Language a barrier for Canadian women in getting screened for cervical cancer

The Canadian Partnership Against Cancer has released the 2017 Cancer System Performance Report which found that language may be a significant barrier for certain groups of Canadian women in getting screened for cervical cancer.

The data show women aged 21-69 who do not speak English or French at home are three times more likely to never have had a Pap test (around 26% compared to those who do speak one of Canada’s official languages in their home (only 8%).

In Canada, an estimated 1,500 women are diagnosed with cervical cancer every year.^[1] Pap tests are one of the most effective methods of screening for cervical cancer and are covered in all provinces and territories for women aged 21–69 who have been sexually active. Cervical cancer has an over 80% survival rate if caught during stage one.^[2]

Health Canada has set a target of having 80% of eligible women participate in cervical screening but, as the report shows, this target is only being met by women who speak either English or French as their first language. The findings suggest that barriers may exist in Canada in communicating the benefits of screening in helping to prevent the development of cervical cancer. They also suggest improvements are needed for immigrants in having access to screening information that is culturally sensitive and addresses language barriers.

In addition to these findings, Cancer System Performance tells the story of the current state of Canada’s cancer control system, as told by national indicators measuring performance across five key themes: quality of care, equity in access to care, sustainability of system resources, seamlessness of patient experience, and maximizing the impact of data.

The report also outlines the challenges that lie ahead in these five areas of cancer control in Canada, and the gaps that need to be addressed to help those who deliver cancer care make necessary, evidence-based changes in the provinces and territories.

Other key findings from the report

Quality of cancer care

• As a result of more effective treatments, better uptake of screening and early detection, and declining incidence rates, the age-standardized mortality rates have been decreasing for prostate, breast, lung (for men) and colorectal cancer.
• Three out of 10 women diagnosed with invasive cervical cancer in Canada had not had a Pap test in at least 5 years.
• A large proportion of Canadians with lung or colorectal cancer are still diagnosed at later stages, when chances of cure and survival are lower.

Equity in access to care

• Data show that households with lower incomes tend to have a higher cancer burden than higher income households – particularly for lung and colorectal cancer.
• Access to care and cancer outcomes can vary based on how much money people make, where they live, and where they were born.
• Although the lowest-income populations are more likely to get lung and colorectal cancer, the opposite is true for breast cancer.

Seamlessness of patient experience

• As a result of concerted efforts by federal, provincial and territorial governments, the vast majority of Canadians who require radiation therapy receive it within appropriate timing – meaning an improved patient experience and improved outcomes.
• Most cancer patients (almost 80%) report experiencing pain, fatigue, depression or anxiety – which can impact patients’ quality of life and satisfaction with cancer care.
• Two-thirds of cancer patients die in hospital, even though many would prefer to die at home.

Sustainability of health system resources

• The most recent data show that smoking (daily or occasional) has declined by eight percentage points in the total population – if this trend continues and Canada reaches the goal of a 5% smoking rate by 2035, it will save the health system over $34 million per year.
• Over 700,000 screening tests for breast and cervical cancer are performed outside the recommended age ranges each year – these tests are often of limited value and are costly to the health system.
• Looking at 5 treatment practices, over 17,000 cancer patients receive treatments that may be of limited value each year.

Maximizing the impact of data

• Data are not routinely being collected for under-served populations, particularly First Nations, Inuit and Métis peoples, and data on the territories are also limited, particularly for cancer diagnosis and treatment.

Improvements in these areas of cancer control will help achieve a future where fewer Canadians get cancer, fewer die from cancer and more people living with the disease have a better quality of life. To measure progress, the Partnership’s System Performance Initiative will continue to monitor and report on cancer system performance to inform cancer control planning, to inform system and practice improvements, and to promote the exchange and uptake of best practices across the country.

Data for the report was gathered from Statistics Canada, the Canadian Community Health Survey as well as several partnering federal, provincial and territorial cancer agencies/programs and health organizations.

View the full 2017 Cancer System Performance Report.

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Notes

^[1] Canadian Cancer Society. Cervical cancer statistics. 2016; cited 2017 Jun 13. Available from:
http://www.cancer.ca/en/cancer-information/cancer-type/cervical/statistics
^[2] Canadian Cancer Society. Survival statistics for cervical cancer. 2016; cited 2017 Jun 16. Available from: http://www.cancer.ca/en/cancer-information/cancer-type/cervical/prognosis-and-survival/survival-statistics