Health Committee on Jan. 31st, 2012

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

First of all, congratulations to Mr. Brown for getting his bill through second reading in principle. We're here at the committee today and we're very happy to be going through the bill, because it's a very important bill. Thank you for bringing it forward, and congratulations on the first vote.

[Patrick Brown, Conservative, Barrie, ON]

Thank you.

[Libby Davies, NDP, Vancouver East, BC]

Also, thank you to the witnesses for providing such detailed and very thorough information. I think it has really helped us understand the issue and what we need to do. Thank you for that.

I have a couple of questions. First of all, to Mr. Brown, going though your bill.... It's a short bill, and it really focuses on increasing awareness and information, which I think is really important. Hearing from the witnesses, it seems to me that we need to go a bit further. We've heard very important information today. I was surprised to learn that ultrasound is not part of a general follow-up.

I think a lot of women are really confused now about what the heck is going on. We keep getting contradictory information about mammograms, such as “Mammograms are no good, don't worry about them”, or “Yes, you should go”. I do think there has been a lot of confusion, maybe because there is new information coming out.

Mr. Brown, when you talk about increasing awareness concerning the implications of heterogeneous or dense breast tissue, I wonder what you mean specifically. In your mind, how does your bill spell out how that should be followed up? Is that something you think would be left to the screening initiative, provincial health authorities, or whoever? It's not quite clear. Clearly, you are saying that awareness should be raised and we have to figure out what information gaps there are, but how does the bill address what actually needs to be done in terms of follow-up?

Based on what we've heard today—I don't know whether you were able to consult with any of these organizations prior to this—it seems to me they have identified a few things here. I would ask you that, and I hope you are open to the idea that we could strengthen the bill based on what we've heard today. I know the NDP has some amendments.

If you could just address that in terms of.... Yes, it's about raising awareness and looking at implications, but what does that actually mean in terms of what is followed up, whether it's with better training for practitioners, or better technologies or tools, or whether it's the ultrasound or the automated machine? How do you see that fitting in with your bill?

[Patrick Brown, Conservative, Barrie, ON]

Thank you for the question.

I appreciate all of the testimony and suggestions today and I appreciate hearing about the collective support that exists for the bill.

You are correct that a major component of the bill is about raising awareness, because there is a lack of awareness regarding the inadequacy of current screening, but I would note that it goes beyond raising awareness. It's not about breast screening in general; it specifically targets dense breast tissue, since that, in my opinion, is where the weakness in the screening exists, and it's about putting a particular focus on those Canadians with dense breast tissue whose health care needs are not currently being met when it comes to breast cancer.

The goal of the bill is to identify approaches that are needed to improve information that is provided to women. Providing that information to women will allow them to make informed health care choices. Doing so would also help determine where there are information gaps relating to breast density in the context of breast cancer screening. The bill also advocates sharing with the Canadian breast screening initiative information related to the identification of dense breast tissue during screening as well as approaches to follow-up.

Obviously, a lot of the screening is done through provincial and territorial governments. We can, I guess, provide guidance, but the actual screening will depend on the goodwill of the provinces and territories, because obviously it's under their jurisdiction. I do think that through the federal Parliament we can provide effective guidance and leadership in this area.

[Libby Davies, NDP, Vancouver East, BC]

Do I have a little more time?

[The Chair, Conservative, Joy Smith]

You have about two minutes.

[Libby Davies, NDP, Vancouver East, BC]

Unless I'm interpreting it incorrectly, your bill seems to say that it is the responsibility of women to sort of figure out that they need to be more aware of dense breast tissue issues--and that's very clear in the bill--and that responsibility rests with patients to follow up. It seems to me we've heard today that it's also about education of the practitioners and about the medical system itself regarding adequate follow-up.

For example, I know that in B.C. you can get regular screening once you reach age 40. You don't even need a referral from a doctor; you just go to the screening. Probably many of the women going for screenings do not have a physician, so this whole issue of who they follow up with and who does that follow-up is a very pertinent issue.

I'm just concerned that the bill sort of leaves you with the idea that you should become aware, but then what do you do? Whose responsibility is it then? It seems to me we all have a personal responsibility, but the system also has to be able to respond, for example, with these new tools that we've heard about today. I wonder if you think your bill can address that as well, so it's not just that we have the information, but we don't know what to do now.

[Patrick Brown, Conservative, Barrie, ON]

I believe the bill would provide females or males who have breast cancer with the information that doesn't currently exist. I suspect that a lot of breast cancer patients are not being provided that early feedback that the mammogram may not provide the certainty they suspected it would. Providing the information to the patient is an important step forward.

Provision of breast cancer screening services falls under provincial and territorial jurisdictions, as I've said. The federal government facilitates the identification and adoption of effective practices and the sharing of information on screening methods and research.

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Brown, can you just wrap up?

[Patrick Brown, Conservative, Barrie, ON]

I just wanted to highlight the component we can change, which is the adoption of best practices for screening.

[The Chair, Conservative, Joy Smith]

Sure. Thank you.

We'll now go to Dr. Carrie, who is going to be sharing his time with Mr. Gill.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madame Chair.

First of all, I want to thank Patrick for bringing this very important issue forward.

I do have some concerns. As my colleagues said, I think here in the committee we'd love to do everything to make sure things were put in place, but we do acknowledge that the bill has a certain scope.

Susan, I was concerned that you are a person who is very aware and you took all of the regular steps, but then there was no protocol for follow-up.

There seems to be a gap in the knowledge out there that would be appropriate for women and health professionals. So as I said, I commend Patrick for bringing this forward at the national level.

I actually have a question for Dr. Ureten. Does your company take extra steps to raise awareness about dense breast tissue within the medical profession as well as with the provinces? It seems to be--and I know I wasn't aware of it the way I should be--that the professionals and the provinces and territories are responsible for this. Does your company do anything to raise their awareness at all?

[Dr. Tina Ureten]

That's our main goal, to make Canadian women aware of breast density issues. We work with a group of volunteers for that purpose. We go to women's health shows. It just started last summer, a couple of months ago, so we are working on that.

[Colin Carrie, Conservative, Oshawa, ON]

Do you focus on the provinces and territories too, or at the ministerial levels or anything like that?

[Dr. Tina Ureten]

We have only one mission in Toronto right now, but we are capable of putting extra missions in big Canadian cities and giving that opportunity to Canadian women to get supplementary tests after they have their mammogram.

The mammogram is the gold standard. In order for a woman to say that she has dense breasts, she has to go through a mammogram. There is no other test that will give us that information. After we see dense breasts, then we can direct them to supplementary tests to see if there is something hidden in the mammogram pictures.

[Colin Carrie, Conservative, Oshawa, ON]

All right. Thank you.

Parm.

[The Chair, Conservative, Joy Smith]

Go ahead, Mr. Gill.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you, Madam Chair, and thank you to all the witnesses for coming out today.

I also want to thank Patrick for his important initiative and applaud his effort in raising awareness on this important issue. I too have two close family members who were affected by this disease.

My question is for VIP Breast Imaging. What sort of equipment is available out there that can help detect dense breasts?

[Dr. Tina Ureten]

The initial test is a mammogram, all the time.

As a second test, the ultrasound plays a really good role, especially automated 3-D ultrasound, because you get the picture of the whole breast and the radiologist can see different planes of the lesion. If they catch something, they can look from different angles.

An MRI is definitely another supplementary test, but it's not cost-effective. The other test is a biopsy. After they find something with an ultrasound or an MRI, they go for a biopsy. There are not many tests, but an ultrasound and MRI are the supplementary tests.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Your website also says that your equipment is radiation-free. Is this the norm now with equipment in clinics across the country?

[Dr. Tina Ureten]

Well, there are some women who stay away from mammograms because of the radiation. They get that information from the media, not from their health care provider.

Some women will visit their naturopathic doctor and mention that, no, they won't go for a mammogram because radiation is involved with a mammogram. That's a personal choice. At least they know there is another tool for them if they choose not to go for a mammogram. That's why we mention it's radiation-free. That's the same ultrasound they use for pregnant women.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Is your organization also doing anything in terms of creating awareness on this issue, or are you aware of any other organizations that are also involved in maybe creating awareness on this topic?

[Dr. Tina Ureten]

Our organization definitely is working on educating women and health care professionals. I am not aware of other organizations....

You are involved, Feather. Are you aware of any organizations?

Feather is from B.C., and she was diagnosed at age 23.

[Feather Janz, Representative, VIP Breast Imaging]

I was diagnosed with breast cancer for the first time 17 years ago. I worked as an advocate as much as possible, learning as much as I possibly could, and this was the first time I was even made aware of it.

I was diagnosed again with breast cancer at 35 years old, with a different form of the disease, a much more aggressive form, and I'm very fortunate to be approaching a five-year cancer-free mark myself. This was the first time I had heard that my extremely dense breast tissue was what made me so at risk of getting breast cancer twice at such a young age. It shocked me, because I was so informed, and this was the first I had heard of it.

[Dr. Tina Ureten]

We met in October at a women's health show. That was the first time Feather heard from us about the dense breast-tissue issues.