Health Committee on Jan. 31st, 2012

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Is it the only one in Canada?

[Dr. Tina Ureten]

Yes.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Are there others like it in Canada, or is this one on the cutting edge: you have it, and that's where it is right now in Canada?

[Dr. Tina Ureten]

The manufacturers are working on those machines in the direction of just making machines for one purpose. I'm sure that, in the future, there will be some more.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you very much.

[Dr. Tina Ureten]

Thank you.

[The Chair, Conservative, Joy Smith]

We have very compelling evidence here today, and it's very important to a lot of people.

Now we'll go into the five-minute round with Ms. Quach, please.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Thank you, Madam Chair.

My thanks to Mr. Brown for introducing this bill and for tabling it in the House. Thanks also to all the witnesses who have given us additional information. I learned a lot as I listened to them.

This bill is a good step forward. It allows us to talk and to get more information. In light of the testimony we have heard today, I wonder whether the federal government should not go a little further and not just target people with dense breast tissue.

Not all provinces have systematic diagnostic programs in place. Basically, that limits screening. We also hear a lot about access to diagnostic tests, be they mammograms or other less common tests. Often access to tests like mammograms or X-rays is inconsistent because some tests are done outside hospitals. So women do not necessarily have the means to get access within a reasonable time. We know how important an early diagnosis is in providing greater chances of survival.

I know that people with dense breast tissue have five to six times more chances of dying, or of drastic consequences. But shouldn't our strategy be broader? Shouldn't we be providing more information, in fact, and providing better access to doctors and to diagnostic tests? My question goes to Ms. Ammendolea, since she was the one who first brought it up, and to Dr. Ureten. Mr. Brown can answer too.

Without changing the basic nature of the bill, we could perhaps broaden it in order to provide a better outcome for more women.

[Cathy Ammendolea]

If I have understood your question, I would say yes, we should broaden to have sort of like a partnership. The physicians need to be educated, and radiology needs to be reported properly. It's like everybody working together. The patient needs to be informed, but it doesn't have to fall on the patient alone. This needs to be, as I said, a full picture.

There are gaps across the country. In my area—I come from Montreal—where there are teaching hospitals, it's not as widely gapped, because in bigger, larger cities with teaching hospitals these are standards that are applied. They fall under studies, and they fall under research projects, etc.

I would think that the gaps across the country are what we're listening to today from our witnesses. It's a part that has to be played out and played by everybody who comes together with the patient.

[Dr. Tina Ureten]

I agree with her. The health-care providers definitely need education, because most of the time when dense breast is seen but no cancer is diagnosed, it comes back as a normal report.

We might end up having staging--whether it is 25% of dense breast or it is 50% of dense breast. The risk increases with that, and that information should be shared with the patient. Also, the patient should know what other choices she will have after being informed that she has dense breast.

[Cathy Ammendolea]

Can I add just one thing very quickly?

I think standards are important. To have it in one area and not to have it in another area causes a lot of confusion. That's where our gaps happen. There have to be standards.

[The Chair, Conservative, Joy Smith]

Mr. Brown, did you want to comment? We're just about out of time.

[Patrick Brown, Conservative, Barrie, ON]

Yes, if I could just quickly add in--and thank you for the questions, Anne Minh.

I think the cases that Susan and Feather have enunciated aren't that rare. In some stats I've seen that up to 40% of females diagnosed with breast cancer have dense breast tissue. So it is a huge issue in itself.

We talked about whether we need to broaden it. This bill is specifically about that gap in service. My concern is that if you broaden it after second reading you change the scope of the bill and it is non-receivable. It's very important that we don't make any amendments that would make this non-receivable in the House. I believe that tackling dense breast tissue alone is an important advancement that we need to make in itself.

Feather's story, as someone who is so involved in this and yet didn't know, speaks volumes to the gap that exists in breast cancer screening, particularly on dense breast tissue.

[The Chair, Conservative, Joy Smith]

Mrs. Block.

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

Thank you very much, Madam Chair.

I want to thank my colleague Patrick for introducing this very important bill and I thank all of the witnesses who have come here today.

By introducing this bill, you have already accomplished much, I believe, by raising the awareness of this issue around this table as well as in the House of Commons.

I am from Saskatchewan, and I recently turned 50 years old. So in the past three months I received a letter from the breast screening program in our province telling me to make an appointment to come in and start that process. Due to the death of my mother to cancer about 15, 16 years ago, I did have a mammogram a number of years ago. I had the mammogram done, was basically told everything was okay, and never was really given any more information.

I was one of the speakers, as the member for Saskatoon—Rosetown—Biggar, who debated this issue in the House. As I said, it's raised awareness for many of us that this is an important bill to get passed in the House.

I do want to address the fact that speculation has been made that the federal government needs to go further than this bill. I would just say that this is a first step, an important step. If it creates an opportunity for more dialogue and for us to begin to look at different ways to go further, I think that's something we need to focus on.

I also want to comment again on the federal-provincial-territorial national committee for the Canadian breast cancer screening initiative. I know my colleague mentioned that they are encouraged to share best practices on raising awareness of dense breast tissue. I'm wondering, Mr. Brown, if you could go a little bit further about that initiative, in terms of what our federal government is doing to encourage those conversations.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Kelly.

Thank you for raising the Canadian breast cancer screening initiative, because that does comprise federal, provincial, and territorial representatives on this committee, where they look at best practices. This bill, in paragraph 2(c), specifically suggests working through that vehicle.

I would note that this Canadian breast cancer screening initiative also works with medical professionals and a variety of stakeholders. So when we talk about Ms. Fry's idea of best practices, this is the vehicle that can do that. We don't need to reinvent another committee with the same purpose; this could be that clearing house. I know they've already looked at screening through that viewpoint. So if they focused on dense breast tissues, I think that would achieve the goal we're all talking about.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Block.

You do have two more minutes if you have some more questions.

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

I don't have any more questions. I just would like to thank Ms. Quinn-Mullins and Ms. Janz for being here and sharing their stories. I think by hearing stories like this, it compels us even more to ensure that this bill gets passed.

I'm not sure if any of my other colleagues have follow-up questions to use my remaining time.

[The Chair, Conservative, Joy Smith]

We have just one more minute.

Mr. Lizon, do you want to share the time with Ms. Block?

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Good morning.

Thank you very much for coming here.

Thank you, Patrick, for your introduction of this important bill.

I have a question for Feather. When you were diagnosed, did you have a history of cancer in your family? Did you have reason to be extra cautious?

[Feather Janz]

My maternal grandmother did have breast cancer very young but had always felt silenced on the issue and never actually told our family until I was diagnosed at 23. That propelled me to want to take every opportunity to expose the disease of breast cancer on behalf of my grandmother, who always felt silenced about this disease.

We were talking about the power of the pink ribbon, and I'm grateful that has opened up the opportunity to speak about this disease.

Her mother also passed away at 39 years of age from a different form of cancer. The family didn't talk about it. My medical professionals believe that the first breast cancer I had was the same kind my maternal grandmother had, and the second was the same kind my maternal great-grandmother had. The only genetic link that we know of now would be the fact that we probably all have dense breast tissue. I now have two young daughters, and I am relieved to know that there will be tests such as those performed with the automated breast ultrasound machines available for my girls.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Janz.

Now we'll go to Dr. Sellah.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Madam Chair.

First, I would like to wish the whole committee team a happy new year. May I also extend those good wishes to everyone seated here and behind us.

As a GP, I am very familiar with the breast cancer issue. I also know that dense breast tissue is associated with a greater risk of breast cancer. I am also aware that dense tissue also decreases the reliability of mammography screening, the standard test, as it is called, in detecting breast cancer in women aged 50 and over.

I have already said in the House that I support this measure introduced by my colleague, Mr. Brown. It is a good thing to talk about this problem that, as Ms. Janz mentioned, is unfortunately taboo in families where illness, let alone cancer, is not talked about. My grandmother died of cancer, but I never found out which kind of cancer, because the word cancer was never even used. But customs and habits may well change with time. Without any doubt, awareness and information are very important.

Equal access to standard testing is something that concerns me. I have heard that Nunavut does not even have a screening centre. It concerns me greatly that such a situation exists in our country.

In addition, a point has been raised that affects me personally. It is all very well to talk about innovative methods and so on, but we have to have the people who can operate the equipment. Unfortunately, as you know, the health care system is suffering from a lack of specialist staff. Generally speaking, Canadian families do not have enough doctors to go round. This issue affects me personally and is one of the factors that led me to seek public office.

I am from Quebec, and I am very concerned. I think everyone has heard of the biopsy tests that had to be redone because of a fear that they have been improperly conducted. In 2007, 400 tests in Newfoundland were incorrectly done. The principle is good, but how are going to go about it?

Don't you think that first, we should find the people to work on awareness and information, or on getting the tests administered, and so on?

[The Chair, Conservative, Joy Smith]

Ms. Sellah, you're running out of time. There's no time to answer.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Okay—