governments and territorial governments to create a breast cancer screening program in Nunavut. The women of Nunavut and other rural communities in the north are already at risk. They are farthest away from hospitals and are often some of the poorest in our country, as we have recently learned with the community of Attawapiskat and many others. It is utterly negligent for the government to deny them access to basic health care while providing, through the bill, education that says, rightly, that more women should be tested and more frequently.

I would ask the Minister of Health to explain this hypocrisy to the House today and, if she cannot, then to commit to creating legislation that will ensure that Nunavut has equal access to essential health services, as it is their right to have.

My colleagues and I are not alone in thinking that the bill is weak and ineffective. The Canadian Breast Cancer Network is the national link between all of Canada's breast cancer prevention organizations, including the Canadian Cancer Society, the Canadian Breast Cancer Foundation and the Breast Cancer Foundation of Canada, and they do not believe that the bill does enough to enhance screening for women at risk of breast cancer.

I know that the government has a hard time listening to expert advice from those members of civil society who know better than it does, but I beg the government to take note of three major recommendations that the Canadian Breast Cancer Network is saying will make a real difference for Canadian women.

First is new clinical screening machines, MRI digital mammogram machines, that are more routinely used on all women. We must invest in state-of-the-art technology to save cancer patients now. A government that can invest in fighter jets can surely afford the diagnostic machines that have been proven to save the lives of cancer patients.

Second, screening for all women should begin at the age of 40. The government must fund a federal program to establish screening programs for women aged 40 to 49. It is proven that early detection is paramount with breast cancer, and that is why a program that gives women access to doctors and screening before the age of 50 is crucial.

Third, the CBCN has identified that Nunavut must have a breast cancer screening program. We must work with the territorial government to fund this program to reach out to at-risk women instead of demanding that they travel out of territory to receive equal health care.

While the Canadian Cancer Society is, of course, eager for legislation aimed at preventing breast cancer, it has come out and said that this bill will not produce any tangible outcomes for breast cancer patients and their families.

It is also important that we speak to the needs of families when we talk about cancer.

Anyone who has had a family member with cancer, as I have, can tell us how important it is to be supported in the role of an informal caregiver. We do not have enough home care in any of our provinces or territories in Canada; when family members become ill, it almost always falls on their family and community to care for them. This has practical repercussions on people's lives. When I say “support”, I do not mean only emotional and spiritual support for the patient. Although the value of emotional support is unquantifiable in difficult times, Canadians need practical financial support as well.

Alex Jahad, a physician who was the keynote speaker at the CAT conference, said in his address that informal caregivers are the largest invisible majority in health care. They are usually women who are also working and at the same time raising children. Less than one-quarter of these women receive any financial support from the system. In consequence, they themselves will develop chronic conditions and illnesses brought on by overwork and stress.

Dr. Jahad said that the amount of unpaid informal care that takes place in Canada translates to $80 billion to $90 billion of labour. I would therefore like to take this opportunity to remind the House about the NDP's position on increasing access to employment insurance for anybody who must take leave from work in order to take care of a sick relative.

There are real changes that can be made to help fight breast cancer, and we know what they are. The experts have told us what they are. This government is lacking the political will to take serious action. We must fund programs and create the legislation that will have real effects on the lives of Canadians, not just short-term bandage solutions.

[Patrick Brown, Conservative, Barrie, ON]

Madam Speaker, before I get into the essence of the bill, I want to respond to a few of the comments made by the member for Scarborough—Rouge River.

This is a bill on breast cancer screening. I know she is new to this chamber, but a royal recommendation is not permitted in a private member's bill. Funding of doctors is not something one can do through a private member's bill. Therefore, I think it is inappropriate to suggest it is something that could have been added to the bill.

May I also add that it is a bit disingenuous, in the sense that the member for Scarborough—Rouge River is an active supporter of the Ontario New Democratic Party; when it was in power, for the first time in Ontario's history it cut medical enrolment, so the root challenge we face in Ontario, in her riding, exists because of the party she supported when it was in office. If we do not train and graduate doctors, we will not have them in our ridings to work on the many essential medical needs.

With regard to the bill, one in nine women will be diagnosed with breast cancer at some time during their lives. According to the Canadian Cancer Society, over 24,000 Canadian women will have been diagnosed with breast cancer this year alone. Sadly, 5,000 of them will lose their fight.

Cancer care has been a critical issue to me, and when I was presented with the opportunity to present a private member's bill, I knew instantly that I wanted to do something in this field. Every year, thousands of Barrie residents in my riding participate in the CIBC Run for the Cure. It really is inspiring to see so many people who care so much about battling this insidious disease.

While putting thought to this bill, I felt it was important not only for women but for all of us to be aware of the fact that screening for breast cancer can save lives. Providing women with accurate information about screening is therefore important and will ultimately help them make decisions that are right for them. This is the essence of Bill C-314. Breast cancer is more easily treated and, in most cases, curable when found early.

Dense breast tissue is one of the top risk factors for breast cancer, and it is important for women to be informed of this fact. This can be done when they are screened for breast cancer by a mammogram, but women who have breast dense tissue should also know that the potential cancer may not be detected because it cannot be seen on a mammogram and therefore diagnosed by radiologists. It appears white on mammograms and therefore is more challenging to detect.

What Bill C-314 would do is highlight the importance of being informed and work with the provinces and territories through the national screening program in order to ensure that women receive this information.

For many women, especially young women, who have a higher incidence of dense breast tissue, having this information is essential to their decision-making process. This knowledge will provide them with the tools they need to make personal health care decisions.

Women who are informed that they have dense breast tissue may need to go for a different type of screening, such as an ultrasound or an MRI. Possible cancers may be deciphered more readily by a specialist using this type of diagnostic testing.

We are fortunate in Canada to have screening programs for breast cancer. Our provinces and territories deliver these programs to detect breast cancer early, before it has spread, so that treatment can be started. Providing more information through these programs will help women and their doctors make well-informed decisions regarding breast cancer screening. Targeting dense breast tissue is one of the means by which, through this piece of legislation, we can make a tangible difference in the fight against breast cancer.

I know too many loved ones, friends and even colleagues on the Hill, who have been touched by cancer. Through this bill I hope to not only make a difference but hopefully save lives.

I hope I can count on the members of the House to support this private member's bill, Bill C-314.

Also, I am thankful to Andrea Paine, in the Minister of Health's office, for her assistance, and I thank also Dr. Rob Ballagh, from the city of Barrie; Councillor Bonnie Ainsworth; Mike Richmond, from Toronto; and my assistant in my Barrie office, Shawn Bubel, who assisted on the drafting of this bill.

In Barrie we are building a cancer centre right now. This is one of the items I discussed with our CEO, Janice Skot. I appreciate her advice that it is this type of initiative that can really help make a difference.

[The Deputy Speaker, NDP, Denise Savoie]

The time provided for debate has expired.

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

[Some hon. members]

Agreed.

On division.

[The Deputy Speaker, NDP, Denise Savoie]

I declare the motion carried. Accordingly, the bill stands referred to the Standing Committee on Health.

(Motion agreed to, bill read the second time and referred to a committee)

It being two o'clock, the motion to adjourn the House is now deemed to have been adopted. Accordingly, this House stands adjourned until Monday at 11 a.m., pursuant to Standing Order 24(1).

(The House adjourned at 2:00 p.m.)