Breast cancer screening in Canada: 2021/2022
Strategies to improve screening for underserved populations
Ten provinces and one territory have employed strategies to improve screening for various underserved populations. Most jurisdictions engage specific underserved populations in decision-making and informing strategies. Screening awareness campaigns, social media posts, and brochures are regularly used to engage underserved populations in screening. Mobile clinics and culturally appropriate client reminders have also been implemented to better reach these populations.
Strategies to improve screening for underserved populations
| P/T | Intended audiences | Strategies used | Strategy co-developed with community? | Description of activities to improve screening for underserved populations |
|---|---|---|---|---|
| NT | · Low-income · Immigrants and refugees · Racial or ethnic minorities · Specific cultural groups · Non-English and Non-French Speakers · People without a primary care provider · People with co-morbidities or chronic illness · People with physical disabilities · People who are houseless · People who live in rural and remote communities |
· Education · Media (small and mass) · Opportunities for self-referral · Client reminder · Recall system · Patient navigation · Healthcare provider cultural competency training · Access to interpreter services (site specific) |
All: ✓ | · Breast Cancer Screening awareness kits were developed and distributed to the community health representatives in all community health centres to promote education at a local level · Social media posts created and launched on the Northwest Territories Health and Social Services social media platforms (Twitter, Facebook, Instagram) · Reminder letters mailed to patients · 1:1 health education available with HCP’s in primary care clinics and community health centres · Re-design breast cancer screening posters, brochures and FAQ’s (including translation of materials to all 11 official languages of the NT). |
| BC | · Racial or ethnic minorities · Non-English and Non-French Speakers · People with physical disabilities |
· Translated and culturally safe materials · Engagement with community groups · Targeted media campaigns · Website · Printed materials |
· BC Cancer Breast Screening is inclusive by featuring and targeting underserved communities in its materials and as part of its outreach strategy. | |
| AB | · Low-income · Immigrants and refugees · Racial or ethnic minorities · Specific cultural groups · Non-English and non-French Speakers |
1. Education (one on one and group) 2. Client invitation and reminders 3. Media (small and mass) 4. Provider assessment and feedback 5. Healthcare provider cultural competency training 6. Development of culturally safe materials and resources 7. Direct community engagement to co-design programs |
1. ✓ 2. 3. ✓ 4. 5. ✓ 6. ✓ 7. ✓ |
· Been engaged in a creating health equity project* for several years with data identified lower screening subpopulations in northeast Calgary to co-design strategies with the intent to scale and spread effective methods across Alberta. |
| SK | · Low-income · Immigrants and refugees · Rural and remote locations · People without a PCP |
· No PCP needed to attend · Mobile unit to avoid unnecessary costs · Education sessions with new to Canada populations |
All: ✓ | · Coordinators provide education on breast screening at local community health centres, Open Door Society Community Fairs and also do classroom presentations both via Open Door Society and Sask Polytech (for new immigrants). Education sessions include pictorial presentations to help comprehension of content. |
| MB | · Newcomers · Low income · Specific cultural groups · People with mental illness or physical disabilities |
· Comprehensive letter campaigns · Informative web site · Interpreter service available · Accessibility – 2 mobile clinics, 4 fixed locations · Social media (Facebook) promoting mobile clinics · PCP booking request form for underscreened persons |
All: ✓ | · Cancer screening education module created with and for educators with students with low literacy · Coordinating interpreter services with appointment times · Translation document included in all public facing letters · Scheduling longer appointments for those individuals who require longer appointment times for physical or emotional reasons |
| ON | · Racial or ethnic minorities · Specific cultural groups · Non-English and non-French speakers · Low-income · People without a primary care provider · Immigrants and refugees · Specific geographic areas (e.g., postal codes) · People who missed their routine cancer screening test due to COVID-19 |
· Mass media · Development of culturally safe materials and resources · Translation service · Mobile screening clinics · Self-referral · Reducing out of pocket costs · Changes to correspondence eligibility · Screening awareness campaign |
· Ontario Health (Cancer Care Ontario) has a Breast Cancer Awareness Month (BCAM) campaign each October. The campaign includes the development and dissemination of promotional materials to regions. These materials include images which are representative of diverse groups. · Ontario Health (Cancer Care Ontario) will translate program material and inquiry responses in various languages upon request. · Ontario has two mobile screening coaches that offer cancer screening services (including breast screening) in the North West and Hamilton Niagara Haldimand Brant regions. · A referral from a primary care provider is not required for screening through the Ontario Breast Screening Program (OBSP)_ · Screening through the OBSP is free for those eligible for the program. Ontario Health Insurance Plan coverage is also not required for people eligible for the OBSP. · The Ontario Ministry of Health issued a directive to pause non-essential screening services in the spring of 2020 as a result of the COVID-19 pandemic. This included a pause in invitation and recall letters, which gradually resumed beginning in December 2020. Recognizing that people who were 74 during the correspondence pause may have since turned 75 (and would no longer be eligible to receive letters within our typical correspondence campaign), the upper age limit for invitation and recall letter correspondence campaigns was extended by one year to ensure those who did not screen due to the pandemic receive notifications to screen. · The Ontario’s Ministry of Health will be leading a public campaign to remind people about the importance of regular cancer screening in September 2021 and have provided Ontario Health (Cancer Care Ontario) with support to develop additional strategies to support COVID-19 recovery. |
|
| QC | · People without a primary care provider |
· Voluntary Program PCP is assigned to the participant | ||
| NB | · People without a primary care provider · Specific geographic area · Immigrants and refugees |
· Program provides information on local breast screening clinics offering mammograms to those without a PCP · Target strategies to improve participation. · Provide program Information/education by working with Multicultural Associations. |
All: ✓ | · Participants can call toll free screening line or go to the GNB website to access information on available clinics offering mammography to eligible participants. · Using GIS mapping, the program is able to identify areas of low participation in order to further assess community needs and services. · Offer informational sessions (virtual or in person) and/or promotional materials with screening information; assess information and language needs and adapt or develop tools, when able. |
| NS^ | · Incarcerated people · New immigrants |
· Education (group) | · The Patient Navigator attends a Wellness clinic every year at a federal women’s prison, and provides breast screening information to the inmates. They also educate the medical staff on how to request mammography screening for the inmates. · The Program Coordinator provides breast screening education to new immigrant individuals at the Immigrant Services Association of Nova Scotia (ISANS). |
|
| PE~ | · Cultural groups · Non-English speakers · People without a PCP |
· Translated materials | · Translated materials · Access to translation services · Participants without PCP can access services · Updates pending for wheelchair access washroom · Larger changerooms with equipment updates |
|
| NL | · Low-income · Immigrants and refugees · People with mental illness · People with physical disabilities · People who are houseless |
· Ongoing work with Regional Health Authorities collaborative clinics for people without access to primary care etc. |
AB: *Current stage is funded by CPAC through the Developing Strategies for Underscreened Populations through Community Engagement grant.
NS: ^Due to the COVID-19 pandemic, some pre-planned presentations at the Immigrant Services Association of Nova Scotia (ISANS) were cancelled.
PE: ~Utilize various translated materials to assist individuals with the mammography process
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