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.

[Bruce Cole, As an Individual]

Thank you, Madam Chairman.

I would like to thank Mr. Patrick Brown for asking me to speak to the Standing Committee on Health regarding Bill C-314, an act respecting the awareness of screening among women with dense breast tissue.

My mother passed away from breast cancer at age 72. Up until then I had heard of breast cancer but did not take much notice. I really took notice when my wife was diagnosed with breast cancer at age 36 and passed away at 40, leaving children aged 17, 15, and 13. Her family had no history of this terrible disease.

Family and friends have spoken to me on many occasions regarding this terrible disease, and I have been able to help and guide individuals through their tough times.

Since my wife passed away from breast cancer, I have been involved with the Canadian Breast Cancer Foundation as a donor and volunteer. Among other important parts of its mission, the foundation provides reliable, evidence-based information to help women make informed decisions about their breast health. I was fortunate enough to attend the world forum on breast cancer last June in Hamilton.

If Bill C-314 is passed, it will help to improve the quality of information provided to women as part of Canada's organized breast screening programs. This will help raise women's awareness about breast density and its implications for their health. If we could identify women with dense breast tissue, they could be monitored with regular breast cancer screening, and we would be in a position to detect and treat breast cancer earlier, when health outcomes, survival rates, and quality of life are usually better.

Collaboration and information sharing is essential between the Public Health Agency of Canada and the provincial and territorial governments through the Canadian breast cancer screening initiative. Let's enhance this sharing of information to benefit women's health. The passing of Bill C-314 would enhance knowledge and understanding of breast density screening, follow-up, and women's health outcomes.

The existing breast cancer screening programs in Canada differ somewhat province by province and from territory to territory. To improve women's health, the organized breast cancer screening programs should be uniform, offering all Canadian women access to the same services wherever they live.

Breast density increases a woman's chances of developing breast cancer. A woman with dense breasts has a three to six times greater risk of breast cancer than a woman who does not have dense breasts. Breast density is higher in younger women who have not gone through menopause. Given this, the women who most need our attention are those in the 40 to 55 age group.

Breast density is diagnosed by mammography. It cannot be diagnosed by touch. A woman's first mammogram will indicate whether she has dense breasts. For women diagnosed with breast density, regular screening by digital mammography or MRI as part of an organized screening program is recommended. Research shows that digital mammography is more effective than screen-film mammography at detecting breast cancer in dense breast tissue. Digital mammography is gradually replacing screen-film mammography in Canada.

Further research is required to better understand the biology of breast density and its role in the development of breast cancer. Further research is also needed to define measures of breast tissue density, optimal imaging modalities, and the frequency of screening.

Knowing about breast density is an important part of a woman's overall breast awareness. If multiple members of a woman's family have been diagnosed with dense breasts, she is encouraged to speak to a health care provider about having a mammogram to assess for breast density.

Women in their 40s, women who are 50 years plus and have not gone through menopause, and women with clinically diagnosed dense breasts are encouraged to ask to be referred to a facility with digital mammography to assess breast density and for regular breast cancer screening.

My wife was 40 when she passed away from breast cancer. She did not have access to the screening technology and knowledge that we have today. I ask you to consider Bill C-314 as a way to raise women's awareness about breast density, how it increases breast cancer risk, and the importance of screening to diagnose breast density and to monitor the breast health and breast cancer risk of women with dense breasts.

I thank the committee for letting me speak today.

[Dr. Tina Ureten]

Madame Chair and dear members of this committee, I would like to thank you for this opportunity.

I support the Breast Density Awareness Act because I believe this act will provide very important information for Canadian women with regard to their breast health. This act can help save lives and can prevent advanced stages of the cancer.

When we talk about breast density, we are referring to the percentage of glandular tissue versus fatty tissue. That's just an explanation of breast density. Glandular tissue consists of milk-producing cells.

Breast density affects quite a large percentage of women, regardless of age and race. Women with dense breasts have five to six times more risk of having cancer. However, women are not informed after having mammograms as to whether or not they have dense breasts. That's why this act is so important.

Dr. Norman Boyd, a leader in breast cancer research at Princess Margaret Hospital, says, “Cancer turns up five times more often in women with extremely dense breasts, signalling the importance of a risk factor rarely discussed with the patients. It has been ignored to an absolutely unbelievable degree.” A poll in 2010 showed that 95% of North American women don't know their breast density. Less than one woman in ten over age 40 was informed by her doctor about breast density issues.

The important facts behind breast density are that 66% of pre-menopausal women and 25% of post-menopausal women have dense breasts. Women whose breast tissue density is over 75% have five to six times more risk of having cancer. Cancer originating from dense breasts is more aggressive, and breast density is one of the strongest predictors of failure of mammography screening programs.

It's obvious we need an adjunctive screening tool to screen dense breasts. It needs to fulfill WHO's criteria for screening. Since the mid-1970s researchers have been looking for the role of ultrasound as a screening tool. All of the results show very promising numbers for screening dense breasts after mammograms. Some authors of studies have even suggested that ultrasound should be the initial imaging used for younger women.

There is a table in your handouts. It shows how over 52,000 women were screened using mammogram and ultrasound. In the end, 186 cancer cases that were missed by mammograms were diagnosed through ultrasound. That's a significant number.

We have two different types of ultrasound these days. One is general ultrasound. We call it hand-held ultrasound. Those machines are used for general purposes. They are good. They save lives. They improve quality of life because they catch the cancer in the early stages, and they also save the cost of treating patients at the advanced stage, but they are very operator-dependent and time-consuming.

They came up with new machines. They are designed just for screening breast tissues, and they are called automated 3-D whole breast ultrasounds. These machines are really fast. They provide high-resolution three-dimensional images. They eliminate the human factor, and the radiologist can see the slices of the whole breast, so if there are multicentric cancers, they can see them in one image. Of course the sensitivity is much higher than that of the hand-held ultrasound, and they are reliable for following up with the survivors.

As my conclusion, I will say that Canadian women definitely need to be informed and educated about breast density. They are supposed to know what other tests are available for them.

The life-saving strategy should be catching the cancer in the earliest possible stage. We can't prevent this disease yet, but early diagnosis saves lives. Ultrasound is capable of detecting dense breast tissues, but automated 3-D ultrasound is a better tool for that purpose. Of the cancers detected by ultrasound, 93% are in the early stage and easier to treat.

As my recommendations, I will say we definitely need a standard mammography reporting system nationwide. We need to educate women. We need to educate health care providers. Women should know about their breast density after they go through a mammogram test. Also, they have to be informed about supplementary tests. Advanced technology with higher sensitivity should be used for effective screening and early diagnosis, and timely action for the changes is necessary before we lose many more lives.

Thank you for your attention.

[Cathy Ammendolea, Chair of the Board of Directors, Canadian Breast Cancer Network]

Madam Chair and everyone, good morning.

I'm very pleased to be invited to speak here this morning on behalf of the Canadian Breast Cancer Network and to offer our support for Bill C-314, an act respecting the awareness of screening among women with dense breast tissue.

The Canadian Breast Cancer Network is the only national survivor-driven and survivor-focused organization in the breast cancer sector and is the voice of breast cancer survivors in Canada. We represent the concerns of over 225 partners and member organizations across Canada, as well as those of all Canadians affected by breast cancer and those at risk. CBCN's main goals are to improve access to quality breast cancer care for all Canadians and expand the influence of breast cancer survivors and families in all aspects of the breast cancer decision-making process.

It is estimated that over 23,000 women will be diagnosed with breast cancer this year and that over 5,100 of them will die from the disease. The Canadian Breast Cancer Network supports efforts made by the federal government to help women make decisions that will increase their chances of survival. As a breast cancer survivor myself, I know first-hand the importance of education and awareness around screening and treatment of breast cancer.

We are pleased to support this bill, as it encourages the use of existing programs to increase awareness, to determine gaps in information, to improve information and education to women undergoing breast cancer screening, and to address the challenges of screening with dense breast tissue. We encourage any pan-Canadian efforts by the federal government, as this will ensure that all Canadians have equal access to breast cancer programs, therapies, and services.

We applaud the efforts brought forward by the member for Barrie in Bill C-314. We would like to see a more clearly defined approach for implementing this bill that will ensure the desired outcomes are met. The member for Saskatoon—Rosetown—Biggar mentioned that there is currently a tool available through the Canadian breast cancer screening initiative to assist in decision-making pertaining to breast cancer screening. She indicated that this tool--“Information on Mammography for Women Aged 40 and Older”--will be revised to include breast density information. While we believe this to be a beneficial step, we would like to see additional mechanisms in place, clearly outlined, to indicate how this bill proposes to ensure that it meets its objectives.

One of the mechanisms the Canadian Breast Cancer Network would like to see clearly identified is an increased awareness and education for practitioners around screening women with dense breast tissue. The practitioners play an integral role in educating the patients and helping to recommend the appropriate type of screening that would most benefit those with dense breast tissue.

The Canadian Breast Cancer Network agrees that patient education and awareness are imperative when trying to provide necessary information to women being screened with dense breast tissue. We do, however, echo the concerns of the member for Vancouver Centre and the member for St. Paul's: while we want to see increased awareness around the issue, we need to ensure that we are not increasing anxiety in this population.

We are pleased with the federal government's continued commitment to work with the provinces through the Canadian breast cancer screening initiative and to provide education and awareness to Canadians through the Canadian Partnership Against Cancer.

The member for Scarborough—Rouge River identified recommendations the Canadian Breast Cancer Network has put forward that will make a difference for Canadian women. We would like to highlight how they relate to breast cancer screening for women with dense breast tissue.

While there are now more digital mammogram machines available across Canada, we need to continue to ensure that we invest in state of-the-art technology. Digital mammograms and MRIs are some of the diagnostic tools that are available to help address the challenges of screening women with dense breast tissue. We urge the federal government to continue to invest in new technologies to help Canadian women.

Currently there are no established or travelling screening facilities available in Nunavut. The federal and territorial governments must work together to establish a screening program for Nunavut that includes technologies that will address the needs of women with dense breast tissue.

In closing, the Canadian Breast Cancer Network would like to add our support for this bill, and we are encouraged that the federal government is taking a step in the right direction. However, we need a commitment from the government that this bill will be implemented in a timely manner in ways that will benefit women fighting this disease.

On behalf of the Canadian Breast Cancer Network, I would like to thank the committee for this opportunity to speak here this morning. Thank you.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair. It's great to have the bill here at the health committee.

It's my pleasure to present some opening remarks about Bill C-314. I want to explain to the committee the genesis of the bill and why I think this is an important initiative to take up.

Over their lifetimes, one in nine women will be diagnosed with breast cancer. According to the Canadian Cancer Society, over 23,000 Canadian women will be diagnosed with breast cancer this year alone. Sadly, over 5,000 of them will lose their lives in this very difficult fight.

In the part of the country I come from, the city of Barrie, health care is of the utmost importance, as it is in most cities. When I was thinking about the type of private member's bill I could undertake, I thought that something in the health care field would be appropriate given the interest that exists in my community.

Every year we have a CIBC Run for the Cure, an annual breast cancer fundraiser, and the incredible numbers who gather to stand up and raise funds and build awareness of the fight against breast cancer always astonish me. There are always thousands and thousands who participate. Right now in Barrie we're also building a regional cancer centre to service all of Simcoe-Muskoka, and battling breast cancer obviously is going to be a key component of that new service.

I consulted the health care community in Barrie and asked what types of initiatives we could undertake to further broaden our health services. A number of issues were identified, but one initiative identified on which we can certainly move the yardstick forward was breast cancer screening. That's the genesis of this bill. I spoke with some of the top doctors and health care administrators in my riding and also with individuals from the Ministry of Health here in Ottawa, and I believe this is a means by which we can make a positive contribution in regard to breast cancer.

I feel that it is 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 critically important and will ultimately help them make the decisions that are right for them. That 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. It is important for women to be informed of this. This can be done when they are screened for breast cancer by a mammogram. Women who have dense breast tissue should also know that potential cancer may not be detected because it cannot be seen on a mammogram and therefore cannot be diagnosed by radiologists. It appears white on mammograms and therefore is more challenging to detect.

What Bill C-314 will do is highlight the importance of being informed and of working 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 the 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 further help women and their doctors make well-informed decisions regarding breast cancer screening.

Through this piece of legislation, targeting dense breast tissue is one of the means by which I believe we can make a tangible difference in the fight against breast cancer. We all know too many loved ones, friends, and even colleagues on the Hill who have been touched by cancer. Through this bill, I believe we will make a positive step forward for individuals who unfortunately have to fight breast cancer.

Think of that overall number of 23,000 people every year in Canada who face breast cancer--believe it or not, both men and women--and of the 5,000 of them who pass away. If even a small percentage of them can have early detection through proper screening, it will make a huge difference.

There has been incredible progress in the fight against breast cancer in Canada. With survival rates up into 80%, it's an accomplishment for our country, but we can do much better. We're at 80% today, but with early diagnosis, with more effective screening, I believe the sky is the limit in terms of the survival rate levels we can achieve here in Canada.

I appreciate that the health committee is looking at this today. That's my brief introduction to what this bill is about. I hope that it can receive favourable support from the health committee and that when this becomes legislation we can all have paid a positive contribution into enhancing health care in Canada.

[The Chair, Conservative, Joy Smith]

Good morning, everyone. We have a quorum, so we're going to start right on time, pursuant to the order of reference of Friday, December 9, 2011, in regard to Bill C-314, an act respecting the awareness of screening among women with dense breast tissue.

We are going to have our witnesses until 10 a.m., when we will suspend for about a minute just so Mr. Brown can take his place on committee. Then we'll do the clause-by-clause.

Our first witness, for a ten-minute opening statement, will be Mr. Brown.

Welcome. Congratulations on your bill, Mr. Brown.

Breast Density Awareness Act

[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.

[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.

[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.

[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.

[Kellie Leitch, Conservative, Parliamentary Secretary to the Minister of Human Resources and Skills Development and to the Minister of Labour]

Madam Speaker, I am pleased to speak in support of Bill C-314 regarding dense breast tissue and the importance of breast cancer screening.

Bill C-314 calls on the federal government to use existing programs and initiatives to increase awareness about dense breast tissue and its impact on breast cancer screening. The bill's focus is on working with partnerships to improve information and share information on screening with women and their doctors. Several current government actions are highlighted. They are supported by other partner organizations focused on cancer, breast cancer and breast cancer screening. I will explain more about these actions in my remarks today, but I would like to begin with a few words about how critical the underlying issue is.

Every year, millions of Canadians are affected by cancer either personally or by the experience of a family member, friend or neighbour. I have personally been affected by this disease with the loss of my mother in 1989. Because of this and my role as a surgeon, I know about the importance of breast cancer screening and awareness. Breast health, regular checkups and exams should be a conversation in every home in Canada. It is one that occurred in my family home. As one can imagine, it is not an easy conversation for a single father who has recently lost his wife to have with his young children. However, it is extremely important that parents have this conversation with all of their daughters.

Awareness starts at home, as well as in a doctor's office. Young women across the country should be in constant dialogue with family physicians when it comes to their breast health and determining what practices for screening are best for them. Breast cancer in particular is a major health concern. One in nine women in Canada develops breast cancer during her lifetime, making it one of the most common cancers affecting Canadian women.

In 2011, it is estimated that 23,400 women in Canada will be diagnosed with breast cancer, an increase from 2010. That represents about 450 women being diagnosed each week. Early detection of breast cancer through organized screening programs is an important public health practice. Our government has invested in partnerships that promote optimal screening. Our government works across different health sectors with partner organizations, as well as with provinces and territories that deliver health care services.

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

This bill recognizes that we are taking action on this issue through a number of initiatives. We are reinforcing existing investments, commitments and action on prevention, detection and control. The bill also recognizes the important work done by the Canadian Partnership Against Cancer. This initiative was established and funded by our government. The bill highlights the work our government does through the Canadian Institutes of Health Research and the Canadian breast cancer screening initiative. The knowledge generated through these initiatives is then shared with doctors and networks that include health organizations like the Canadian Cancer Society.

The central initiative supported by our government to fight cancer is the Canadian strategy for cancer control. This is a co-ordinated comprehensive strategy developed with government, non-governmental cancer organizations, cancer survivors, researchers and health care professionals. Screening and early detection is the main priority of the strategy. Breast density and its implications for screening is a part of this.

The Canadian strategy for cancer control is implemented by the Canadian Partnership Against Cancer. The partnership is an independent not-for-profit organization that is working on prevention, early detection, treatment and the support for Canadians living with cancer. This organization has done much to ensure cancer patients and health care professionals across Canada have state-of-the-art knowledge about what works to prevent, diagnose and treat cancer.

Notably, the partnership has encouraged hard-to-reach populations to undergo screening, helping doctors to identify cancer earlier. Funding of $250 million to the partnership was recently renewed for five more years, from 2012 to 2017. This funding will help the partnership continue its invaluable work on reducing cancer cases, enhancing the quality of life of cancer patients and increasing the likelihood of survival.

Through CIHR, the government is funding research on more effective diagnostics, treatment and prevention for all cancers, including breast cancer. Research investments in this area support important Canadian scientific work. I want to stress that the search for a cure is only part of the incredible research being undertaken in this country. Research is helping to reduce the burden of cancer on individuals and families through informing the development of prevention strategies.

As well, scientific research is helping to improve screening in health care settings. It is contributing to early diagnosis and, in many cases, allows access to better quality cancer care. This year alone $22.7 million was spent on breast cancer research.

Bill C-314 highlights the importance of providing women and their doctors with the most recent information. Our government's Canadian breast cancer initiative contributes by making education and information resources available to communities across Canada. This work facilitates action on breast cancer, women's health, inter-sectoral collaborations, and stakeholder involvement.

The government supports the Canadian Breast Cancer Foundation's screening initiative, a key component of the Canadian breast cancer initiative. The screening initiative is a joint provincial-territorial collaboration to develop screening approaches. It contributes to improving breast cancer screening programs by developing nationally agreed upon quality indicators.

For women with higher breast density, breast cancer is generally harder to detect using mammograms, resulting in more frequent screenings. The Canadian breast cancer screening initiative supports national standards for prevention, early detection and screening. It seeks to develop and share best practices in breast cancer and women's health. Our government recognizes the importance of participating in cancer screening. Raising awareness around breast density supports this goal.

Through the screening initiative, we are working with the provinces and territories as well as local and non-governmental organizations to increase early detection and screening for populations less likely to be screened, such as newcomers to Canada, rural Canadians and persons with disabilities. This cross-Canada project enables the sharing of best practices, and ensures that information and support programs are available to women with breast cancer.

Through the Canadian breast cancer screening initiative and the Canadian partnership against cancer, our government helps the provinces and territories benchmark performance against national standards. It is equally important to share knowledge through health organizations such as the Canadian Cancer Society. The bill reinforces the current actions on breast cancer screening that reflects the government's commitment to keep Canadians and their families healthy, to help doctors detect cancer, and to give women better information on which basis to make their decisions.

I want to commend the hon. member for Barrie for his initiative which will not only better the information women receive regarding their breast health but will also lead to earlier detection and to more women's lives being saved.

I came face to face with the ramifications of breast cancer when I lost my mother 22 years ago. Compounded by my role as a physician, it is why I am so passionate on this issue. I strongly urge every member of the House to support this bill on the awareness of breast cancer screening, so that we can stand unanimous in this chamber in support of women's breast health.

I once again commend the member for Barrie for his excellent work on this bill.

The House resumed from October 24 consideration of the motion that Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, be read the second time and referred to a committee.

[Michelle Rempel, Conservative, Parliamentary Secretary to the Minister of the Environment]

Mr. Speaker, first, I thank my colleagues for their excellent debate on this issue this morning.

I rise today to address Bill C-314, an act respecting the awareness of screening among women with dense breast tissue. I thank my colleague, the member for Barrie, for bringing this important bill forward.

As October is Breast Cancer Awareness Month, it is time to draw attention to breast cancer and to raise awareness of this important health issue affecting Canadians.

Statistics tell us that breast cancer is the most common form of cancer among Canadian women. One in nine women will be diagnosed with the disease.

Those statistics are more than just numbers. They represent women whose lives are affected by breast cancer. They are wives, mothers, daughters and friends. This year it is estimated that thousands of women across the country will be diagnosed with breast cancer and that approximately 5,000 women will die from the disease.

Thankfully research is providing answers to many questions regarding breast cancer. We are learning more about prevention, risk factors and treatments. Our government's investments into health research through the Canadian Institutes of Health Research support scientific discoveries regarding all types of cancers including breast cancer. We are learning more about the early detection of breast cancer.

The bill focuses on raising awareness regarding breast density and its effects on breast cancer screening. It emphasizes the importance of this issue in an effort to help women and their doctors make well-informed decisions with regard to breast cancer screening.

Why is that important? More than ever before Canadians are taking an active role in their health and require good information to support that role. Canadians need information on what has been proven as well as what is not yet well understood. Only then can they weigh the risks and benefits of the different courses of action.

As well, the Internet revolution allows Canadians to find a great deal of information on health topics. It also means Canadians are faced with the difficulty of deciding what is accurate, inaccurate, important or misleading.

Therefore, providing accurate information to Canadians will increase their awareness and help them make well-informed decisions.

There is a great deal of information available on breast cancer and breast cancer screening which addresses the particular issue of breast density and its implications on breast cancer screening.

A mammogram is an X-ray taken of the breast and is used as a screening method for breast cancer. However, for women with dense breast tissue it can be more difficult for this method to detect small changes that could denote cancer.

Canada's breast cancer screening programs are delivered by the provincial and territorial governments under their jurisdiction for health care delivery. These excellent programs operate according to the highest standards. The federal government is helping breast cancer screening programs through investments made in the Canadian breast cancer screening initiative. This initiative measures the performance of breast cancer screening programs across the country. The information is used by those programs to improve the services they provide to Canadian women.

We are also assisting breast cancer screening programs in sharing their best practices. A key feature of these programs is the important information they provide to women on all aspects of breast cancer screening including breast density. That way we can build on the good work that is already under way.

National non-governmental organizations and their volunteers also play integral roles in raising awareness. The bill recognizes the important role of organizations, such as the Canadian Cancer Society and the Canadian Breast Cancer Foundation, as well as numerous other women's health organizations. All of these organizations work to promote cancer prevention, early detection, effective treatments and research. They also provide education and awareness programs and work to improve the quality of life for those living with breast cancer.

The fact that so many Canadian organizations and programs already provide high quality information to women on breast cancer reflects upon the dedication that exists with regard to this enormous health challenge. Researchers, doctors, nurses and provincial and territorial cancer agencies are committed to reducing the rates of breast cancer.

Our government's investment in the Canadian strategy for cancer control and its implementation by the Canadian Partnership Against Cancer is part of this national commitment. As its name implies, the partnership is working across the country to speed up the use of effective approaches to cancer prevention and control so that all Canadians will benefit. It is helping to fill gaps, build new models and expand existing programs where needed. Cancer screening is one of the partnership's priorities and its work to provide information to Canadians is consistent with the intent of the bill. The renewed investment in the Canadian Partnership Against Cancer announced by our Prime Minister in March will help that excellent work that is under way continue.

We have much to build on and many best practices to apply as we continue to support Canadian women in accessing the information they need to make decisions on their health. Of course, our efforts are in line with the role of the federal government in supporting health research and identifying best practices in creating partnerships and of promoting the health of Canadians.

In closing, Bill C-314 encourages the Government of Canada to use existing initiatives to raise awareness of breast density in the context of breast cancer screening. This is important for Canadian women.

I sincerely hope we have the support of all members in this House for this important bill.

[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 second time and referred to a committee.

Mr. Speaker, I am very pleased to speak to my private member's bill, Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue, which calls on the federal government to encourage the use of existing federal initiatives in order to increase awareness among Canadian women about the impact of having dense breast tissue and the complications it poses for breast cancer screening.

Breast cancer touches many Canadian women and their families and friends, and is the most common form of cancer in women. I know this is something Canadians from coast to coast to coast care deeply about. Just last month Barrie held its annual CIBC Run for the Cure in support of breast cancer research. I saw 2,000 residents out early on a cold and wet Sunday morning to support the battle against breast cancer. Runs like that occur across the country because Canadians are deeply concerned.

In my community of Barrie, in less than 12 months, the Royal Victoria Hospital's regional cancer care centre will open. There have been literally thousands of fundraising events over the last five years to support this very large cancer centre. It will help battle a variety of cancers, including of course, breast cancer.

This year it is estimated that about 23,000 women will be diagnosed with breast cancer, and 5,000 women will die from this insidious disease. Over their lifetime, one in nine women will be diagnosed with breast cancer. This is very difficult to accept. It touches many women and their loved ones. Sixty-four Canadian women will be diagnosed with breast cancer and 14 will die of breast cancer every day. It is my sincere hope that over time this bill will help reduce those troubling numbers. Health sectors in other areas of the world are beginning to more aggressively target dense tissue to enable early detection of breast cancer.

It is important 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 will help them make decisions that are right for them. The federal government supports a number of initiatives to support Canadians dealing with cancer.

Bill C-314 aims to raise awareness about dense breast tissue and breast cancer screening. It will help women and their doctors make well-informed decisions regarding breast cancer screening. It includes a number of elements, which I will briefly outline. I will also address initiatives currently under way to address them.

First, this bill requires the Government of Canada to assess whether gaps in information exist relating to breast density in the context of breast cancer screening. Second, this bill requires that approaches be identified, where needed, to improve information for women in order to: one, address the challenges of detecting breast cancer in women with dense breast tissue; and two, raise awareness concerning these challenges. Third, the bill requires 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 deemed necessary.

Canada is fortunate to have screening programs for breast cancer. The provinces and territories deliver these programs to detect breast cancer before it has spread so that treatment can be started. We are learning more and more from scientific research about breast cancer and its risk factors. New and better treatments are being developed. However, there is still much to learn. We know that good information is fundamental to the decisions that each of us makes with the advice of our doctors about our own health. This dialogue is the key to doctor-patient relationships.

Let me take a few moments to explain how the issue of breast density relates to breast cancer screening. First, breast density refers to the amount of tissue in the breast. Dense breasts have more tissue. Breast cancer screening is done using a mammogram, which is an X-ray of the breast. A woman's breast density can affect the accuracy of a mammogram and it may be more difficult for a doctor to see an abnormality. There could be cancer present if the breast tissue is dense because both cancer and dense breast tissue appear white on mammograms.

High breast density is also linked to an increased risk of developing breast cancer, although it is not yet known why this is the case. We also do not know how common dense breast tissue is among Canadian women, although some statistics point to the fact that it could be as high as 40%. Providing women with information of what is known about breast density would help them make well-informed decisions about screening and would open the door for women to engage in follow-up procedures, such as an MRI or ultrasound, if they have dense breast tissue which could skew the mammogram.

In addition to raising awareness on breast density, the bill recognizes the responsibility of the provinces and territories for providing breast cancer screening. Provincial and territorial breast screening programs are invaluable in the early detection of breast cancer in Canadian women.

As noted in the bill, the federal government plays a role in breast cancer screening by facilitating the identification and adoption of effective practices in screening. We also support the sharing of information on screening methods and outcomes through our federal roles in research and surveillance.

Through the Canadian Institutes of Health Research, our government provides funding to researchers to investigate the full spectrum of cancer prevention and control. One of the priorities of the Canadian Institutes of Health Research is early detection of cancer. The CIHR works with partners both nationally and internationally to advance its research priorities, including breast cancer research.

Our government has demonstrated its commitment to breast cancer screening by investing in the Canadian breast cancer screening initiative. We work with provincial and territorial governments to measure the performance of breast cancer screening programs across Canada. This means that all jurisdictions regularly share information on the screening programs and discuss what they are learning. They share best practices, discuss the challenges they are facing and the questions that are important to all of them.

Information sharing about ways to improve these programs ensures that women receive the full benefits of early detection. This includes providing women with information about all aspects of breast cancer screening. The federal, provincial and territorial national committee for the Canadian breast cancer screening initiative provides opportunities for provincial and territorial governments to work together to develop their screening recommendations and approaches. This committee is comprised of medical professionals and key stakeholders.

For example, the committee is currently looking at breast cancer mortality and improving screening for underserviced populations. We have the Canadian breast cancer screening database, which is a source of valuable information on breast cancer screening. Participating provincial and territorial screening programs contribute to the national database, which is used to monitor and evaluate breast cancer screening programs. Non-government organizations play a vital role in this process as well.

I am proud to say that our government is taking action on cancer through our continued investment in the Canadian Partnership Against Cancer which has led to the implementation of the Canadian strategy for cancer control. The partnership is the first of its kind and was established by our Conservative government. It covers the full spectrum of cancer control, from prevention to palliative and end-of-life care, policy to practice, and from research to health system applications.

Together with the cancer community, the partnership is accelerating the use of effective cancer prevention and control strategies. Its objectives are to reduce the number of cancer cases, minimize cancer-related deaths and improve patient quality of life.

In March of this year, our Prime Minister announced renewed funding of $250 million over five years, beginning on April 1, 2012. This will allow the partnership to continue its invaluable work. In the words of the Prime Minister:

We are making progress on prevention, diagnosis, treatment and hope, and in tracking our progress closely, the partnership is leading us on the path to a cure.

The partnership plays a key role in providing information to women on cancer screening, which aligns with the spirit of this bill. The bill also recognizes the important role of organizations such as the Canadian Cancer Society and the Canadian Breast Cancer Foundation in providing reliable information that supports women in making decisions about their health.

All of us are familiar with the Canadian Cancer Society. This national volunteer organization works in cancer prevention, research, advocacy, information and support for all cancers.

The Canadian Breast Cancer Foundation is a national volunteer organization dedicated to working toward a future without breast cancer. The foundation funds, supports and advocates for research, education and awareness programs, early diagnosis and effective treatment, as well as a positive quality of life for those living with breast cancer.

Women's health organizations, such as the Canadian Women's Health Network, raise awareness on many health issues faced by women in Canada, including breast cancer.

Working with the above-listed breast cancer stakeholders, the federal government will continue to raise awareness through existing initiatives on the issue of breast density in the context of breast cancer screening. These stakeholders will be very critical in our battle to raise awareness about breast density.

This bill is particularly timely given that October is breast cancer awareness month. Through efforts to raise awareness, Canadian women and their families can become more informed about breast cancer. They will learn about breast density and its implications for breast cancer screening. They will be able to make well-informed decisions based on this knowledge.

I would like to thank Andrea Paine at the Ministry of Health in Ottawa, Dr. Rob Ballagh of Barrie, Mike Richmond from Toronto, and my assistant in Barrie, Shawn Bubel, for their assistance in the drafting of the bill.

The bill provides an opportunity for the Government of Canada and the House to recognize the critical importance of raising awareness about breast density and breast cancer screening.

It would be an honour for me to have the support of all members in the House for this bill. Too many families have been touched by this form of cancer. I am hopeful that by ensuring women get the information they need which could lead to early detection, this legislation could potentially save lives.

[Patrick Brown, Conservative, Barrie, ON]

moved for leave to introduce Bill C-314, An Act respecting the awareness of screening among women with dense breast tissue.

Mr. Speaker, this enactment would require the Government of Canada to encourage the use of existing initiatives in order to increase the awareness of women about the implications of dense breast tissue for breast cancer screening and to assist health care providers in making well-informed decisions regarding screening.

According to the Canadian Cancer Society, in 2011 it is expected that over 23,000 Canadian females will be diagnosed with breast cancer, of which, regrettably, over 5,000 will pass away.

The Government of Canada can certainly play an effective role in the adoption of effective early detection screening practices. Targeting dense tissue is one of the means by which we can make a tangible difference.

(Motions deemed adopted, bill read the first time and printed)