December 11, 2012
Honourable senators, by the end of 2012, an estimated 23,000 women will be diagnosed with breast cancer. One in nine women is expected to develop breast cancer during her lifetime and one in 29 will die of it. We have lost mothers, sisters, friends, aunts, grandmothers and spouses to this disease, and more are diagnosed each year. This is a disease that deserves attention and support at the highest level.
My colleagues, Senator Seth and Senator Merchant, have both spoken before me, conveying the many concerns held by the breast cancer community. I would like to thank them for bringing these perspectives to the chamber.
Honourable senators, the field of screening for breast cancer is evolving. There is no question that progress is being made; however, new evidence has complicated the picture to such an extent that normative practices have changed dramatically.
The increasing perception of mammography as unreliable has sparked fierce debate. For example, many question the appropriate age to begin screening. In 2009, the U.S. Preventive Services Task Force weighed in, recommending against annual mammograms for women in their 40s, and advised women 50 and over to only have them every other year.
In 2011, the Canadian Task Force on Preventive Health Care released new guidelines for breast cancer screening, which suggested that women aged 50 to 74 get mammograms every two to three years. The Canadian task force warned that there was potential for harm from over diagnosis and unnecessary biopsy, particularly for younger women.
Today, there are many different technologies used in breast cancer screening. Efforts to improve conventional mammography continue to develop as researchers explore the potential of digital mammography, MRIs, PET scans, breast thermography and diffuse optical tomography, which uses light instead of X-rays to create a picture of the breast.
In September of this year, the FDA approved the first ultrasound device for use in combination with standard mammography in women with dense breast tissue.
Recently, debate has focused on breast density and screening. A 2012 study in the Journal of the National Cancer Institute found that the risk of dying from breast cancer was not related to high mammographic breast density in breast cancer patients. The study did link breast density to a number of other risk factors. It found “association between low density and increased risk of breast cancer death among obese patients, or those diagnosed with large or high-grade tumors.”
Barbara Monsees, Chair of the American College of Radiology, was surprised by the results of this study. She said:
“It shows we have a lot to learn about dense breast tissue and its implications for screening, diagnosis and treatment.”
How can we, as legislators, make a positive contribution? In the United States, several state governments have passed laws requiring doctors to inform women if they have dense breast tissue. A bill calling for a federal law has been introduced in the House of Representatives. However, these decisions have been met with significant opposition from some members of the medical community, professional societies of radiologists, and cancer experts, who fear such laws may lead to a spike in unnecessary tests and treatment. Women’s advocacy groups are concerned as well, suggesting such requirements may create unnecessary confusion, undue anxiety, and even a false sense of security.
Honourable senators, Bill C-314 requests the following: That we, first, determine whether gaps in information exist relating to breast density in the context of breast cancer screening; second, identify approaches, where needed, for improving the information provided to women undergoing screening for breast cancer in order to address the challenges of detecting breast cancer in women with heterogeneous or dense breast tissue, and raise awareness concerning these challenges; and, third, share, through the Canadian Breast Cancer Screening Initiative, information related to the identification of heterogeneous or dense breast tissue during screening and any follow-up procedures.
Honourable senators, this bill rightly identifies the need for more information about the relationship between breast cancer screening and breast density. Current research, changing technology and the complexity of the issues, all surely warrant more serious examination before proposing any new legislation. A Senate committee typically provides such an opportunity for study. In committee, we would have the benefit of hearing testimony from experts that draws on the most recent evidence. Ultimately, the results of such a study may lead to an expert-informed, action-oriented piece of legislation that responds to the gap in information so correctly identified in Bill C-314. Canadians deserve no less.
Honourable senators, therefore, I move:
That Bill C-314 be not now read a second time but that the subject matter thereof be referred to the Standing Senate Committee on Social Affairs, Science and Technology; and
That the Order to resume debate on the motion for the second reading of the bill not appear on the Order Paper and Notice Paper until the committee has tabled its report on the subject matter of the bill.