Advancing Equitable Access to Cancer Screening in Primary Care

Cancer remains the leading cause of death in Ontario, with 1 in 4 Ontarians expected to die from cancer. While screening programs for breast, cervical, lung, and colorectal cancer are designed to catch disease early, many patients continue to face barriers that delay or prevent access, especially those from underserved backgrounds.

While local data is limited because of inadequate race-based data collection, research from Canada, the US and the UK highlights persistent inequities in screening access and outcomes, particularly among:

• First Nations people, who are 42% more likely to develop colorectal cancer and less likely to be screened for breast, cervical, and colorectal cancers.
• Métis women, who are screened less often for breast and colorectal cancer.
• Black women, who face higher rates of aggressive breast cancer subtypes and later-stage disease.
• Filipina women, who are diagnosed with breast cancer at higher rates than white women.
• Newcomers and residents of low-income, ethnically diverse neighbourhoods, who are more likely to be overdue for colorectal and lung cancer screening, including refugees with limited funding for cancer screening via the Interim Federal Health Plan (IFHP).
• Patients without a fixed address or phone number, who face logistical challenges that limit access.

Practical Steps to Expand Cancer Screening Access

If not already part of your approach, please consider these clinic-ready strategies to support equity in cancer screening:

• Self-referral for unrostered patients: If time constraints are impeding in-clinic cancer screening, encourage unrostered patients to self-refer to the Champlain Screening Outreach Program.
• Support culturally safe conversations with Indigenous patients: Cancer Care Ontario’s cancer screening toolkit supports dialogue with Indigenous patients.
• Discuss earlier screening: While screening is available to all eligible individuals through the Ontario Breast Screening Program (OBSP), prioritize breast cancer screening discussions with Indigenous, Black, and Filipina women, especially those with family history or other risk factors.
• Bundle appointments: If a patient without a fixed address or with limited access to transportation has an appointment for one issue, consider offering cervical cancer screening at the same visit.
• Update contact info strategically: For patients without reliable access to a phone, having consent to use contact information for a case worker or shelter staff can to help coordinate cancer screening.
• Stay connected: local screening opportunities: Follow Ottawa Public Health’s social media for updates on same-day cancer screening events, such as the Mobile Mole Clinic.
• Extend screening access to refugees when eligible: If you have billing privileges under the IFHP, offer cervical cancer screening to refugees, which is currently the only funded cancer screening.

These strategic adjustments can help ensure more patients receive the support they need for early detection and better outcomes.

Physician & NP Resources

• Champlain Screening Outreach Program for screening access to individuals without a family doctor. Patients can self-refer to the Champlain Screening Outreach by calling 1-833-551-4125 or by booking an appointment online to get screened for cervical, breast, colorectal, and lung cancer.
• How to Provide HPV Testing to Refugees, Ottawa Public Health
• Provincial cancer prevention, screening and management guidelines & advice repository, Cancer Care Ontario
• Ottawa Public Health’s social media to stay in the loop on cancer screening related events

Patient Resources

• First Nations, Inuit, Métis and Urban Indigenous Cancer Screening Resources: Culturally appropriate information to support Indigenous peoples in accessing cancer screening services and understanding screening pathways in Ontario
• Ottawa Health Team’s Multilingual Cancer Screening Outreach Toolkit: Toolkit with cancer screening information and outreach materials available in multiple languages to support diverse communities in Ottawa

Chantal Phillips, MD, CCFP
Public Health and Preventive Medicine Resident
University of Ottawa

Emil Prikryl, MD, MSc, FRCPC
Associate Medical Officer of Health
Ottawa Public Health