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Ontario Cancer Facts

Less Breast Screening in Areas with a High Concentration of First Nations People

Oct 2017

Highlights

 

  • Areas with a high First Nations concentration have lower participation in breast cancer screening than other areas in Ontario.
  • First Nations women are often diagnosed with breast cancer at a later stage than other women in Ontario.
  • Limited access to healthcare, strained patient–provider communication and limited access to cancer screening sites are major barriers for cancer screening among First Nations.

 

In areas with a high concentration of First Nations people, breast cancer screening participation is significantly lower than in all other areas of Ontario. These high concentration areas are census areas where at least 33% of the population has identified as Aboriginal, most of whom are First Nations.

In 2013–2014, 56% of screen-eligible women in areas with a high concentration of First Nations people had a mammogram in the previous 30 months, compared to 65% of women in other areas. Although participation in breast cancer screening varied by age, in high concentration areas participation was lower than in other areas across all age groups. Among women living in high concentration areas, the lowest participation was in women ages 50 to 54 (49%) and the highest was in women ages 65 to 69 (63%).

Data source: Ontario Health Insurance Plan Claims History Database, Integrated Client Management System, Ontario Cancer Registry, Registered Persons Database, Postal Code Conversion File Plus.
Notes: Areas with high concentration of First Nations are census dissemination areas where 33% or more of the total population self-identified as Aboriginal and where the most prevalent Aboriginal identity was First Nations. Screen-eligible women include women betwen the ages of 50 and 74.
95% confidence limits. Overall estimate is age-standardized to the age distribution of the 2011 Canadian population.

Percentage of screen-eligible women who completed at least one mammogram within a 30-month period, by age and area of residence, 2013–2014
Age group Estimate for breast screening participation in areas with high concentration of First Nations people 95% Lower confidence limit for breast screening participation in areas with high concentration of First Nations people 95% Upper confidence limit for breast screening participation in areas with high concentration of First Nations people Estimate for breast screening participation in areas with high concentration in other areas in Ontario 95% Lower confidence limit for breast screening participation in other areas in Ontario 95% Upper confidence limit for breast screening participation in other areas in Ontario
50–74 56 55.5 57.5 65 64.8 64.9
50–54 49 47.6 51.3 62 61.5 61.8
55–59 59 57.0 60.9 66 65.9 66.2
60–64 62 59.3 63.7 68 68.1 68.4
65–69 63 60.1 65.2 69 68.7 69.0
70–74 51 47.6 53.6 58 58.1 58.5

This analysis was based on census area (as opposed to individuals) because there are no First Nations identifiers in most health administrative databases, making it challenging to fully understand cancer screening practices in First Nations people.

Breast cancer screening has been associated with improved breast cancer survival. Screening can detect cancer at an earlier stage, when it is easier to treat. Previous research has found that First Nations women are more likely to be diagnosed with breast cancer at a later stage (stage II or higher) than non-First Nations women, and more likely to be diagnosed with a cancer detected by themselves, a physician or another health professional rather than through breast screening. These findings are consistent with the finding of lower breast cancer screening participation in areas with a high concentration of First Nations people. Efforts are needed to help improve access to and participation in breast cancer screening for First Nations women, especially among those living on-reserve.

Investigators of a forthcoming research study led by Cancer Care Ontario in partnership with Wequedong Lodge of Thunder Bay and Sunnybrook Research Institute have identified several barriers to cancer screening in areas with a high concentration of First Nations populations in northwestern Ontario. A lack of awareness of cancer screening among First Nations community members and limited culturally relevant educational resources were identified as key concerns. Furthermore, participation in cancer screening can be difficult due to the combination of limited access to healthcare providers in rural and remote First Nations communities and other health issues that may take priority when providers are available. Strained patient–provider communication and relationships, as well as limited trust in healthcare providers, are also significant challenges. Limited physical access to cancer screening sites is another major barrier to screening because community members must often make long trips to the health centres where the appropriate equipment and expertise is available. These health centres are located far away from the home communities of First Nations people and also often lack critical social supports to help guide them through screening processes.

Through this research study, recommendations are being developed to improve access to and participation in cancer screening among First Nations people in Ontario, and several initiatives aimed at tackling the many challenges surrounding this issue are already underway. Cancer Care Ontario’s Aboriginal Cancer Control Unit has developed cancer and cancer screening education resources geared towards First Nations communities, and will soon be launching a revised set of Aboriginal Relationship and Cultural Competency e-learning courses. The Screen for Life Coach—a bus that provides breast, cervical and colorectal cancer screening services—is another initiative aimed at improving access to cancer screening. In the North West region, the coach travels to rural towns and First Nations communities to help increase screening participation. These resources will help improve access to cancer screening, as well as increase education to support informed, engaged and safe screening participation.