Population outreach

There are many existing strategies that can be used to increase screening participation, as well as improve the overall screening experience. Which strategies are used depends on the jurisdiction employing them, and the target population. Most jurisdictions have outreach strategies for all eligible people, First Nations, Inuit, and/or Métis, underscreened and underserved populations, rural and remote populations, and LGBTQ2S+.

6.1 Strategies to Improve Breast Screening for All Eligible People

Ten provinces and one territory employ various strategies in order to improve breast screening for all eligible people. Many use social media campaigns, presentations, and program material to increase awareness and education on breast screening. The use of client reminders and mobile screening clinics is a prevalent strategy to increase screening participation and access.

Table 20: Strategies to Improve Breast Screening for All Eligible People

NT:

Strategies used:

Education
Media (small and mass)
Client reminder
Recall system
Patient navigation
Healthcare provider cultural competency training

Description of Activities to Improve Breast Screening for All Eligible People

Breast Cancer Screening awareness kits were developed and distributed to all community health centres
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
Recall systems for patients in place
1:1 health education available with HCP’s in primary care clinics and community health centres

BC:

Strategies used:

Health care provider education
Patient reminder letters
Provider-to-patient letters for overdue patients
Provider recall and result systems
Annual provider report cards
Traditional media
Digital engagement and social media
Website
Suite of printed resources for patients and providers
Translated and culturally relevant materials and resources
Broad campaigns and awareness months
Patient testimonial videos
Animated patient education videos
Advertising (Online, Radio, TV)

Description of Activities to Improve Breast Screening for All Eligible People:

BC Cancer Breast Screening employs a comprehensive approach to health promotion, including the engagement of health care providers in supporting patient education and navigation of screening pathway. The program provides screening information to patients in diverse ways, from printed resources to digital engagements, while considering their place in the screening journey, from initial awareness to long term participation in the program.

AB:

Strategies used:

Education (one on one and group)
Client invitation and reminders
Media (small and mass)
Provider assessment and feedback
Mobile screening clinics
Healthcare provider cultural competency training

Development of culturally safe materials and resources

Description of Activities to Improve Breast Screening for All Eligible People:

Program developed materials are in plain language.
Share evidence and learnings with service providers to provide culturally safe care.
Inclusive language in Standards and Guidelines.
Work with our partners to provide consistent messaging to eligible people.
Work with partners to provide providers with their annual panel reports on screening.
Ongoing communication about screening through profession associations and colleges.

SK:

Strategies used:

Education
Reminders
Media campaigns
Recall system
Mobile unit

Description of Activities to Improve Breast Screening for All Eligible People:

Patient navigation
Hiring outreach manager to develop strategies and a team to target populations with low screening rates

MB:

Strategies used:

Comprehensive letter campaigns
Informative web site
TV advertisement (run at select periods)
Satisfaction surveys
Accessibility – 2 mobile clinics, 4 fixed locations
Social media promoting mobile clinics

Description of Activities to Improve Breast Screening for All Eligible People:

Invitation letters sent to all new 50-year old’s and new Manitobans
Reminder and recall letters sent at appropriate intervals
Screening Program web page on CCMB site that educates and provides for test requests
TV ad runs in October. Promotional pieces in development that support tv ad
Satisfaction survey sent to all clients testing positive who have gone on to have follow up investigation
Interactive map showing active mammogram clinics https://www.cancercare.mb.ca/screening/breast

ON:

Strategies used:

Mass media (small and mass)
Development of culturally safe materials and resources
Correspondence campaigns (invitation, recall and reminder letters)
Provider reminder and recall systems (Screening Activity Reports)
Provider incentive strategies
Participant navigation

Description of Activities to Improve Breast Screening for All Eligible People:

Mass media (small and mass) and development of culturally safe materials and resources:

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.
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

Correspondence campaigns (invitation, recall, and reminder letters):

The Ontario Breast Screening Program sends letters to eligible people inviting them to participate in screening by talking to their PCP and reminding them when it is time for their next screening test (recall letter).

Provider reminder and recall systems (Screening Activity Reports): Ontario Health (Cancer Care Ontario) helps PCPs identify people eligible for screening or follow-up through the Screening Activity Report, an online tool that gives physicians who participate in Patient Enrolment Model practices the screening status of each of their enrolled age eligible patients (i.e., those who are overdue, never been screened or require follow up).

Provider incentive strategies: To support family doctors in ensuring that their patients participate in relevant screening programs, the Ministry of Health has implemented Cumulative Preventive Care Bonuses. Through this program, eligible family doctors who practice as part of a Patient Enrolment Model, meaning, patients are formally rostered to a family doctor, may receive bonuses for maintaining specified levels of preventive care for their enrolled patients.

Participant navigation: After a participant has an abnormal screening result, their Ontario Breast Screening Program (OBSP) site will notify their family doctor or nurse practitioner and may help to schedule a timely follow-up appointment. A participant with an abnormal mammogram who does not have a family doctor or nurse practitioner will be assigned a doctor who will follow them to diagnosis. If the participant does have breast cancer, they will be referred to a specialist for further care and management.

QC:

Strategies used:

Provider reminders and recall systems
Mobile screening clinics
Providing transportation to screening services

Description of Activities to Improve Breast Screening for All Eligible People:

n/a

NB:

Strategies used:

Education (groups)
Participant reminders and correspondence
Media (social media, radio, transit ads)
Provider correspondence
Bilingual program materials
Community engagement for program feedback
Leverage learnings from under screened population project
Patient Navigation

Description of Activities to Improve Breast Screening for All Eligible People:

Offering virtual and in person education sessions on cancer screening programs in general, and specific to each screening site as requested by the public, health care providers, regional health authorities, community groups or special interest groups.
Some health zones send letters to participants to remind of screening appointments or that it is time to re-book screening. Every screening site includes an additional information sheet about breast density with the screening result letters mailed to participants.
Coordinated communication and awareness strategies are planned regularly throughout the year to promote and increase visibility of provincial cancer screening programs via various media such as radio ads, targeted digital ads, Facebook, Twitter, billboard and transit ads, website, animated and testimonial videos)
Screening sites send result correspondence to primary care providers to alert them of screening results.
ALL program correspondence, educational and promotional materials are offered in English and French. The program offers a toll-free phone line for public inquiries on cancer screening which is answered by bilingual staff.
Public surveys have been offered by phone, online and following education sessions. Feedback provided to the program is collected and evaluated regularly.
Plan to leverage the recommendations from the ongoing project ‘Developing Strategies for Underscreened Populations through Community Engagement’.
Breast health navigation services are available to patients in most health zones across the province.

NS:

Strategies used:

Media (mass)

Description of Activities to Improve Breast Screening for All Eligible People:

The coordinator for the mobile van places radio ads about upcoming mobile breast screening dates and locations.

PE:

Strategies used:

Business cards for physician office use
Educational sessions with groups & new physician groups
Media ads
Health fairs
Reminder letters for recalls
Promotional items

Description of Activities to Improve Breast Screening for All Eligible People:

Extended hours of operation one day per week as well as Saturday appointments

NL:

Strategies used:

Client reminders
Provider reminders and recall systems
Patient navigation

6.2 Strategies to Improve Screening for First Nations, Inuit. and Métis

According to the limited data available, participation rates for breast screening are much lower among First Nations, Inuit and Métis than non-Indigenous people in Canada. The data also indicate considerable variation in screening participation across geographic location.⁹

Screening programs in nine provinces and one territory report work with First Nations, Inuit and/or Métis to increase participation and improve the screening experience. This work includes engaging First Nations, Inuit and Métis in decision-making and informing approaches to culturally appropriate screening, program resources specific to First Nations, Inuit and Métis, and engaging with healthcare providers working directly with First Nations, Inuit and Métis communities. Dedicated mobile visits have been implemented into several screening programs in order to reach First Nations, Inuit and Métis communities, along with other program resources such as culturally appropriate material, presentations and social media campaigns. In addition, some strategies were put in place to help educate health care providers working directly with First Nations, Inuit and Métis communities.

Table 21: Strategies to Improve Screening for First Nations, Inuit, and Métis

NT:

Intended Audience(s):

First Nations, Inuit and Métis

Strategies Used:

Education
Media (small and mass)
Client reminder
Recall system
Patient navigation
Healthcare provider cultural competency training

Strategy co-developed with community: Yes

Description of activities to improve screening:

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
Recall system for patients in place
1:1 health education available with HCP’s in primary care clinics and community health centres

BC:

Intended Audience(s):

First Nations

Strategies Used:

Website
Print resources
Peer support materials
Provider materials
Mobile screening First Nations communities
Community-based outreach
Patient videos

Strategy co-developed with community: Yes

Description of activities to improve screening:

BC Cancer is partnering with First Nations Health Authority to co-design interventions and promotional activities to engage First Nations population in BC. Breast screening services are also delivered to First Nations communities via the mobile mammography service.

AB:

Intended Audience(s):

First Nations, Inuit, and Métis

Strategies Used:

Education (one on one and group)
Client invitation and reminders
Media (small and mass)
Provider assessment and feedback
Mobile screening clinics
Healthcare provider cultural competency training
Development of culturally safe materials and resources
Direct community engagement to co-design programs

Strategy co-developed with community: Yes (all but client invitations and reminders and provider assessment and feedback)

Description of activities to improve screening:

Partner with Indigenous representatives to conduct screening disparities evaluations and use findings to inform strategies to improve screening in Indigenous populations.
Share evidence and learnings with service providers to provide culturally safe care.
Work with Indigenous partners to develop and provide culturally appropriate information.

SK:

Intended Audience(s): First Nations and Métis

Strategies Used:

First Nations and Métis Cancer Surveillance strategy

Strategy co-developed with community: Yes

Description of activities to improve screening:

Outreach manager and program coordinators working with communities to identify needs and gaps in care.
Adjusting mobile route to serve the communities when it works best for them
Educating staff on cultural safety and competency
- working with communications to develop culturally safe materials and resources

MB:

Intended Audience(s): First Nations and Métis

Strategies Used:

Comprehensive letter campaigns
Informative web site
Interpreter service available
Accessibility – 2 mobile clinics, 4 fixed locations
Social media (Facebook) promoting mobile clinics
Culturally sensitive appointment booking processes

Program arranges and funds group flights for communities without road access to mammogram clinics

Strategy co-developed with community: Yes

Description of activities to improve screening:

Community engagement and outreach through Prevention and Screening Program
Partnerships with Regional Health Authorities, Nursing Stations, Health Directors, tribal councils, Wellness Centers, healthcare providers and valued stakeholders
Partnership with Community Engagement Liaisons.
Mobile screening vehicles hosted on First Nation community.

ON: * *Listed activities are not inclusive for all First Nations, Inuit and Métis populations. More information about the First Nations, Inuit, Métis and urban Indigenous Cancer Strategy can be found here: https://www.cancercareontario.ca/en/cancer-care-ontario/programs/aboriginal-programs/indigenous-cancer-strategy

Intended Audience(s): First Nations, Inuit, and Métis

Strategies Used:

Group education
Mass media
Development of culturally safe materials and resources
Provider reminders (Sioux Lookout area only)
Mobile screening clinics (North West only)
Providing transportation to screening services (for First Nations through Non-Insured Health Benefits [NIHN])
Promotion of health literacy
Direct community engagement to co-design programs

Strategy co-developed with community: Yes

Description of activities to improve screening:

Through the Indigenous Cancer Care Unit (ICCU), Regional Indigenous Cancer Leads and regional teams, communities are engaged to inform programs/initiatives to improve education and awareness of cancer screening.
The ICCU is currently engaged in a study to investigate current correspondence and identify methods to enhance participant reminders. Ontario Health (Cancer Care Ontario) sends reminders following cancer screening invitation and recall letters to all eligible people in Ontario.
A grant received by Dr. Jill Tinmouth and Dr. Amanda Shephard (“Catching Cancer Early how well do Ontario screening programs perform for First Nations and Métis persons?”) will provide Ontario Health (Cancer Care Ontario) with strategies to improve participation for First Nations and Métis people and may inform cancer screening recommendations in these populations
Continued ICCU support for the Cancer Screening Fact Sheets, Toolkit, and awareness postcards/posters which were designed and tailored with and for each First Nation, Inuit and Métis population.
Cancer 101 Video: Ontario Health (Cancer Care Ontario) made this video for First Nations people. The video gives basic cancer information and answers many common questions about cancer. Other groups that helped make the video are CAREX Canada, the Occupational Cancer Research Centre and the Canadian Cancer Society.
The Screening Activity Report (SAR) is an online report, which provides screening data to help family doctors improve their cancer screening rates and appropriate follow-up. The report allows family doctors to quickly find specific cancer screening information for each patient, including those who are overdue or have never been screened. In June 2018, the SAR was expanded to the Sioux Lookout Zone, which consists of several First Nations communities, providing non-patient enrollment model physicians and nurses access to their community data. This SAR was developed specifically for the Sioux Lookout municipality and the 27 First Nation communities that reside in the Sioux Lookout Zone.
The ICCU continues to raise awareness with regional and community partners of medical transportation coverage available to eligible First Nations through the First Nations and Inuit Health Branch Non-Insured Health Benefits (NIHB) for breast cancer screening
The ICCU and Northwestern Regional Cancer Program in partnership with communities jointly plan community events to provide access to screening through a mobile screening coach in the North West region.
Through the relationships developed and fostered by the ICCU, regional teams have been able to continue working with communities as guided through the First Nations, Inuit, Métis and urban Indigenous Cancer Strategy

QC:

Intended Audience(s): First Nations, Inuit, and Métis

Strategies Used:

Mobile screening clinics
Providing transportation to screening services

Strategy co-developed with community: Yes

Description of activities to improve screening: n/a

NB:

Intended Audience(s): First Nations and Métis

Strategies Used:

Group education
Leverage learnings from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’

Strategy co-developed with community: Yes (Group education – based on invitation to participate, no for leverage learnings)

Description of activities to improve screening:

The program offers group presentations upon request from First Nations Communities based on education needs for targeted audience.
Plan to leverage the recommendations from the ongoing underscreening population project being conducted in NB.

NS: * NS: Due to the COVID-19 pandemic, health fairs at First Nations communities that the Patient Navigator would have attended, were cancelled.

Intended Audience(s): First Nations

Strategies Used:

Patient Navigator

Strategy co-developed with community: n/a

Description of activities to improve screening:

Patient navigator maintains community engagement with First Nations Health Directors.

PE:

Intended Audience(s): First Nations

Strategies Used:

Health fairs, social media ads, educational clinics,
Promotional items

Strategy co-developed with community: N/A

Description of activities to improve screening:

Participation in educational sessions (individually) at health fairs as well as group educational presentations
Reminder letters & recall letters

NL:

Intended Audience(s): N/a

Strategies Used: N/a

Strategy co-developed with community: N/a

Description of activities to improve screening:

Cancer Screening Program regularly presents to the FNIM initiatives
We are currently working on establishing a satellite breast screening centre -Labrador-Grenfell Health Region

6.3 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 target 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.

Table 22: Strategies to Improve Screening for Underserved Populations

NT:

Intended Audience(s):

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

Strategies used:

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)

Strategy co-developed with community: Yes

Description of activities to improve screening for underserved populations:

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, instgram)
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:

Intended Audience(s):

Racial or ethnic minorities
Non-English and Non-French Speakers
People with physical disabilities

Strategies used:

Translated and culturally safe materials
Engagement with community groups
Targeted media campaigns
Website
Printed materials

Strategy co-developed with community: N/a

Description of activities to improve screening for underserved populations:

BC Cancer Breast Screening is inclusive by featuring and targeting under-served communities in its materials and as part of its outreach strategy.

AB: *Current stage is funded by CPAC through the Developing Strategies for Underscreened Populations through Community Engagement grant.

Intended Audience(s):

Low-Income
Immigrants and refugees
Racial or ethnic minorities
Specific cultural groups
Non-English and Non-French Speakers

Strategies used:

Education (one on one and group)
Client invitation and reminders
Media (small and mass)
Provider assessment and feedback
Healthcare provider cultural competency training
Development of culturally safe materials and resources
Direct community engagement to co-design programs

Strategy co-developed with community: Yes (except for client invitation and reminders, and provider assessment and feedback)

Description of activities to improve screening for underserved populations:

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:

Intended Audience(s):

Low-Income
Immigrants and refugees
Rural and remote locations
People without a PCP

Strategies used:

No PCP needed to attend
Mobile unit to avoid unnecessary costs
Education sessions with new to Canada populations

Strategy co-developed with community: Yes

Description of activities to improve screening for underserved populations:

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:

Intended Audience(s):

Newcomers
Low income
Specific cultural groups
People with mental illness or physical disabilities

Strategies used:

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

Strategy co-developed with community: Yes

Description of activities to improve screening for underserved populations:

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:

Intended Audience(s):

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

Strategies used:

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

Strategy co-developed with community: N/A

Description of activities to improve screening for underserved populations:

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:

Intended Audience(s):

People without a primary care provider

Strategies used:

Voluntary Program PCP is assigned to the participant

Strategy co-developed with community: N/A

Description of activities to improve screening for underserved populations: N/A

NB:

Intended Audience(s):

People without a primary care provider
Specific geographic area
Immigrants and refugees

Strategies used:

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.

Strategy co-developed with community: Yes

Description of activities to improve screening for underserved populations:

Participants can call toll free screening line or go to the GNB website to access information on available clinics offering mammography to eligible women.
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: *Due to the COVID-19 pandemic, some pre-planned presentations at the Immigrant Services Association of Nova Scotia (ISANS) were cancelled.

Intended Audience(s):

Incarcerated women
New immigrants

Strategies used:

Education (group)

Strategy co-developed with community: N/A

Description of activities to improve screening for underserved populations:

The Patient Navigator attends a Wellness clinic every year at a federal women’s prison, and provides breast screening information to the inmates. She also educates the medical staff on how to request mammography screening for the inmates.
The Program Coordinator provides breast screening education to new immigrant women at the Immigrant Services Association of Nova Scotia (ISANS).

PE: * Utilize various translated materials to assist women with the mammography process

Intended Audience(s):

Cultural groups
Non-English speakers
Women without a PCP

Strategies used:

Translated materials

Strategy co-developed with community: n/a

Description of activities to improve screening for underserved populations:

Translated materials
Access to translation services
Women without PCP can access services
Updates pending for wheelchair access washroom
Larger changerooms with equipment updates

NL:

Intended Audience(s):

Low-Income
Immigrants and refugees
People with mental illness
People with physical disabilities
People who are houseless

Strategies used: N/A

Strategy co-developed with community: N/A

Description of activities to improve screening for underserved populations:

Ongoing work with Regional Health Authorities collaborative clinics for people without access to primary care etc.

6.4 Strategies to Improve Access to Screening for Rural and Remote Populations

Rural and remote populations face a variety of barriers in accessing preventative care, including higher travel times and costs and fewer available health resources, and thus are less likely to access or participate in cancer screening. Ten provinces and one territory have specific strategies which they employ to improve access to screening in these populations. Most of the strategies have been co-developed with the community, and many include mobile screening clinics.

Table 23: Strategies to Improve Access to Screening for Rural and Remote Populations

NT:

Strategies used:

Providing transportation to screening services
Provider reminders and recall systems
Patient navigation
Access to interpreter services

Strategy co-developed with community: Yes

Description of activities to improve screening for rural and remote populations:

Medical travel coordinated through the community health centres when mammography not offered locally
Recall systems in place at a local level,

BC:

Strategies used:

Mobile mammography vehicles

Strategy co-developed with community: N/A

Description of activities to improve screening for rural and remote populations:

Mobile mammography vehicles provide service to rural and remote populations. BC Cancer Breast Screening promotes these stops through social and traditional media, and digital advertising.

AB:

Strategies used:

Education (one on one and group)
Client mobile announcement letters
Media (small and mass)
Provider assessment and feedback
Mobile screening clinics
Patient navigation

Strategy co-developed with community: For Mobile screening clinics and Patient Navigation, Yes

Description of activities to improve screening for rural and remote populations:

Facilitated referral and provision of results to navigation program to ensure abnormal screens are followed up in timely manner.
Timed correspondence to mobile schedule.
Pilot nurse practitioner led integrated mobile screening services (mammogram, Pap, and FIT).

SK:

Strategies used:

Mobile unit

Strategy co-developed with community: Yes

Description of activities to improve screening for rural and remote populations:

Invitations sent to invite participant to closest screening location.

MB:

Strategies used:

Comprehensive letter campaigns
Informative web site
Accessibility – 2 mobile clinics, 4 fixed locations
Social media (Facebook) promoting mobile clinics
PCP booking request form for underscreened persons

Strategy co-developed with community: Yes

Description of activities to improve screening for rural and remote populations: n/a

ON:

Strategies used:

Mobile screening clinics

Strategy co-developed with community: Yes

Description of activities to improve screening for rural and remote populations:

Ontario has mobile screening coaches that offer cancer screening services including breast screening in the North West and Hamilton Niagara Haldimand Brant regions.

QC:

Strategies used:

Mobile screening clinics
Providing transportation to screening services

Strategy co-developed with community: N/A

Description of activities to improve screening for rural and remote populations:

Mobile screening clinics are transported by plane, train and boat to remote locations.

NB:

Strategies used:

Direct mailing of program invitation to eligible population
Awaiting results of Under-screened Population Project

Strategy co-developed with community: Yes (all but direct mailing)

Description of activities to improve screening for rural and remote populations:

Program invitation letters are mailed directly to participant regardless of area of residence.
Plan to incorporate recommendations from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’.

NS:

Strategies used:

Media (mass)

Strategy co-developed with community: N/A

Description of activities to improve screening for rural and remote populations:

The coordinator for the mobile van places radio ads about upcoming mobile breast screening dates and locations.

PE:

Strategies used:

Extended program hours

Strategy co-developed with community: n/a

Description of activities to improve screening for rural and remote populations:

Appointments available for evening & weekends

NL:

Strategies used: N/A

Strategy co-developed with community: N/A

Description of activities to improve screening for rural and remote populations:

Currently have a working group for the establishment of a satellite breast screening clinic in Happy-Valley Goose Bay (Labrador-Grenfell Health Region)

6.5 Strategies to Improve Screening for LGBTQ2S+ People

LGBTQ2S+ people may have additional barriers in accessing or participating in breast cancer screening, including stigma. Examples of LGBTQ2S+ may include gay or lesbian individuals, transgender people, non-binary people, two spirit people, as well as many other identities. Eight provinces have specific strategies which they employ to improve screening in these populations. Most of the strategies have been co-developed with the community. Inclusive language and specific screening guidelines and recommendations are two examples of common strategies used.

Table 24: Strategies to Improve Screening for LGBTQ2S+ People

Examples of LGBTQ2S+ audiences may include: gay individuals, transgender people, non-binary people, two spirit people, etc.

BC:

Intended Audience(s):

Transgender people

Strategies used:

Website
Printed materials
Provider education

Strategy co-developed with community: Yes

Description of activities to improve screening for LGBTQ2S+ people:

BC Cancer Breast Screening provides information and education about screening guidance for transgender persons.

AB:

Intended Audience(s):

People identifying as LGBTQ2S+
PCP of LGBTQ2S+ people

Strategies used:

Website
Printed materials
Provider education

Strategy co-developed with community: Yes

Description of activities to improve screening for LGBTQ2S+ people:

In early stages of engagement with representatives from LGBTQ2S+ communities to develop resources, appropriate inclusive language in correspondence, and supports for PCPs.
Exploring methods to modernize how sex/gender data collection can help inform appropriate screening engagement.

SK:

Intended Audience(s):

LGBTQ2S+

Strategies used:

Partnerships

Strategy co-developed with community: Yes

Description of activities to improve screening for LGBTQ2S+ people:

Partnership with OUT Saskatoon and Health Navigators to build more inclusive screening software.

MB:

Intended Audience(s):

LGBTQ2S+

Strategies used:

Inclusive guidelines

Strategy co-developed with community: Yes

Description of activities to improve screening for LGBTQ2S+ people:

Screening recommendations for trans men and women are published in our guidelines,
Inclusive language used in all materials and website
BreastCheck staff have participated in culture safety training regarding LGBTQ2S+ populations

ON:

Intended Audience(s):

Non-binary and gender diverse people
Ontario Health (Cancer Care Ontario) staff

Strategies used:

Overarching Policy for the Screening of Trans People in the Ontario Breast Screening Program and the Ontario Cervical Screening Program
Educational webinars

Strategy co-developed with community:

Advocates, experts, and community members with expertise in better serving the LGBTQ2S+ community in healthcare (e.g., Rainbow Health Ontario) were involved in the development of the policy
Delivered by Rainbow Health Ontario

Description of activities to improve screening for LGBTQ2S+ people:

In March 2019, Ontario Health (Cancer Care Ontario) released the Overarching Policy for Screening of Trans People in the Ontario Breast Screening Program and Ontario Cervical Screening Program. The policy contains 17 recommendations on screening eligibility, interval and method for trans people at average and increased risk of breast and cervical cancer. The policy can be found at: www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/61546. A plan to implement the policy recommendations is currently being developed.
Ontario Health (Cancer Care Ontario) is moving towards using gender-neutral language in screening products, wherever possible. Newly developed program resources in the Ontario Breast Screening Program will include gender-neutral and inclusive language (e.g., referring to “people” as opposed to “women”); older materials are in the process of being updated.
Ontario Health (Cancer Care Ontario) staff participated in webinars on better serving the LGBTQ2S+ community in healthcare and cancer screening (i.e., access, eligibility)

NB:

Intended Audience(s):

General public

Strategies used:

Inclusive language

Strategy co-developed with community: n/a

Description of activities to improve screening for LGBTQ2S+ people:

Reviewing and adapting program correspondence, materials and media for more inclusive language and images.

NS:

Intended Audience(s):

Transgender people

Strategies used:

Developed draft transgender screening guidelines.

Strategy co-developed with community: n/a

Description of activities to improve screening for LGBTQ2S+ people:

NSBSP plans to conduct focus groups to learn more about how to make breast screening more accessible to the transgender population.

PE:

Intended Audience(s): n/a

Strategies used: n/a

Strategy co-developed with community: n/a

Description of activities to improve screening for LGBTQ2S+ people:

Extended hours & evening appointments
All gender washrooms