Mr. Patrick Brown (Barrie, CPC)
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.
He said: 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.
Ms. Libby Davies (Vancouver East, NDP):
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.
Hon. Hedy Fry (Vancouver Centre, Lib.):
Mr. Speaker, I will speak, as I have done in the past, in support of the bill at report stage, but not with the same enthusiasm that I did earlier. As my hon. colleague for Vancouver East just mentioned, the bill went to committee, and it did not implement many of the changes that would have strengthened the bill and made it far more effective. I will speak to that a little later.
The bill's intent is to ensure that women and health care providers have the best information possible regarding screening, especially regarding new technology, and an understanding about dense breast tissue so that women know about it and health care providers and technologists understand what to look for. We know that tumours can be harder to identify in women with dense breast tissue. I would like to add, though, that it does not necessarily mean that a woman with dense breast tissue is more likely to have breast cancer. It is just that it is harder to identify if she does.
Twenty-three thousand women will be diagnosed with breast cancer in Canada this year. Sadly, nearly a quarter of those women will die from that disease, so in many ways this is an important bill, in that it speaks to the issue of identifying and finding a cancer as early as possible.
The federal government has a definitive 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, which is a federal initiative with the provinces, especially, as well, since the 2004 health accord strengthened the federal leadership role in ensuring access to health care services no matter where people live in Canada.
Where I find a problem, and I find it disappointing, is in relation to the health committee's recent study this bill. We heard from many witnesses. We heard from experts, health care professionals, patients and researchers. They all agreed that the intent of the bill is a very good one. They all agreed that awareness is important and that information sharing is important. However, they all felt that the bill would fall short of achieving any really important outcomes unless some pieces were added to it.
The member who moved the bill earlier on praised the co-operation and collaboration across parties on his bill. However, it stopped short in the House of Commons and at committee stage, where witnesses made some very compelling testimony. They talked about ways to improve the bill to improve its effectiveness. This was voted down, not only by the member for Barrie, who moved the bill, but also by members of the Conservative Party.
A couple of items that I moved as recommendations to strengthen the bill came from the witnesses. One of them is about sharing best practices. Subclause 2(c) of the bill talks about the ability of the Public Health Agency of Canada to look at information and data sharing, et cetera. I consulted so that it would not add cost at all. I heard from the legislative wing of the Library of Parliament that in fact there was a way to make sure this would incur no cost. It would use the already existing infrastructure of the Public Health Agency of Canada, where they have data and information sharing, to add best practices.
The reason for this, as we heard from witnesses, is that there are provinces, such as my province of British Columbia, where the outcomes of breast cancer are, by enormous percentage points, better than anywhere else in Canada. Therefore, why do we not take a page from their book? Why are we allowing people to continue to reinvent the wheel when we know what would work? Of course, as with anything to do with health, time is of the essence. Why wait six years for someone to discover a new wheel, when other people discovered it six years ago and we could be implementing it now for the benefit of patients?
Therefore, I was really very disappointed that the member himself did not accept that amendment. In fact, he said that his concern was with the word “ensuring”. He said that the work of the Canadian breast cancer screening initiative is not controlled by the Public Health Agency of Canada and that as such it should not be “ensuring” the collection, processing and distribution of information or “ensuring” the identifying, synthesizing and distribution of best practices. However, in subclause 2(c) he himself suggests sharing information through the Canadian breast cancer screening initiative.
It seemed as if this amendment, which would have enhanced the bill, was blocked purely because it was going to change the bill in some small way, even though to improve it.
Perhaps in his final remarks today, the member could clarify why such a no-cost, important thing that we heard from witnesses over and over was rejected.
I do not for one moment impugn the intentions of the member. He did a lot of hard work. I think it is an important bill and I think he brought forward a lot of things about it, but it had no teeth. There was nothing that would really change outcomes, other than increasing awareness.
This is an example of what concerns many of us, which is that the government is not listening to the expert testimony of witnesses appearing before committee, especially on bills and especially when these witnesses enhance the bill. It is a pattern.
I would like to say that we saw the same thing with Bill C-300. Witnesses appeared before the health committee and made several suggestions to establish a truly effective framework for suicide prevention. Twenty-one amendments were brought forward, including nine by the Liberal Party, and every single one of them, none of which incurred new costs, was voted down for no really logical reason that was given.
What we are left with are toothless bills that sound good and do small things, but do not really improve very much the lot of women with dense breast tissue or a suicide prevention strategy.
I hope this is not about ideology, because most of us have been supporting these bills because the intent is good. However, we would like to see them actually make a difference to the patients.
As I said before, I support the bill, but with a great deal of disappointment and reluctance.
Mr. Rick Dykstra (Parliamentary Secretary to the Minister of Citizenship and Immigration, CPC):
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.