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.

Private Members' Business

[The Speaker, Conservative, Andrew Scheer]

I would like to make a statement concerning private members' business.

As hon. members know, our Standing Orders provide for the continuance of private members’ business from session to session within a Parliament.

In practical terms, this means that notwithstanding prorogation, the list for the consideration of private members' business established at the beginning of the 41st Parliament shall continue for the duration of this Parliament.

As such, pursuant to Standing Order 86.1, all items of private members' business originating in the House of Commons that were listed on the Order Paper at the conclusion of the previous session are automatically reinstated to the Order Paper and shall be deemed to have been considered and approved at all stages completed at the time of prorogation.

All items will keep the same number as in the first session of the 41st Parliament. More specifically, all bills and motions standing on the list of items outside the order of precedence shall continue to stand. Bills that had met the notice requirement and were printed in the Order Paper but had not yet been introduced will be republished on the Order Paper under the heading “Introduction of Private Members' Bills”. Bills that had not yet been published on the order paper need to be recertified by the Office of the Law Clerk and Parliamentary Counsel and be resubmitted for publication on the notice paper.

Of course all items in the order of precedence remain on the order of precedence or, as the case may be, are referred to the appropriate committee or sent to the Senate.

Specifically, at prorogation there were three private members' bills originating in the House of Commons adopted at second reading and referred to committee.

Therefore, pursuant to Standing Order 86.1, Bill C-458, an act respecting a national charities week and to amend the Income Tax Act (charitable and other gifts) is deemed referred to the Standing Committee on Finance.

Bill C-478, An Act to amend the Criminal Code (increasing parole ineligibility), is deemed referred to the Standing Committee on Justice and Human Rights.

Bill C-489, an act to amend the Criminal Code and the Corrections and Conditional Release Act (restrictions on offenders) is deemed referred to the Standing Committee on Justice and Human Rights.

Accordingly, pursuant to Standing Order 97.1, committees will be required to report on each of these reinstated private members’ bills within 60 sitting days of this statement.

In addition, prior to prorogation, nine private members' bills originating in the House of Commons had been read the third time and passed. Therefore, pursuant to Standing Order 86.1, the following bills are deemed adopted at all stages and passed by the House: Bill C-217, an act to amend the Criminal Code (mischief relating to war memorials); Bill C-266, an act to establish Pope John Paul II day; Bill C-279, an act to amend the Canadian Human Rights Act and the Criminal Code (gender identity); Bill C-290, an act to amend the Criminal Code (sports betting); Bill C-314, an act respecting the awareness of screening among women with dense breast tissue; Bill C-350, an act to amend the Corrections and Conditional Release Act (accountability of offenders); Bill C-377, an act to amend the Income Tax Act (requirements for labour organizations); Bill C-394, an act to amend the Criminal Code and the National Defence Act (criminal organization recruitment); and Bill C-444, an act to amend the Criminal Code (personating peace officer or public officer).

Accordingly, a message will be sent to the Senate to inform it that this House has adopted these nine bills.

Consideration of private members’ business will start on Thursday, October 17, 2013.

As members may be aware, among the items in the order of precedence or deemed referred to committee, there are four bills standing in the name of members recently appointed as parliamentary secretaries who, by virtue of their office, are not eligible to propose items during the consideration of private members' business.

Bill C-511, an act to amend the Federal-Provincial Fiscal Arrangements Act (period of residence) and Bill C-517, an act to amend the Criminal Code (trafficking in persons) were awaiting debate at second reading in the order of precedence at the time of prorogation.

Bill C-458, An Act respecting a National Charities Week and to amend the Income Tax Act (charitable and other gifts), and Bill C-478, An Act to amend the Criminal Code (increasing parole ineligibility), were in committee at the time of prorogation and, as stated earlier, have been returned there.

This is in keeping with the principle expressed at pages 550-551 and 1125 of the House of Commons Procedure and Practice, second edition, which provides that bills remain on the order of precedence since they are in the possession of the House and only the House can take further decision on them.

These items are therefore without eligible sponsors but remain in the possession of the House or its committees. If no action is taken, at the appropriate time these items will eventually be dropped from the Order Paper, pursuant to Standing Order 94(2)(c).

Hon. members will find at their desks a detailed explanatory note about private members’ business. I trust that these measures will assist the House in understanding how private members' business will be conducted in this session. The table officers are available to answer any questions members may have.

I thank all members for their attention.

Breast Density Awareness Act

[The Speaker, Conservative, Andrew Scheer]

The House will now proceed to the taking of the deferred recorded division on the motion at third reading stage of Bill C-314 under private members' business.

The House resumed from May 8 consideration of the motion that Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, be read the third time and passed.

Health

[Leona Aglukkaq, Conservative, Minister of Health and Minister of the Canadian Northern Economic Development Agency]

Mr. Speaker, I would like to thank my colleague, the member for Kildonan—St. Paul, for that great question. I would also like to thank the member for Barrie for introducing his bill, Bill C-314, regarding raising awareness for women with dense breast tissue. I hope it will result in more lives being saved.

Our government has invested almost $1 billion for cancer research since we formed government in 2006. We also renewed our funding commitment over the next five years for the Canadian Partnerships Against Cancer so that it can continue to do the great work that it is doing. Thanks to this, more people are—

Breast Density Awareness Act

[Rick Dykstra, Conservative, Parliamentary Secretary to the Minister of Citizenship and Immigration]

Mr. Speaker, I am certainly pleased to be speaking in support of Bill C-314, regarding dense breast tissue and the importance of breast cancer screening.

The bill was introduced by our colleague, the hon. member for Barrie. I would like to thank him for bringing it forward. When it comes to his health, this member is certainly putting his money where his mouth is. He is constantly ensuring that he is staying in the shape he needs to be in to be able to do his work.

In fact, as many of us know, the Toronto marathon was held over the weekend, and the member for Barrie competed, running a tremendous marathon and coming in one minute short of being able to qualify for the Boston marathon. Bringing this bill forward speaks highly of this member.

This bill puts a spotlight on an important issue. Breast cancer is the most common form of cancer among women in Canada. There are a number of risk factors associated with breast cancer, and dense breast tissue is a significant one.

Greater awareness of this risk is needed. Bill C-314 calls for exactly that, for expanding awareness of breast cancer screening for women with dense breast tissue. It is well established that early detection through breast screening can save lives.

By supporting this bill, we can make a difference in the lives of many Canadians. As noted in the bill, Canadian women will benefit from increased awareness of the challenges related to breast cancer screening for women with dense breast tissue. An important aspect of the bill is that it is dedicated to improving collaboration with partners to improve and share information on breast cancer screening with women and their doctors.

Bill C-314 will complement several current government actions supported by other partner organizations on cancer, breast cancer and breast cancer screening in our country. It is a priority for our government. Every single year, millions of Canadians are affected by cancer, either personally in terms of being subjected to the disease or by the experience of a family member or a friend or neighbour.

One in nine women in Canada will develop breast cancer during their lifetime. I am sure all of us who sit in the chamber today know a relative, friend or neighbour who has been affected and how stressful an experience it can actually be.

Early detection through organized screening programs is a key public health practice. It can protect women from breast cancer and the emotional, financial and personal costs that can often be associated with the disease.

Breast cancer screening can find cancer even when there may not be symptoms. The goal is to find breast cancer early, when it is small and less likely to have spread to other parts of the body. The most common method of breast cancer screening is a mammogram, which uses X-rays to take pictures of the internal structure of the breast.

For women with dense breast tissue it can be more difficult to detect small changes in the tissue that could be cancer, because both dense tissue and tumours appear as white space. This is why it is important for women in Canada and health professionals to be well informed so that they are able to discuss and make the best decisions around dense breast tissue screening.

Through better sharing of information and raised awareness of the risks presented by dense breast tissue, early detection through organized screening programs can help women in Canada by catching cancer at an early stage.

Our continued progress on cancer prevention and control relies on working across sectors, jurisdictions and organizations. The government has invested in partnerships that promote optimal screening, working with provinces and territories that deliver the services and with partner organizations.

Together we want to improve screening and early detection and to provide desperately needed information to women. That is exactly what Bill C-314 calls for: an assurance that we are doing all that we can with what we have to increase awareness and to assist health care providers and women in making well-informed screening decisions.

The bill's preamble recognizes that we are taking action related to screening through a number of initiatives. This bill reinforces our commitment and action on prevention, detection and control. It acknowledges the work this government does through the Canadian Partnership Against Cancer, the Canadian Institutes of Health Research and the Canadian breast cancer screening initiative. The knowledge and information generated through these initiatives is then shared with doctors and networks that include health organizations.

The central initiative supported by the government to fight cancer is the Canadian strategy for cancer control. It is a coordinated, comprehensive strategy that was developed with governments, non-governmental cancer organizations, cancer survivors, researchers and health care professionals.

The government created and provides funding to the Canadian Partnership Against Cancer to lead the implementation of the Canadian strategy for cancer control in collaboration with provincial and territorial governments and non-governmental organizations.

The Partnership Against Cancer is an independent, not for profit organization whose work is focused on prevention, early detection, treatment and support for Canadians who live with cancer.

Screening and early detection is one of the main priorities of the strategy. Breast density and its implications for cancer screening are part of this strategic priority.

The Partnership Against Cancer has done much to ensure that cancer patients and doctors across Canada have state of the art knowledge about what works to prevent, diagnose and treat cancer. It has encouraged hard to reach populations, such as newcomers to Canada, rural Canadians and people with disabilities, to undergo screening. This work has helped doctors to identify cancer at a much earlier time in an individual's life.

The government's cancer strategy is about people making a difference by working together and learning from each other so that Canadians, no matter where they live, can benefit.

One of the main resources offered by the federal government is the cancer view portal. This is a convenient single window for information for Canadians on cancer issues, including breast cancer screening. Cancer view connects Canadians to quality cancer resources. It provides tools to health professionals, patients and families, and it links people in the Canadian cancer community with each other.

To ensure that the valuable work of the partnership continues, the government has renewed its funding from 2012 to the 2017 fiscal year, providing up to $250 million over that period of time. It is not the amount that is important, it is what the funding enables the Partnership Against Cancer to continue to do, and that is to raise awareness and provide the tools that strengthen prevention. It is important work aimed at reducing the number of new cases of cancer, increasing the likelihood of Canadians surviving cancer and improving a patient's quality of life. Its activities cover a wide range of areas, from cancer control and prevention to palliative and end of life care.

The federal government also makes significant investments in research, surveillance and education, focused on preventing and reducing cancer.

The Canadian Institutes of Health Research is at the centre of the government's research efforts. It provides more effective diagnostics, better treatment and more efficient prevention strategies for all cancers, including breast cancer.

Research investments in this area are supporting Canadian scientists and they are helping to fill critical knowledge gaps in our understanding about breast cancer.

In addition to searching for a cure, Canadian medical researchers are also helping to reduce the burden of cancer on individuals and families by providing information to develop prevention strategies.

CIHR's Institute of Cancer Research is leading an international imaging initiative in personalized medicine and this initiative includes breast cancer as a focus. Such scientific research is helping to improve screening in health care settings and contributes to building understanding about early diagnosis, as well as access to better quality cancer care.

Bill C-314also highlights the importance of providing women and their doctors with the information they need to make decisions that affect and impact their health. The government is taking steps to increase awareness, to fund research and to provide information to Canadians about cancer prevention and early detection.

In addition to the good work already mentioned, the federal government is promoting education and makes information and resources available to communities across our country through the Canadian breast cancer initiative.

The community capacity building program is a key component of the Canadian breast cancer initiative. The community capacity building program supports organizations and provinces and territories to network with provincial and community breast cancer groups. This cross-Canada collaboration enables the sharing of best practices and ensures that information and supports are available for women with breast cancer.

Together, they regularly assess new information about screening to improve programs and to ensure that women have the full benefit of early detection. By raising awareness around breast density, we are also encouraging this important practice. It is essential to have the right information about dense breast tissue in order to determine the best screening method.

The government is engaged in cancer prevention research and education. We are raising awareness about the many health issues faced by Canadians. Clearly, we all have a role to play in the fight against breast cancer.

The member for Barrie understands, as does this House and this government, that this bill ensures the federal government will continue to raise awareness through existing initiatives about the challenges related to breast cancer screening for women with dense breast tissue.

Bill C-314 is another step forward for Canada in tackling breast cancer. I ask all members of the House to support this very important bill.

[Libby Davies, NDP, Vancouver East, BC]

Mr. Speaker, I am very pleased to rise in the House today to speak at report stage, the first hour of debate, to Bill C-314. I would like to congratulate the member for Barrie for bringing forward this bill. I agree that when we bring forward private members' business, whether it is a bill or a motion, it is an opportunity for each of us to show initiative, to bring forward an issue for greater awareness and, hopefully, get support in the House to make an advancement. There are women who live with dense breast tissue and may not be aware of their higher risk. There is still unfortunately too little known about the issue. So we very much appreciate this bill coming forward.

When we were at committee, we heard a number of fantastic witnesses. I agree with my colleague that the witnesses who shared their personal experience with us were very compelling. This tells us where things are and what it is that we need to do. I was struck by the witness who talked about innovation and new technologies. There is technology available that will assist women with dense breast tissue 100%. I am very concerned that even if women are aware of that, they may not be able to access the technology because of where they live. It may be very far to travel or they may not be able to afford the fees. It is a private service. It seems to run contrary to the fundamental principles of the Canada Health Act: universality, accessibility, public administration, comprehensiveness and so on.

I want to put on record here at report stage that the NDP supports the bill. However, after we heard from the witnesses, our concern in committee was that the bill was quite limited in its scope. It talks about information and information sharing, best practices and creating better awareness. All of those things are an absolute must, but they are sort of the bottom floor. For us in the NDP, when we heard the witnesses, we felt that we needed to go some extra distance with the bill.

We introduced a number of amendments. The most significant amendment said, “working in collaboration with provincial and territorial governments to establish national standards for systematic breast cancer screening”. Unfortunately, that amendment and all the other amendments were defeated. It was disheartening that all of the amendments put forward in good faith from the opposition parties at the committee were turned down. I do not think they were beyond the scope of the bill. While I concur that information and awareness are very important, we could be doing so much more.

We are now more aware of which women are at risk. I believe this bill will help get a message out, and that is very important. However, we in the NDP believe that there should be a nationwide systematic breast cancer screening program for all women. It should be free of charge and it should be by self-referral. It is quite alarming that, for example, there is no screening program in Nunavut. This seems to be a glaring omission and speaks strongly to the need for a nationwide systematic screening program with standards for screening.

We heard from practitioners at the committee that if a woman has gone beyond a mammogram and is going for an ultrasound, even that can be very problematic. It depends on how experienced the practitioner is doing the ultrasound. It is not about human error, but it is a very delicate procedure in terms of what one is looking for. It did surprise me to hear that even if a woman has an ultrasound, it may not identify the fact she is at risk or may have cancer present.

Similarly, we all think that MRIs are a real window into what is going on. However, we heard that for women with dense breast tissue, even an MRI may not pick up their particular situation. We heard from a witness about the newest technology that involves 360° imaging.

This speaks to a lack of available screening and a lack of national standards to ensure that wherever one is in the country, one can be assured of getting the highest quality screening and care. Under the Canada Health Act, that is very much a part of our health care system.

I do not want to be negative, but the bill is mostly about information and awareness. While it is important, I feel that we missed an opportunity to do a lot more with this bill. Although opportunities were put forward at the committee, unfortunately the government members decided not to vote for those amendments. Now here we are at report stage with a bill that is quite limited in its scope.

We will support the bill because it is a step to providing much better awareness about dense breast tissue. I was not aware of it before I heard about the bill. It is an eye opener for all of us. For that it is commendable.

However, I wish that we had been able to strengthen the bill in the way that we wanted, and that we could have responded to witnesses' suggestions to the committee. Maybe at some point there will be another bill and we will get another opportunity.

When we hear from people at committee we should do our utmost to respond to what they say. We should listen in good faith to their suggestions. Where it is possible for us to incorporate those recommendations in a way that is realistic within a private member's bill, then why on earth would we not do that?

That is my only regret. I certainly appreciate the member putting this bill forward and getting it this far. I am sure that the bill will be approved. Let us all make a commitment in this House today, not only to support this bill but also to advocate for a nationwide breast cancer screening program to ensure that women in Nunavut have access to even the most basic screening.

We need to address the issue of standards for screening to ensure that where there are these unique challenges of detecting cancer in women, particularly women with dense breast tissue, that they are getting the very best they can get so that their risk is lowered and not increased.

[Patrick Brown, Conservative, Barrie, ON]

moved that Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, be read the third time and passed.

Mr. Speaker, it gives me great pleasure to speak to Bill C-314, an act respecting the awareness of screening among women with dense breast tissue, for the final hour of debate in the House.

Bill C-314 calls on the federal government to encourage the use of existing federal initiatives in order to increase awareness among Canadian women about dense breast tissue and the implications for breast cancer screening.

Breast cancer is the most common form of cancer among women. It claims many lives, and many deaths can be avoided through screening and early detection.

This year alone about 23,000 women will be diagnosed with breast cancer and 5,000 women will die from this disease. That represents about 450 women diagnosed each week. This situation is difficult to accept. It affects women and their loved ones profoundly.

For women with dense breast tissue, breast cancer is generally harder to detect using mammography, resulting in the need for more frequent screening.

Raising awareness about dense breast tissue is important for Canadian women. Through the bill we can raise awareness of breast cancer screening for women with dense breast tissue. Greater awareness and information about dense breast tissue is a tangible way we can make a difference. It would help women and their doctors make well-informed decisions regarding breast cancer screening. For these reasons I will ask my colleagues to continue to show their support for the passage of the bill.

Bill C-314 would support a number of initiatives that the federal government already has under way to support early detection and screening of breast cancer.

As noted in the bill, the federal government plays a role in facilitating the sharing of best practices and information on screening, as well as supporting research through its programs and networks. Building on existing initiatives, the bill is focused on raising awareness in several ways.

First, the bill requires the government to determine if there are breast density information gaps in relation to breast cancer screening. Through research we can investigate the full spectrum of cancer prevention and control, including breast cancer.

In this regard, the federal government's cancer research investments through the Canadian Institutes of Health Research, or CIHR, are serving to fill some research gaps. Through the CIHR, the federal government is supporting research on more effective diagnostic treatment and prevention for all cancers, including breast cancer. In 2010-11, $171 million was spent on cancer research, and $22.7 million was spent for breast cancer research.

These research investments are supporting important scientific work. In particular, CIHR's Institute for Cancer Research is supporting research that will lead to reducing the burden of cancer on individuals and families through improved prevention efforts. It has placed a priority on research concerning early cancer detection, and it is working with partners to advance this research priority.

For instance, the institute is currently exploring partnerships with groups such as the Canadian Breast Cancer Foundation and the Breast Cancer Society of Canada, and it would include efforts in early detection as part of this focus. The institute is looking at targeted funding for research on the early detection of cancer, including breast cancer, to address information gaps. Scientific research such as this is helping to improve screening and is helping to raise awareness about the challenges related to breast cancer screening.

In addition, to raise awareness, the second element of the bill requires that approaches be identified, as needed, to improve information for women in order to, first, address the challenges of detecting cancer in women with dense tissue and, second, raise awareness concerning these challenges.

In response to the bill, the government will continue to raise awareness about breast density and its screening implications through the Canadian breast cancer screening initiative. This initiative respects the role of provincial and territorial programs and the role they play in early detection of breast cancer among Canadian women. Through it, we are working with the provincial and territorial governments to measure screening program performance nationwide and to develop better screening approaches.

The Canadian breast cancer screening initiative supports the good work already under way with our provinces and territories. By facilitating information-sharing about breast cancer screening across Canada, the initiative can achieve its goal of evaluating and improving the quality of organized breast cancer screening programs.

The Canadian breast cancer screening initiative is helping raise awareness about cancer screening, including screening for women with dense breast tissue. By building upon best practices and lessons learned, breast cancer screening programs can be improved and strengthened across the country.

The third element of the bill even more directly relates to the Canadian breast cancer screening initiative. The bill would require the existing Canadian breast cancer screening initiative to share information on dense breast tissue and its relationship to breast cancer screening and any follow-up procedures that may be necessary. The follow-up procedures are a pretty important part of this.

Sharing information about ways to improve cancer screening programs ensures women receive the full benefits of early detection, including information about all aspects of breast cancer screening.

We must sustain this collaboration and collective assessment of breast cancer screening programs. In this regard, the government has established a federal, provincial and territorial national committee for the Canadian breast cancer screening initiative, which also includes medical professionals and key stakeholders.

This is a platform for engagement. It provides opportunity for governments to work together on screening recommendations and approaches. For example, the national committee is currently looking at breast cancer mortality and improving screening for underserved populations. This committee encourages the sharing and pooling of information. This is a basis for a balanced set of protocols across Canada, based on best practices. There is no monopoly on a good idea, and an effective screening mechanism in one part of the country can easily be adopted in another part of Canada.

In addition to the Canadian breast cancer screening initiative, the government has also established a national repository on breast cancer screening. This national database is housed and administered by the Public Health Agency of Canada. Information is provided by provinces and territories and rolled up into a biannual report to Canadians on new cases of breast cancer and cancer deaths. The report also contains data on participation in organized screening programs, mammography use and follow-up.

In line with the bill, the database would include breast density information in the future. This is an important addition to the repository. In turn, information would be provided to Canadians on this important issue.

The Canadian breast cancer screening initiative would continue to provide a decision-making tool for women. It, too, would include information on breast density.

All this good work is helping build awareness and understanding of the effects of breast cancer screening on breast cancer survival rates and other important issues.

In sum, the Canadian breast cancer screening initiative is an invaluable collaborative effort. It accesses new information about screening on a regular basis; it ensures that programs and policies are informed by the most up-to-date information; and it provides good information to help Canadians and to help professionals make the best possible decisions about breast cancer screening.

The bill also recognizes the important work done by the Canadian Partnership Against Cancer on cancer prevention and control, more generally. Our government established the Canadian Partnership Against Cancer in 2006 to implement the Canadian strategy for cancer control. In March 2010, we renewed its funding, investing $250 million for another five years.

The Canadian Partnership Against Cancer is an independent, not-for-profit corporation. Its work includes prevention, early detection, treatment and support for Canadians living with cancer, and it involves many players, such as cancer experts, charitable organizations, government cancer agencies, national health organizations, patient survivors and others. Our investments in the Canadian Partnership Against Cancer help provide women with up-to-date information on breast cancer screening.

Recently, the bill was discussed at length in committee and a number of experts and witnesses shared their stories with us. I thought I would share a few.

Ms. Feather Janz detected a lump in her breast at age 20. However, despite going for numerous tests, cancer was not detected. She was finally diagnosed with highly aggressive grade three breast cancer at the age of 23. She underwent a radical surgery and her left breast was removed.

About 12 years later, Feather started to feel that her remaining breast was not quite right. Over the next four years, she continually went for mammograms but, again, nothing was detected.

The reports contained notations like “high dense breast tissue”, “too dense”, “quite dense” and “not able to see any abnormalities”. That is all the reports said. Feather insisted on surgery to have the other breast removed, and after the procedure the pathology report stated that it, indeed, had been a case of advanced aggressive breast cancer that had already spread to her lymph nodes. Feather told the committee she was shocked when she found out that the likely reason for this happening, and her life being threatened due to it, was because of dense breast tissue.

Another example is Mr. Bruce Cole, who testified before the committee about his wife, Sharon, who was diagnosed with breast cancer at age 36 and passed away at 40. Bruce Cole is from the same region of the country that I come from, Simcoe County. Mr. Cole talked about the incredible tragedy of losing his wife, who left behind children aged 17, 15 and 13. Her family had no history of this terrible disease and Mr. Cole testified that, regrettably, his wife did not have access to the screening technology and the knowledge we have today.

Since Sharon's tragic death, Bruce has been very active with the Canadian Breast Cancer Foundation as a donor and volunteer, and he attended the world forum on breast cancer last June in Hamilton. Bruce urged the committee to pass Bill C-314. He said it would help improve the quality of information to women as part of Canada's organized breast screening programs. Bruce knows this bill would help raise women's awareness about breast density and its implications for their health.

Bruce correctly pointed out to us that digital mammography or MRI are more effective than screen-film mammography at detecting breast cancer in dense breast tissue like his wife had, and he emphasized the need for sharing information between the Public Health Agency of Canada and the provincial and territorial governments. Sadly, Bruce understands that his wife might be here today if these practices had been in place when Sharon needed them most, but he bravely soldiers on, fighting this battle in her memory.

With all of us working together, we can improve screening and early detection and provide important information to women, health care professionals and Canadians. Bill C-314 calls on us to do exactly that. By passing this bill, we can ensure awareness is raised about breast cancer screening for women with dense breast tissue. We can ensure that existing initiatives assist women and health care professionals in making well-informed decisions regarding screening. Raising awareness about breast cancer screening can lead to early detection, and early detection can save lives.

For these reasons, I encourage all members of the House to support my bill, and I sincerely hope that it will go a long way in helping to save more lives in the future.

I know this is something Canadians care passionately about. Every October the breast cancer walk is held in communities across Canada. In my home town, Barrie, there is a sea of pink, people walking on the shores of Kempenfelt Bay to support breast cancer research. This is a way to support the collective will of Canadians who say they want us to act and make a tangible difference in fighting breast cancer.

[Patrick Brown, Conservative, Barrie, ON]

moved that Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, be concurred in.

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, and of Motion No. 1.

Motions in amendment

[Christine Moore, NDP, 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.

[Rosane Doré Lefebvre, NDP, 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.

[Patrick Brown, Conservative, 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.

Speaker's Ruling

[The Speaker, Conservative, 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.

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.

Health

[Joy Smith, Conservative, Kildonan—St. Paul, MB]

Mr. Speaker, I have the honour to present, in both official languages, the third report of the Standing Committee on Health in relation to Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue. The committee has studied the bill and has decided to report the bill back to the House without amendment.