MR. SPEAKER: This being Private Members’ Day, the House of Assembly will now hear the private member’s resolution as put forward by the hon. the Member for Cartwright-L’Anse au Clair and the Leader of the Opposition.

The hon. the Leader of the Opposition.

MS JONES: I am pleased today to rise in the House of Assembly to debate this particular motion, Mr. Speaker. I would like to read the motion into Hansard.

Before I do that, I would like to ask the Pages if they could distribute a copy of some information that I prepared in promoting breast screening for women under the age of 50 in Newfoundland and Labrador. There is some information here that I just want to share with my colleagues in the House of Assembly. Whenever they are ready, you can take it and have it distributed.

WHEREAS breast cancer is the most common cancer among Newfoundland and Labrador women, excluding non-melanoma skin cancer, with approximately 370 women to be diagnosed with breast cancer in Newfoundland and Labrador this year; and

WHEREAS we have one of the highest mortality rates from breast cancer and breast cancer in young women tends to be more aggressive; and

WHEREAS the benchmark for Newfoundland and Labrador’s organized breast screening program is age 50; and

WHEREAS women aged 40 to 49 are not eligible to participate in Newfoundland and Labrador’s organized breast screening program, while women aged 40-49 are eligible in the provinces of British Columbia, Alberta, Nova Scotia, Prince Edward Island, Northwest Territories, and Yukon; and

WHEREAS the earlier breast cancer is diagnosed, the better the outcome in terms of health and the therapeutic regimen women will be subject to; and

WHEREAS there is evidence that routine mammography screening of women in their 40s can reduce mortality from breast cancer by at least 24 per cent, but Newfoundland and Labrador still does not allow women in that age group to self refer into their breast screening program; and

WHEREAS Newfoundland and Labrador has the capacity to accommodate the additional women between the ages of 40 and 49 into organized breast screening programs;

BE IT RESOLVED that this House calls upon government to examine the reduction of the eligible breast screening age in Newfoundland and Labrador and to establish a new benchmark at the age of 40.

Mr. Speaker, I am not unlike most people in this House of Assembly or anywhere in the world; oftentimes, there are personal experiences that trigger you to look at things much more closely. My own experience, what I have gone through, certainly caused me to sit back and look at what is happening with breast screening, not only in my own Province, but right across the country. I have participated in a number of discussions with others throughout the country in terms of what we should be doing in Canada to allow for a different benchmark for breast screening.

Mr. Speaker, over the course of my chapter with breast cancer, I have had the opportunity to meet a lot of women in our own Province, a lot of them who are being diagnosed at a much younger age. I have had an opportunity to listen to their stories about how they were able to access the services in Newfoundland and Labrador and realized, Mr. Speaker, very early on that I was not alone in trying to get into the system for breast screening. I had made several attempts in asking for breast screening to be done before I was even eligible for a referral. The reason I was not given a referral is because I had no predisposition of breast cancer in my family. There was not any genetic reason for me to be referred, I did not find anything on my own; therefore, I was on no one’s priority list and I was not a candidate in Newfoundland and Labrador to be screened.

Mr. Speaker, it was really my own will that kept me going back and asking for a referral, and finally I got a referral. Six months later I was able to get into the system to start doing the rounds of testing and biopsies that were required to make a firm diagnosis of whether I had cancer or whether I did not. I learned, Mr. Speaker, from many other young women out there who were in the age category that I was in, that they were unable to access the system as well.

In some cases it was very easy for women between the ages of 40 and 49, depending on where they lived in the Province. In some cases there were doctors who were very understanding of the need and had no problems with the referral. Some of them were fortunate, that when they went to their family doctor they would automatically get a referral and just be put on the waitlist to get the diagnostic testing done. There were other cases, and in fact, Mr. Speaker, in one region in particular, in Labrador West, I received a number of calls from women who were in this age category who could not get referrals, because they could not get referrals in that particular community. It seemed it depended on where you lived in the Province; it depended upon who your family doctor was in terms of whether a woman in that age group, who had concerns, would be referred or not be referred to have the testing done.

Mr. Speaker, upon doing more research into screening of women in this category, I learned that women who are diagnosed with breast cancer at an earlier age have a higher risk of mortality, they often have breast cancers that are more aggressive; therefore, it is very important that it be identified earlier on. I also know that in Newfoundland and Labrador each year there is a total of 370 women who are diagnosed with breast cancer, and 110 women will die from it. Nineteen percent of breast cancer cases today occur in patients who are under the age of 50 and that breast cancer diagnosed in women in their 40s accounted for about an estimated 16.5 per cent, or one in six of all breast cancer deaths. Decreasing the breast cancer screening age from 50 to 40 will mean an extra 41,471 women in our Province will be eligible for breast screening this year. This is about a 40 per cent increase in capacity which is required to accommodate these women.

Mr. Speaker, I believe other provinces are far more advanced than what we are, simply by the fact that they have already taken it upon themselves to establish a benchmark at the age of 40. In Canada today there is a national benchmark for breast screening of women, which is set at the age of 50. As I said earlier, provinces like British Columbia, Alberta, Nova Scotia, Prince Edward Island, Northwest Territories, and Yukon have already realized through the research that has been done both nationally and in Canada, and internationally in the United States, that there is a rapid number of documents and research being done these days that are recommending that all breast screening should now be done for women at the age of 40 and onward. Those provinces have already recognized that and they have already taken it upon themselves to establish clearly new benchmarks for breast screening in their particular provinces.

In Ontario right now, there has been a private member’s bill debated in the Legislature. I have met with both the Opposition parties and the government parties in Ontario and it is obvious they are moving in that direction right now. They will establish a benchmark which will allow breast screening in their province to be reduced from the age of 50 to the age of 40. In Canada, that would leave our own Province, Newfoundland and Labrador, Saskatchewan, Manitoba, Quebec and New Brunswick and, of course, Nunavut does not have any breast screening programs at any age to date.

Mr. Speaker, basically, breast screening would include, as we have normally known, self-examination or examination by a doctor. It is still one of the preferred methods because it has no side effects and it is still a method I would recommend that all women use. Every year when women go to have their regular well-woman checkups they usually undertake or have a self-examination done by their physicians. There are still a lot of women who are diagnosed through that procedure and there is absolutely nothing wrong with that, but what science is telling us today - and there are a number of documents out there in Canada and the United States to support this - is that by using digital mammography we are able to identify any signs of breast cancer in a lot earlier stages which is helping to reduce the mortality rate in women all across the country who have the opportunity to be checked.

Mr. Speaker, in Newfoundland and Labrador we have a good system of digital mammography. One of the things I have to say is that by far we are one of the provinces with some of the best digital mammography equipment that exists in Canada today. We have sixteen units in this Province that can accommodate the capacity which is required to do the number of women that we are asking. Mr. Speaker, we feel we are one of the best provinces in Canada to deal with this increase on our units, simply because we have a capacity that currently exists. We do not have 100 per cent take up on our digital mammography equipment across the Province, but we have some of the best equipment that is available.

Today, we have three breast screening centres – one in Corner Brook, one in Grand Falls, and one in St. John’s. Mr. Speaker, I have heard only good things about these breast screening clinics and centres that are there. I did not use that particular centre; because of my age I was not allowed to use that centre and I was referred to another hospital where there was a unit. So, because of my age, I was not entitled to use the centre that we have in St. John’s for breast screening. Everything I have heard about this centre has been good, as well as the ones in Corner Brook and in Grand Falls.

In fact, Mr. Speaker, I am told, unfortunately, only 64 per cent of the women in this Province over the age of 50 – or between the ages of 50 and 69 – actually take up the opportunity to use breast screening. I think we need to do more to encourage that, because the older you get, as well, the higher the risk becomes of developing breast cancer.

Mr. Speaker, research has shown that one in five, or 20 per cent of breast cancer deaths were in women between the ages of 35 and 49. Because of the relative youth, the years lost to breast cancer are greater in this age group, accounting for a third of all life-years lost to breast cancer.

Mr. Speaker, there are lots of statistics, and I am talking a lot about women, but I think it is important to realize that men can get breast cancer as well; there have been many cases where men have been diagnosed. I keep referring to women, and I guess it is because women are one hundred times more likely to get breast cancer than men, but breast cancer is diagnosed in men on many occasions as well. The prevalence of breast cancer, as I said, increases with age, which makes advancing age the most common risk factor that you can find in breast cancer today.

Mr. Speaker, I talked a little bit about where the recommendations are coming from to reduce the age from 50 to 40 in Canada and in North America in general. Today, the sources of information are coming from a document that the Canadian Breast Cancer Foundation did just this fall. In that, a lot of the research was done by a Dr. Yaffe, who is based out of Ontario. He is renowned for his research in breast cancer and the scientific evidence that he has been able to provide. What Dr. Yaffe’s recommendation is, Mr. Speaker, is that breast screening should be done today in Canada for women in the age group between 40 and 49.

There is also scientific evidence, Mr. Speaker, available – a whole host of it – that has been done by the Society of Breast Imaging, the American Cancer Society, the American College of Obstetricians and Gynecologists, the U.S. Preventative Services Task Force, and the American College of Radiology. Mr. Speaker, just last month there was a report done by the American journal of radiology – another task force that was looking at guidelines for doctors, insurance companies and policy makers – which made the recommendation as well that screening for women should be done at age 40 now, not at age 50.

I think it is important to recognize that countries like Australia, Austria, Greece, and Japan all right now have breast screening reduced to the age of 40. It is nothing new; there is tons of research out there on this. Obviously, there are some arguments against it; I am sure I would have the opportunity to talk a little bit about that in my closing remarks. Mr. Speaker, when you look at some of the arguments that are against testing, again, I think that they are overrated compared to what the benefits are. That is what we really need to look at. The real thing here is to give women the option, to educate them and let them make their own decisions.

Mr. Speaker, I bring this motion forward today so that we can progressively move forward in Newfoundland and Labrador with new benchmarks for breast screening, for women in our Province to fall in-line with what is happening with other provinces in Canada, in other regions of North America and other countries around the world. I ask my colleagues today to give favourable support to this for the 47,000 women out there in this Province who will require and should have the option to have that screening done.

Thank you, Mr. Speaker.

MR. SPEAKER (T. Osborne): The hon. the Minister of Health and Community Services.

SOME HON. MEMBERS: Hear, hear!

MR. KENNEDY: Thank you, Mr. Speaker.

I thank the hon. member for her comments. I would like to commend her for bringing forward this motion and also for the courage she has shown in her personal fight.

Mr. Speaker, cancer is something that affects all of us, everyone in this Chamber and everyone in our society. We have recently watched one of our colleagues die from cancer, and she courageously fought it for a long period of time, Mr. Speaker.

In terms of breast cancer, I myself have six sisters, most of them who are in their 40s now, or getting to their 40s. I have a wife and a daughter, so it is obviously something that personally concerns me, as it does everyone in this House.

I just want to be clear, Mr. Speaker, on what we are debating here today. The member opposite has asked for a resolution that the House calls upon government to establish a new benchmark by reducing to 40 years of age the eligibility for self-referral to the provincial breast cancer screening program. Mr. Speaker, the hon. member opposite is correct; there is plenty of scientific literature out there in terms of the benefits, the pros and cons, of reducing the age to 40, but I would suggest that it is not as clear-cut as put forward by the hon. member.

Mr. Speaker, our government has invested significantly in cancer care over the last seven years, to the tune of $125 million. We also invested $18 million in Budget 2010 for cancer treatment and prevention. Mr. Speaker, we are all aware of the devastating effects of breast cancer and cancer, especially on the women who testified and who were part of the Cameron inquiry. As a government we have sought to implement the Cameron recommendations. Mr. Speaker, I think it is thirty-nine recommendations that are either completed or substantially completed as of my update last year. I will be updating this hon. House or the public in the not-too-distant future.

Mr. Speaker, in November 2010 we brought in the provincial cancer control strategy. The goal of that strategy is to reduce the incidence and impact of cancer and to improve the quality of life of those living with cancer in Newfoundland and Labrador. With that, Mr. Speaker, we invested approximately $1.3 million in various initiatives, in everything from $70,000 for Young Adult Cancer Canada to support its organization, to the alliance of tobacco, to $400,000 especially to examine ways of improving existing screening programs. One of those will be breast screening, Mr. Speaker.

Also, in the cancer control strategy, the framework states on page 21: "A Provincial Cancer Control Advisory Committee will be established to advise the Minister of Health and Community Services on: i) priorities for action; ii) monitoring progress; and iii) the development and implementation of an evaluation plan for the framework.

"In addition, the Advisory Committee may be asked to liaise with the cancer control community, nationally and provincially including patients, survivors, advocates and community organizations, and identify for the Minister’s consideration, additional evidence-based objectives or priority directions that have the potential to improve the control of cancer in Newfoundland and Labrador."

Mr. Speaker, Dr. P. K. Ganguly, a well-known oncologist, a leading oncologist in the Province, was appointed as Chair of that Committee at the time the announcement was made. Mr. Speaker, we are in the process of finalizing the Cancer Control Advisory Committee. That Committee, Mr. Speaker, will be made up of Dr. Ganguly as Chair; the deputy minister or his representative in the Department of Health and Community Services; I think the Dean of the Medial School; the Vice-President of Cancer Care at Eastern Health; other representatives of regional health authorities; cancer survivors, including at least one breast cancer survivor; and they will be asked to advise the minister. Their appointments will be completed in the next month. Mr. Speaker, this Committee will be put in place to advise the minister on issues such as the expansion of the breast cancer screening policy.

Mr. Speaker, the member opposite is correct in terms of what she is outlining in terms of the guidelines. The current guidelines we have in this Province are based on the Canadian Task Force on Preventative Health Care 2001, which does provide mammograms and breast education to women between the ages of 50 and 59. This range was selected, Mr. Speaker, because of the evidence and research of the previous thirty years. Now, if that has changed, Mr. Speaker, we will change with it. Then, there was competing evidence on the issue of the ages, the effect on women of ages 40 to 49.

Mr. Speaker, there are groups who are advocating for universal screening at age 40, as outlined by the member opposite. Mr. Speaker, as I just indicated, we have invested $400,000 into the provincial cancer policy framework for reviewing existing screening programs including the breast screening program.

Mr. Speaker, the statistics in this Province indicate that there – excuse me, before I get to that, the member opposite, again, is quite correct. If a woman under the age of 50 feels the need to have a mammogram, she will discuss this request with her family physician, who will access her health status and the potential risk factors. Then, if a referral is made, the woman will have a mammogram at a hospital-based site. Annual rechecks may also be requested with a doctor’s referral.

Mr. Speaker, there are six other provinces who have screening similar to Newfoundland and Labrador’s. These provinces are: New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and Newfoundland and Labrador. As the Leader of the Opposition has indicated, Mr. Speaker, she has had discussions with one of the other provinces and they are considering changing their screening policy. In BC, Nova Scotia, PEI, and the Territories, women ages 40 to 49, as outlined by the member opposite, self refer to the screening program and are then recalled annually.

One of the interesting statistics, Mr. Speaker, we are showing in this Province that 60 per cent of the women between the ages of 40 to 49 have had at least one mammogram. In BC, Nova Scotia, and PEI, where women ages 40 to 49 self refer to the screening program, the uptake is 33 per cent, 34 per cent, and 19 per cent respectively. Mr. Speaker, in Alberta they will accept women under the age of 50 in their program with a physician’s referral and will recall her annually.

Mr. Speaker, our statistics show that almost 90 per cent of women in Newfoundland and Labrador between the ages of 50 to 69 have had at least one mammogram. That is why, again, Mr. Speaker, I thank the member opposite for raising this issue because it is so, so important that this kind of issue be discussed in this hon. House. We look to solve issues, we look to improve situations, and we are certainly open to all of that, Mr. Speaker.

In 2009-2010, the program screened a little over 20,000 women; 1,745 were referred for further follow up and 78 of these women were diagnosed with cancer. Mr. Speaker, our wait-lists vary throughout the Province in that a mammogram for diagnostic purposes can occur the same day or within days and the times then will vary throughout the regional health authorities.

Mr. Speaker, in terms of the resolution put forward, I would suggest, though, to the member opposite that it is not as clear-cut in terms of the scientific literature. The Public Health Agency of Canada, Mr. Speaker, in its publication Information on Mammography for Women Aged 40 and Older in 2009 advises that, "…the benefits of screening mammograms outweigh the harms for women aged 50 to 69. For younger and older women, the balance of benefits and harms is not so clear."

The United States Preventative Services Task Force, which was referred to by the Leader of the Opposition, Mr. Speaker, modified their recommendations recently for mammography screening, and this was in November, 2009, for specific age groups. For women aged 50 to 74 years, Mr. Speaker, biennial screening mammography was recommended. The previous recommendation was for women from age 40 to 69.

I think the member opposite referred to the American College of Obstetricians and Gynecologists, the American College of Radiology and the American Academy of Family Physicians. There have been two recent articles in The Globe and Mail on the efficacy of breast screening programs in general, Mr. Speaker. We know that the Canadian Task Force on Preventative Health Care guidelines on breast screening in Canada are currently being reviewed. I am informed, Mr. Speaker, that the task force will be releasing their updated guidelines in late April or early May.

Mr. Speaker, this is my proposal today. If you look at the resolution, and I am going to go through it clause by clause, the first clause the first WHEREAS certainly is correct. The second WHEREAS is again correct. The third WHEREAS is correct. The fourth WHEREAS is correct. Now, Mr. Speaker, as I have indicated, in clause 5 there is some debate in terms of the scientific community - this is not me, Mr. Speaker, this is the scientific community - however, I will accept that clause for the purposes of today’s argument. Mr. Speaker, when it comes to clause 6, my officials have not been able to find the empirical evidence that shows that mammography screening of women can reduce mortality from breast cancer by at least 24 per cent.

Mr. Speaker, my recommendation today or what I am going to put forward is that the sixth clause be amended by deleting the words "empirical evidence" and substituting the words "conflicting evidence"; and also by deleting "by at least 24 per cent". The amendment suggested, Mr. Speaker, is: WHEREAS there is conflicting evidence that routine mammography screening of women in their 40s can reduce mortality from breast cancer.

Clause 7 is correct, Mr. Speaker. When we get to clause 8: WHEREAS Newfoundland and Labrador has the existing capacity to accommodate women between the ages of 40 and 49. There is no question, I am glad to hear the member opposite talk about the breast screening program we have here, the digital mammography machines. I am very glad to hear that they are working, that we have invested significantly in this area; however, again, I am suggesting we amend this clause. I am not suggesting that we strike it out. At this stage - and this will fit in to what I am going to suggest that the resolution be here today. Mr. Speaker, as opposed to reading, in the eight recital clause "has the existing capacity", I would suggest that we substitute the words ", if required, will ensure capacity".

Mr. Speaker, my suggestion is that recital clause 8 will read: WHEREAS Newfoundland and Labrador, if required, will ensure capacity to accommodate women between the ages of 40 and 49 years in the provincial breast screening programs. This government, Mr. Speaker, has indicated through our investments in cancer care how seriously we take this. Again, if you look around this House or anyone watching this today, we have all been affected by cancer, Mr. Speaker.

What I am suggesting in the resolution today, Mr. Speaker, is that we delete the words "establish a new benchmark by reducing to 40years of age…" Take out that whole sentence, Mr. Speaker, and say: THEREFORE BE IT RESOLVED that this House call upon government to refer this matter to the Cancer Control Advisory Committee for recommendation.

Mr. Speaker, this is why I am suggesting I want to take this route. This is a very serious issue and one that has been raised by the member opposite and, again, I give her full credit for it; but, as the minister, I have to act on the advice that is given to me by medical officials and by scientists. In this particular case, Mr. Speaker, we are in the process, and within a month we will have a Cancer Control Advisory Committee in place made up of various experts, breast cancer survivors, and representatives of the Canadian Cancer Society, Young Adult Cancer, et cetera.

Mr. Speaker, also, we expect that within the month, in late April or early May, the Canadian Task Force on Preventative Health Care guidelines on breast screening in Canada being reviewed. So, those are two; we have the Cancer Control Advisory Committee, which will be in place within a month, and then we have the recommendations that will come out of Canadian Task Force on Preventative Health Care.

Mr. Speaker, what I want to reiterate here today is that we will take whatever steps are necessary to ensure that the health of our residents, of our citizens, is well looked after. I have to, as the Minister of Health, make such decisions based on empirical evidence, on facts, on evidence-based literature.

I would suggest, Mr. Speaker, this is a very good compromise here today; it says to the member opposite, we take very seriously what you are suggesting here, that we are listening to what you are saying. What we are saying here is that I would like to refer this to the Cancer Control Advisory Committee who will then come back with a recommendation, and I can assure you that will be done as expeditiously as possible.

Mr. Speaker, I have the proposed amendment here. I will be moving it, and the amendment will be seconded by the Member for Lewisporte.

Mr. MacKenzie? Or, is the House Leader supposed to do that? I am not sure.

In any event, Mr. Speaker, thank you very much for the time to address this very serious issue.

MR. SPEAKER: The hon. the Government House Leader.

MS BURKE: Mr. Speaker, I would just like to make a point of order based on the amendment that was just put in regarding the debate this afternoon. I just want to clarify that on the Order Paper it reads: THEREFORE BE IT RESOLVED that this House calls upon Government to establish a new benchmark by reducing to 40 years of age the eligibility for self-referral to the provincial breast cancer screening program.

Mr. Speaker, the amendment that was submitted by the Member for Carbonear-Harbour Grace is in relation to the resolution as indicated on the Order Paper. Just for clarity, I want to ensure that we are following the appropriate motion, because when the Leader of the Opposition spoke, the resolution said, "BE IT RESOLVED that this House call upon Government to examine the reduction of the eligible breast screening age in Newfoundland and Labrador and to establish a new benchmark at the age of 40."

I just want to clarify that the amendment is in relation to the motion that is on the Order Paper, and not necessarily what was read into the record when the Leader of the Opposition was speaking earlier in her comments.

MR. SPEAKER: Order, please!

In relation to the comments made by the Government House Leader, she is correct. Our Standing Orders very clearly indicate, and Standing Order 55 indicates, that notice shall be given at a previous sitting for leave to present a bill, resolution, or address.

Further, Standing Order 63.(3) "On the Monday before the Wednesday of the week in which a Private Member’s motion is to be debated, the Government House Leader or the Opposition House Leader, as the case may be, shall announce to the House the Private Member’s motion to be debated on that Wednesday."

So, the motion that is before the House, as stated on the Order Paper, shall be the motion that is under debate today.

We have received an amendment from the Member for the District of Carbonear-Harbour Grace and the Minister of Health and Community Services. I have not yet had an opportunity to review that amendment, and I will ask the House to recess for a few moments to allow me to review the amendment and make a decision on the amendment.

The House shall recess for a few moments.

MR. SPEAKER (Osborne): Order, please!

Are the House Leaders ready to proceed?

The Chair, having reviewed the amendments as put forward by the Minister of Health and Community Services, deems the amendments to be in order.

The hon. the Member for the District of Signal Hill-Quidi Vidi.

MS MICHAEL: Thank you very much, Mr. Speaker.

It is very interesting what has happened here right now with the amendment because, in actual fact, the amendment I think is the way in which we should be going. We are dealing with a very serious issue and a very serious question here today when we are talking about breast screening for breast cancer. I think it has been outlined very well by the Leader of the Official Opposition, whose motion is on the floor, and as well by the Member for Carbonear in his response, and in his response as Minister of Health and Community Services.

I am not going to go through all the statistics and put a lot more statistical information out on the floor because quite a bit has been put out. We do know that the debate is an important debate and it is going on and has gone on in many places. The fact that we have provinces who have changed the benchmark for breast screening from women over 50 to women over 40 – this has happened in a number of provinces and those provinces have been outlined here on the floor a couple of times this afternoon.

I lived in Ontario, actually, in the 1990s when this was a major discussion going on. Finally, in Ontario, I think, they are close to moving to passing legislation that will change the benchmark. Yet, I agree with the Minister of Health and Community Services that we cannot make a decision here on the floor today with regard to benchmark. We do have to come to an agreement that we have to do the required study on this issue in order to make that decision.

I would like to point out one thing to the Minister of Health and Community Services. He did make reference to the sixth WHEREAS in the original motion that was put forward; WHEREAS there is empirical evidence that routine mammography screening of women in their 40s can reduce mortality from breast cancer by at least 24 per cent. The minister indicated that they had not been able in his department to come up with this empirical evidence. Obviously, time is needed to look for that kind of information. That is the kind of work that the cancer control committee would do.

I would like to point out that we did find empirical evidence to that effect. As a matter of fact, both the European Journal of Cancer and the US Society of Breast Imaging and the American College of Radiology have named studies of nearly 500,000 women around the world which actually show a 26 per cent reduction in mortality with earlier testing. Even more specifically, a large national study by a Swedish university found that mammography on women aged 40 to 49 reduced breast cancer mortality by 29 per cent, and the BC cancer agency found a 25 per cent reduction in breast cancer mortality rates as a result of screening women between 40 and 49. There are a number of studies out there on an international level which in actual fact do back up the WHEREAS in the resolution that has been put on the floor. I think there is quite a bit of work that needs to be done to confirm the empirical evidence. But the reason I want this to happen is because I do believe that there is a lot of empirical evidence out there and more evidence is being gathered almost on an annual basis. Our taking this issue seriously and wanting to put it forward to the Cancer Control Committee, which would then give advice back to the House, is a very, very good way to go. I think it is the wise way to go because the issue is very complex.

There is absolutely no doubt that breast cancer screening programs have greater ability to reduce cancer mortality because of the higher levels of population coverage and a centralized commitment to quality and monitoring. The cancer does exist in people under 50; especially in women under 50 – the breast cancer does exist. The greater the population we can stop the cancer in – or catch it early – the better for our society. When it comes to catching it earlier, it also makes economic sense as well because the earlier we catch cancer the better it is for the whole health care system and that is certainly true of breast cancer as well.

I think there are all kinds of reasons for us to follow the lead of the many provinces and countries that now routinely screen women at the age of 40 rather than at the age of 50. Some of the countries that are doing it are Australia, Austria, Greece, Japan, Slovakia, most of Sweden, and many U.S. states. We know, of course, that we also have the provinces that have been named here on the floor today. As well, you have some other countries where the benchmark is lower than 50, but not as low as 40. So, for example, the Czech Republic, Hungary, New Zealand, Portugal, and most of Spain start at the age of 45.

So, taking all this information, studying it, and taking the time to make a wise a decision, I think, really is the way to go. We do know that breast cancer is the most common cancer diagnosed, and the second leading cause of cancer mortality in Canadian women. So, it just makes absolute sense that we would want to reduce, as much as possible, the mortality of women in this country, because of having breast cancer. In Canada, in 2009 alone, 22,700 new cases came up, and 5,400 deaths were expected down the road to result from those extra cases.

The mortality rate is what really disturbs. One in nine women will be diagnosed with breast cancer, and one in twenty-seven will die from breast cancer in their lifetime. We know things have really gotten a lot better, and the mortality rate is improving, but the earlier we find the cancer, the better. We do know, certainly, that for women in their 40s and in their 30s, catching that breast cancer at the early stage is extremely important, because of the aggressive nature of cancer in pre-menopausal women. That is really what it comes down to.

So, Mr. Speaker, I am very happy to vote for the amended resolution that is here on the floor, this afternoon. I think it is something that we owe to all the women in the Province. We owe it to those especially who are in families where breast cancer is prevalent. I should knock on wood when I say it, but I luckily do not come from a family where that is the case when it comes to breast cancer, but we know we have many families in the Province where great-grandmothers and grandmothers and mothers and daughters have died and are dying from breast cancer. The more we can do to cut down on the mortality rate the better it is.

Having said all that, Mr. Speaker, I think it is sufficient to show that we do need to vote on this resolution and vote on the amended resolution, and not only take the minister at his word, but thank him for the commitment he has made here in the discussion today that this will move forward and recommendations from the cancer control committee will eventually end up on this floor again. That is what I look forward to.

Thank you very much, Mr. Speaker.

MR. SPEAKER: The hon. the Minister of Innovation, Trade and Rural Development.

SOME HON. MEMBERS: Hear, hear!

MS SULLIVAN: Thank you, Mr. Speaker.

Again, like others before me, I want to emphasize the importance of this debate and to extend to everybody out there who is watching this, anybody who has ever suffered breast cancer, anybody who has had family who have suffered breast cancer and been victims of breast cancer; I want to let them know that this government is certainly very happy with the fact that we have opportunity on the floor of this House today to debate this very, very important issue.

I thank the Leader of the Opposition for bringing forward this motion. Certainly her battle and her courage has been a symbol to all out there who have had to face this particular cancer in their lives. I certainly thank her for sharing that with us and for bringing it forward so that we have opportunity to talk about that here today.

I also want to tell her how happy we all are that she is so courageously and so successfully battling this cancer in her life, and wish her all the best from this side of the House, as I am sure many people across the Province who are watching this debate today would wish me to say on behalf of all women. We certainly applaud her courage and her strength, and again thank her for this opportunity here in the House today.

Good health for women in Newfoundland and Labrador I think is something that we cannot emphasize enough, Mr. Speaker. As the Minister Responsible for the Status of Women, I have many opportunities to network with women, to speak with women, and one of the things I hear most often is that women in today’s society perhaps do not do as good a job as they should of looking after their own health. I hear oftentimes of the difficulties of balancing work, of balancing a family life, of balancing committees and other commitments within the volunteer sector that many women – and men, of course – like to be involved with. I hear this from conversations that I have with women as a result of this new portfolio that I happily have embraced. I hear that quite often. What is ignored, what we do not pay attention to would be issues around our own health care, around taking the time for that preventative health care that we so often need to do. The importance of good health for women in Newfoundland and Labrador, for persons in Newfoundland and Labrador, certainly cannot be overstated no matter what the age.

Women in Newfoundland not only suffer from breast cancer, Mr. Speaker, but from cervical cancer, ovarian cancer and then there are other just as important illnesses, ailments, diseases out there, and I speak, certainly, of diabetes, heart and lung disease and so on. In fact, one of the leading causes of death for women in this Province is cardiovascular disease.

Again, the opportunity just to take a moment to highlight, for all of us, that health care is important and no matter what the issues that we are facing in our daily lives, no matter how busy the work schedule gets, no matter how busy our commitments in other areas of our lives can become, we do need to pay attention to our own health.

Breast screening is certainly one of those essential health care initiatives that women must, I believe, seriously consider. There is no question that cancer continues to touch the lives of everyone in our Province and our continued investment in cancer treatment and prevention is something that we have to take seriously and that we have to continue to expand.

All of us have stories to tell, Mr. Speaker, and that is an unfortunate thing. In my own family, a very close relative just, in the last seven or eight weeks, had her second mastectomy, Mr. Speaker. I certainly understand how breast cancer touches the families and the lives of all of us. For myself, personally, I have had a couple of incidents where interventions were required as well.

Again, breast cancer is not something that is about just the woman either. It is about the whole of the family, the whole of the community that must respond, and thankfully we all have supportive families around us that are there for us in these times. They are difficult times, Mr. Speaker; the emotion that is involved when one hears the word cancer – when one understands that a medical intervention is required because of a cancer. The emotion that is involved, just in the hearing of that, is exceptionally difficult; not just for women I am sure. It is something that we have to face; therefore, as a government we have to be responsible about it.

One of the parts of, I think, our recent past that we will never want to revisit, Mr. Speaker, and we should never have to revisit, have to do with the laboratory and Health Sciences Centre’s discovery of inconsistent results in breast tumour samples. The tests that were done at the time examined two hormone receptors in breast cancer samples which help physicians to decide on a course of treatment for each patient. While I do not intend to go back through all of what happened through the Cameron inquiry and all of what happened through that period of time, suffice it to say, Mr. Speaker, it is something that we should never have to revisit in this Province again.

The Commission of Inquiry on Hormone Receptor Testing that was established in July, 2007, resulted in some sixty recommendations being put forward to the provincial government. I think we showed our commitment to cancer care in the Province when we adopted those recommendations. I think that commitment continues to show as we work through the implementation of the recommendations.

Since receiving the Commission of Inquiry on Hormone Receptor Testing, the provincial government has invested more than $26 million directly to respond to those recommendations. Mr. Speaker, I find that to be a great reassurance to the women, the men, the children of the Province of Newfoundland and Labrador, that we have heard those recommendations, that we take those recommendations seriously and that we are prepared to act on them. I know personally as a result of the cancers in my own family, I find that exceptionally reassuring.

This time last year, as well, the Minister of Health and Community Services announced that we had completed or substantially completed thirty-nine of the sixty recommendations. The remaining twenty-one were partially complete at that time. Again, I think that is evidence of the commitment that as a Province we need to know, as a Province we need to feel. I think it is important we reiterate that again today, that as a Province, as a government, we truly are concerned about ensuring that part of our history is never repeated and that we never have to revisit it, that there never has to be another Cameron inquiry.

I understand in the coming days the Minister of Health and Community Services will be providing an update on our current progress with regard to the other recommendations that have come from the Cameron inquiry, and I look forward to those. Certainly, we have made some progress, and by working together I believe we will continue to make progress in this area because no matter what, patient safety must be first and foremost on the minds of all of us as we go through the daily business of living our lives. When we do encounter whatever it is that is out there, that we all will meet some day, then we need to understand that patient safety is there. This is the responsibility of our government, and I would like to ensure that the people of the Province understand that we take that responsibility very seriously.

Some of Justice Cameron’s recommendations were fairly straightforward and we were able to adopt them relatively quickly, such as the implementation of apology legislation, which our government passed in 2009. Others of those recommendations, Mr. Speaker, which we stated were very necessary and the groundwork needed to be done, others of them, such as mandatory lab accreditation, they will take a little bit more time to finalize. Again, the assurance needs to be given that we are on the road to ensuring that that does happen. Some other recommendations will be implemented but will be forever ongoing, and that is certainly a good thing. Particularly, we reference the continuing education for medical professionals; another very, very important piece in the prevention of all cancer care, but in this case, particularly in terms of the prevention of breast cancer.

We have made a significant number of investments in cancer care and prevention and treatment since our time here in government, to the tune of about $125 million, just in cancer prevention and treatment alone, Mr. Speaker. I do not want to go through all of these and outline each of these initiatives that we have invested in, but I think it is important for the people of the Province to understand and to know that we accept our responsibility here to ensure that as much as possible can be done, is being done here, and we will continue to see the investments.

I would like to draw attention to the fact that the provincial government, in Budget 2009, did invest some $10.9 million to purchase twelve new digital mammography units. I know the Leader of the Opposition has already made reference to these, but having these units placed throughout the Province is such an important piece of the puzzle in terms of the prevention piece of breast cancer. I am really happy that we have been able to do that much. Again, I say this because I think it is assuring for the people of the Province to know that these new units provide the best imaging technology that is available for diagnostic breast cancer testing here. The technology allows the mammogram to be enlarged or magnified to provide the best quality picture and allows images to be electronically filed and stored where they can be accessed in seconds. I think for those of us who have had the experience, and have had reason to need a mammography, it is important to know that when that happens, that the mammography we are receiving is coming from a unit which is described as being one of the best imaging technologies that is available. Again, the new units are available in twelve centres across Newfoundland and Labrador. Just to highlight: St. John’s, Carbonear, Clarenville, Burin, Gander, Grand Falls-Windsor, Corner Brook, Stephenville, St. Anthony, Happy Valley-Goose Bay and Labrador City.

The Cancer Control Strategy itself, which this government launched in November, 2010, I think is another very good initiative that can offer some reassurance to the people of the Province. The goal of the strategy is to reduce the incidents and impact of cancer and to improve the quality of life of those living with cancer in Newfoundland and Labrador. Several new initiatives will be announced, or have been announced actually during the launch of the Cancer Control Strategy, specifically those that address the policy direction of the strategy, including identifying individuals at risk, which, as we all know, is exceptionally important in the diagnosis of breast cancer; identifying individuals at risk and other initiatives such as access and advocacy, education and training in prevention through promoting a healthy population.

All of those initiatives that were announced at the launch of the Cancer Control Strategy Committee I think are exceptionally important. The framework itself, I believe, will help to strengthen the services that are being offered for the prevention and treatment of cancer but particularly the prevention and treatment of breast cancer to ensure the best possible health outcomes for the people of the Province. I think the framework complements as well other provincial strategies that are aimed at combating chronic conditions.

Just for the sake of clarity, I would like to say we are very supportive of the motion that was brought forward. I understand we took a recess to take a look at some of the differences here in terms of the amendments but we are not offside here at all. I think it is safe to say that government and the Leader of the Opposition, in bringing forth this motion, are very much onside.

The original clause of the motion read: that this House calls upon government to establish a new benchmark by reducing to 40 years of age the eligibility for self-referral to the provincial breast cancer screening program. The amendment itself, I believe, is not offside at all when it says: BE IT RESOLVED that this House call upon Government to examine the reduction of the eligible breast screening age in Newfoundland and Labrador. Once again, something that is exceptionally important, something that we have to do in this Province, but we have to do it based on science. We have to do it based on the best, professional information we can get. That is not for people like you and me in this House to do, Mr. Speaker. That is for the professionals to do. That is for the medical experts to do. That is to be fed by all kinds of consultations, I would assume, as well when the Committee starts to do its work in terms of looking at this.

So, I think we would leave it in very good hands when we ask that Cancer Control Advisory Committee to take a look at the recommendation that we are making here today, to take a look at the motion that we are looking at here today, and then to come forward and make a recommendation.

Again, on behalf on all women in Newfoundland and Labrador, I am extremely happy that this motion has been on the floor today and that we have had an opportunity to discuss it and debate. I look forward to supporting very much the amended motion that we have before us.

Thank you, Mr. Speaker.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER: The hon. the Member for the District of Lewisporte.

SOME HON. MEMBERS: Hear, hear!

MR. VERGE: Thank you, Mr. Speaker.

Mr. Speaker, it gives me a great honour to stand today and to speak to this motion. I do so with a little bit of fear and trepidation. I fear somewhat that in talking about this subject it may raise some emotions within. I hope that does not happen because I want to talk about it and I want to get through a discussion that I think is a very valuable discussion here today.

First of all, let me start by thanking the Leader of the Opposition for bringing this motion forward today. I saw in the media interview earlier - maybe last fall – that she had originally hoped to bring forward this motion in the fall sitting of the House. I think her health challenges probably prevented that, but I am glad she brought it forward today.

I also want to sincerely say to her that I am glad she is back in the House of Assembly. While her personal battle with breast cancer is ongoing, I am glad she has mustered the energy and the fortitude needed to be here and to debate issues. I am glad she is here. I do not always agree with what she says, but I am glad she is here.

Mr. Speaker, breast cancer, indeed many types of cancer, affect families and individuals throughout our Province. The very word cancer is able to send chills up your spine. It is an awful word, a word that people do not want to hear.

I want to share today in a few minutes a personal perspective regarding breast cancer specifically. Two people in my family have been recently diagnosed with breast cancer. I have a sister, Jean, who is currently undergoing an orally administered chemotherapy drug for the treatment of Stage IV breast cancer. Jean was diagnosed just last year at the age of 58. She is doing well. The chemo drug that she is on is being administered orally. Her health is improving, she is doing well, and her energy is up. She has a great family support, great friends, and great faith. I am sure it is mainly through her faith that she attributes her good progress today.

I want to share, in a little more depth, the experience of my wife, Maxine, who just last year was diagnosed - actually, it was in June of 2009, at the age of 49, Maxine felt a lump in her breast. If anybody who has ever gone through that, you feel that and immediately there is a little shock, but then you kind of dismiss it and you say: Well, it is probably nothing. Many women go through that. They feel a lump and it is something. They go, they get checked out, and it is nothing to worry about.

We thought: Well, that is going to be the case with us, even though we were pretty anxious. Eventually Maxine went and had a mammogram. The mammogram showed that further testing was required. She went and had some more testing; she had a biopsy. We received the news sitting in the doctor’s office, myself and her, that indeed she did have breast cancer; she did have what is called inflammatory breast cancer. The whole language surrounding breast cancer, the drugs, the stages, and all of the wording became familiar to us in a short period of time. We were told she had what was called Stage IIIB inflammatory breast cancer. For us, I guess coming to grips with that, the first thing you do is have an emotional breakdown, you wonder why and wonder how you are going to get through it. Then, you get past that, you gather strength, you say we are going to face it, we are going to fight it, and we are going to do whatever needs to be done to make sure that we get through it.

In November of 2009, Maxine started chemotherapy, started in Grand Falls. I remember we went into the cancer clinic the first day. We went there about 8:00 or 8:30 in the morning, and she was hooked up to an IV at about 9:00 or 9:30. We were kind of the first ones there. At 5:00 o’clock in the day, after being on this drip of three different chemotherapy drugs, we went home. She felt pretty good, but then over the next day there was a nausea that came with the after-effects of chemotherapy. I remember being up with her for most of one night with the violent throwing up and everything that came with it. You go through four or five days of that because usually chemotherapy is once every three weeks, and then after about day six or seven she starts to feel a bit better. Then, toward the end of the first session, you start to lose your hair and there is the torment that goes with that.

I apologize to anybody who is listening to this today, if they find it hard, especially to the Leader of the Opposition, but I just feel like it is important that we fully paint the picture and people understand here because lots of people in our Province go through treatment of cancer; and, folks, it is a very, very hard battle.

Following chemotherapy, there was the surgery that came in February. The news: No, there is not a lump that can be removed; we have to remove the full breast. For a woman, there is the impact of that. It is not just the pain of surgery. It is not just the torment of surgery. It is not just the recovery and having a health nurse come to your home for a week. It is also the psychological battle that comes with it.

Following surgery, there are weeks of radiation. The burning of radiation is, well, it is something that Maxine describes as very intense, draining. Finally, after that, after all that long battle, there comes a feeling of hope; there comes a feeling of optimism. The intervention that takes place as people – the medical professionals in the field – how they treat you with such dignity and such respect and such care and such compassion, out of all of that comes a feeling of optimism, a feeling of hope that we can beat this.

So, that is Maxine’s story, Mr. Speaker, and cancer is something that many people throughout our Province get affected by, and it is a hard, hard battle. As we debate this motion today and I listen to the Minister of Health, self-referral for screening, and it has been asked in this motion as it was originally put forward that we lower the age from 50 down to 40, and I have no issue supporting that. I have no problem with it.

As the Minister of Health has said, what we need to do is refer this to the professionals in the field. We need the proper science behind it, because there is conflicting evidence. I have researched it, and I am by no means a medical professional; I have researched it and some reputable groups say that starting self-referral breast cancer screening at age 40 is good. Also, some other reputable groups say that if we start breast cancer self-referral screening at age 40 that the negative outcomes outweigh the positive outcomes. So, there is conflicting evidence, and I am very, very comfortable with supporting the amendment that the Minister of Health has put forward today, which says we will take a look at this after the professionals have looked at, after the Cancer Control Advisory Committee has done their piece of work, and then we will move from there.

Again, I thank the Leader of the Opposition for bringing forth this motion today. I thank her for what she represents to the people of the Province and I wish her the very best in her battle. I wish the people of the Province who are facing cancer, whether it is breast cancer or any other type of cancer, I want to say to all of the people that are out there is to hang on to your family, your friends, your faith. Follow the advice that your physician is giving you and by all means we wish you the very best in your battle.

Thank you very much, Mr. Speaker.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER: Order, please!

I understand that the Leader of the Opposition has had to step away for a few moments and I will ask the discretion of the House to recess for a few moments to allow the Leader to come back.

MR. SPEAKER (T. Osborne): Order, please!

Are we ready to proceed?

The hon. the Leader of the Opposition.

MS JONES: Thank you, Mr. Speaker.

I want to thank all of those today who contributed to the debate. I just want to make a few brief closing comments.

First of all, as I said, I introduced this motion today simply because of awareness of the issue in the last year or so because of my own personal circumstance. As a result of that, I have gotten to dialogue with many young women, not just in Newfoundland and Labrador but certainly across Canada in recognizing the importance of breast screening for women under the age of 50 and the need to have that policy changed in Legislatures right across the country.

As I have already outlined, Mr. Speaker, in my opening comments, there have already been a number of provinces and territories that have already undertaken, in Canada, to change the breast screening age for women from age 50 to age 40. I want to applaud those provinces, Mr. Speaker, for having done that. I also want to say today to the Minister of Health, I really appreciated his comments and his sincerity on this particular issue, and I think he, too, realizes that it is a serious policy issue that needs to be looked at in Newfoundland and Labrador. While, Mr. Speaker, I was somewhat disappointed that government did not come today prepared to make a more firm decision around changing the benchmark in Newfoundland and Labrador from age 50 to age 40, I am somewhat optimistic by the fact that they have referred it out to a task force to have a look at.

The fact, Mr. Speaker, that I defer with the need that there should be more medical expertise brought to bear on it I certainly do not take exception to government wanting to move in that direction. I do think, Mr. Speaker, that it is worthy of pointing out that there is a lot of medical expertise already out there in the country today that will document and solidify the motion that I have brought forward and the need for it to be done. I want to refer people to one of the reports that was presented back last fall and that was a scientific report that was done by a committee out of Ontario and it was chaired by a Doctor Martin Yaffe. Mr. Speaker, Dr. Yaffe has a distinguished career at Sunnybrook Research Institute and has focused on the physics of breast cancer imaging. That has been one of his specialities.

In that report, Mr. Speaker, he recommends that breast screening in Canada should be age 40 and not at age 50. It is his report that is being used in Ontario today to make the decision to move forward with this particular legislation. While I heard and listened very attentively to the Member for Grand Falls-Buchans and the fact that she felt there needs to be more medical expertise or medical experts to look at this, I would say that there is already a lot of evidence out there. Some of that evidence is conflicting; I would be the first to admit that. Mr. Speaker, if you look very clearly at where the evidence and recommendations for this is coming from, it is coming from leading experts in the country and in the field of breast cancer research.

Mr. Speaker, I have been engaged as well in some work with the Canadian Breast Cancer Foundation that have also taken it upon themselves to launch a movement across Canada to have this new benchmark established as the new national benchmark so that all provinces would hopefully comply over a period of time in that particular fashion.

Mr. Speaker, there is, in my opinion, a tremendous amount of evidence already there that is supporting this particular move. I would encourage my colleagues, although it has been referred to a task force in Newfoundland and Labrador - and I must say a task force being chaired by Dr. Ganguly, a radiologist in which I have a tremendous amount of confidence, as I chose him as my own personal radiologist. I do have confidence in his abilities and in his knowledge that he will bring to bear on this particular issue; however, Mr. Speaker, I also realize that when we refer out different things like this when we already have evidence on which to draw upon, it is a lengthy process. I would imagine that we will be sometime before we can achieve the goal that we are trying to achieve as women under the age of 50, or between the ages of 40 and 50 in the Province to have this done.

Mr. Speaker, I will draw my comments to a conclusion, other than to say to members opposite that there has been a lot of support expressed to me by women in the Province to have this done, especially between the ages of 40 and 49. I would ask that you use some urgency in carrying out the work of the task force and that you would come to a conclusion on it sooner rather than later. I think that, Mr. Speaker, you will find that the evidence of moving this to age 40 will save lives of women in Newfoundland and Labrador. I think that would be the objective and the goal of all of us who sit in this Legislature who certainly have been affected in one way or another with cancer and are enforced with the mandate of making policies that are there to enhance and help people in society. I think that we would certainly see the favouritism in moving forward with this.

I ask that it be done in the quickest time as possible that government can undertake to do this. I would ask that government would look at supporting this and bringing forward some new benchmarks in the Province in the near future.

Thank you very much.

SOME HON. MEMBERS: Hear, hear!

MR. SPEAKER (Fitzgerald): Order, please!

Is the House ready for the question?

Shall the amendment as put forward by the hon. the Minister of Health and Community Services carry?

All those in favour, ‘aye’.

SOME HON. MEMBERS: Aye.

MR. SPEAKER: All those against, ‘nay’.

The amendment is carried.

On motion, amendment carried.

MR. SPEAKER: Shall the resolution, as amended, carry?

All those in favour, ‘aye’.

SOME HON. MEMBERS: Aye.

MR. SPEAKER: All those against, ‘nay’.

The amended resolution is carried.