Regular screening for breast and cervical cancer can save women’s lives by detecting cancer at early, treatable stages. This is especially the case for breast cancer, which is the second leading cause of cancer-related deaths among Canadian women. In Canada, it is recommended that women between the ages of 50 and 69 undergo screening mammography once every two years. The good news is that over the past decade; mammography rates have been steadily increasing. However, Ontario screening participation rates currently stand at 61%, which lies a bit below the Cancer Care Ontario target of 70%.
This gap in participation can be attributed to the lack of cancer screening in vulnerable populations, such as immigrant women. Research has shown that immigrant women tend to be one of the most vulnerable population groups with respect to healthcare and are more prone to cancers related to viral infections. For many of these women, it is not just their biological susceptibility that shapes their health status; there are social forces that influence their health as well, such as pre- and post migratory factors. These factors include: migration conditions (war, displacement, etc.), the level of integration within a new society, and the migrants’ newly acquired social status. The health conditions of these women can be further exacerbated if they don’t engage in means of secondary prevention, such as screening. Many immigrant women are reluctant to partake in cancer screening programs due to cultural stigma, poor proficiency in the new language, and cultural insensitivity of healthcare personnel. In addition, some women fear discrimination, may feel embarrassed or worried in the presence of a male physician, and screening may be inaccessible due to their low income or a general lack of information regarding the benefits of screening.
Mananda Vahabi of Ryerson University has shown that overall, immigrant women in Ontario have lower breast cancer screening rates, which she believes is the underlying reason for increased levels of advanced breast cancer among immigrant women. In her study, Vahabi wanted to see if there were any significant differences in screening rates amongst immigrant populations from varying regions of origin. Surprisingly, Vahabi found that screening is disproportionately low for certain subgroups of women: South Asian women had the lowest cancer screening rates (48.5%), followed by Eastern European and Central Asian women (52.5%). The highest screening rates (62.5% and 63.7%) were found in Western European, Caribbean, and Latin American women, respectively. Similar to breast cancer screening, cervical cancer screening is also low amongst immigrant women, with the lowest rates found amongst older, poorer South Asians.
Due to the hesitancy and scepticism that immigrant women harbour towards mammograms and pap smears, the number of immigrant patients whose cancer is identified at later stages is much greater than the general populace. Immigrant women’s likelihood of developing cancer isn’t greater than any other person, but their reduced levels of screening may result in cancers going undetected, which in turn, makes them more life threatening. A population based study by Ginsburg and colleagues compared breast cancer stage at diagnosis in three mutually exclusive groups: Chinese women, South Asian women, and the remaining general population. They found that South Asian women were at a more advanced stage of breast cancer than were Chinese women and those in the general population.
Given the important role that primary care physicians play in educating patients on the importance of screening, the Health Care Connect program in Ontario aims to finds primary care physicians for individuals who don’t have one. Programs geared towards cancer prevention in immigrant women aim to provide them with culturally and linguistically appropriate education about screening services. There are also community cancer education programs available such as the Ko-Pamoja (“Learning Together) project, the first African cervical and breast cancer peer education program in Toronto. Furthermore, a program titled “Cancer Awareness: Ready for Education and Screening” (CARES) was recently developed in Toronto to increase knowledge and screening amongst newcomer and marginalized populations. This was done through outreach programs via community agencies, linguistically appropriate educational sessions led by peers in community settings, facilitated access to screening, and follow up phone calls that reinforced previous messages. Over the course of 17 months, of the 1993 women who participated,14% went on to get a pap smear and 20% had a mammogram. In previous reviews, an average success rate of 7.8% was obtained in efforts geared towards mammography, thus demonstrating the impact of CARES on mammography screening.
By increasing awareness of cancer screening, programs like Ko-Pamoja and CARES can help bridge the gap in cancer screening participation rates and ensure that all women, regardless of immigrant status, are able to detect their cancer at an early enough stage. In this way, they can be placed on the road to treatment much earlier, increasing their chance of survival to match that of the general populace.