One of the frustrating paradoxes of cancer-screening programs is that those who could benefit most are often the least likely to be tested.
In India, Pakistan, Bangladesh, and Sri Lanka, cervical cancer is one of the biggest killers of women. But among immigrants from these South Asian countries, barely 20 per cent of women undergo Pap tests to screen for cervical cancer.
By contrast, about 75 per cent of women in the general Canadian population get routine Pap tests.
“It’s a big gap, so we need to understand the barriers,” said Dr. Aisha Lofters, a family physician and clinician scientist in the department of family and community medicine at St. Michael’s Hospital in Toronto.
She is conducting research in Peel Region, just west of Toronto, which has one of the highest concentrations of South Asians in Canada.
Lofters said there are a number of cultural and practical barriers keeping women from being tested. These include a fatalistic attitude (the belief that cervical cancer is deadly when, in fact, it is one of the most easily treatable cancers if caught early), a common myth that cervical cancer affects only “promiscuous” women, a reluctance to undergo pelvic exams because of modesty (especially if the doctor is male), difficulty getting information in their own language, and simply not being able to find time to go for testing because of family and work responsibilities.
“The South Asian population in Peel is tremendously underscreened and therefore much more vulnerable to cancer death. This can be prevented,” Lofters said. “But we have to understand and address the barriers.”
Lofters said groups such as the Cancer Society – which sponsored the research – need to do a better job of reaching out to immigrant communities about the benefits of screening.
Arifa Muzaffar, CEO of the popular South Asian-language radio station WTOR 770, said what is essential is reaching out to women in their native languages, like Urdu and Punjabi.
“They have cancer brochures in many languages but that’s not enough,” she said. “In our community people get their information from the radio.”
Muzaffar said that, beyond basic education about the benefits of screening, cultural factors have to be considered and heeded.
“Let’s be clear: Our women prefer lady doctors for such things,” she said.
Sian Bevan, director of research at the Canadian Cancer Society, said the findings and interest from high-profile members of the community is encouraging.
“There’s not a single solution to dealing with lower screening rates,” she said. “But this type of research provides us with evidence that we can use to better serve the needs of all Canadians.”
In 2013, an estimated 1,450 Canadian women will be diagnosed with cervical cancer and 380 will die.