Jaimie Roebuck is a communications advisor at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital in Toronto.
One in eight. That’s the number of Canadian women estimated to develop breast cancer, according to the Canadian Cancer Society. This year alone, 28,600 will be diagnosed with the disease, representing 25 per cent of all new cancer cases in women across the country.
We know that early detection saves lives, yet breast cancer screening disparities still prevail. Muslim women, Black women, women with a BRCA mutation, transgender men and non-binary individuals make up much of the underscreened population.
International data reveals that Black women are 41 per cent more likely to die of breast cancer than white women. BRCA mutations predispose women to a higher lifetime risk of breast cancer – as much as 80 per cent – while a study at St. Michael’s Hospital in Toronto revealed that breast screening rates among patients who identified as trans were 33 per cent, compared with 65 per cent for cisgender women. And alarmingly, rates of breast screening are 11-per-cent lower among immigrant women from Muslim-majority countries in Ontario than among women from other countries.
In the pursuit of equitable care, we must take actionable steps to give every person every chance to beat breast cancer, and screening is an essential part of that process. Mammograms are critical for early detection, when breast cancer is at its most curable, and can lower the risk of dying from this disease. So when we apply a health equity lens to cancer screening and prevention, remove barriers to access and improve education among underscreened groups, we can help combat patient-, provider- and system-level barriers, enhancing equity and quality of care for all.
“We know that not everyone accesses screening equally, putting these groups at higher risk of later diagnosis and the subsequent consequences,” said Dr. Aisha Lofters, chair of implementation science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital. “As healthcare system providers, it’s our responsibility to seize any opportunity to promote equitable access to breast screening for all.”
Collectively, we need to work toward closing current disparities in routine examinations. Provincewide screening programs are important, but one size seldom fits all, particularly in healthcare. When we apply this approach, we fail to consider the unique backgrounds, experiences and needs of our diverse patient population. Screening gaps often stem from reasons that are multilayered and intersectional, including but not limited to access, health literacy, structural barriers and bias. Social determinants of health can significantly influence one’s ability to prevent, detect, treat and survive breast cancer; we cannot underestimate the role they play in shaping both health equity and health outcomes. Understanding and acknowledging the complexities of these determinants can catalyze action and change.
Research findings, data and evidence are also used to inform general cancer screening guidelines, but many people may fall outside these parameters. The Ontario Breast Screening Program encourages most eligible women, trans and nonbinary people aged 50 to 74 to get screened with a mammogram every two years; for those 30 to 69 who qualify for the High-Risk Ontario Breast Screening Program, screening is recommended every year with both mammography and breast magnetic resonance imaging. However, these guidelines do not always account for the individualized needs of different groups. For example, if those most vulnerable wait until age 50 to be screened, as is currently the provincial recommendation for average-risk individuals, it may be too late.
It’s important that patients speak with their primary-care provider about when and how to start getting screened based on their personal health histories. Screening and prevention reduce the morbidity and mortality of cancer, but system changes are needed to expand access to this crucial first point of care.
Prioritizing targeted outreach, coupled with education and direct engagement, can increase cancer-screening uptake among underscreened groups. As we gradually emerge from the pandemic, we have an opportunity to reimagine and reform our healthcare system. By reducing breast cancer-related health inequities, we can help build a stronger healthcare system for all.
For those eligible – based on provincial programs or heightened susceptibility – the time for screening is now. Every breast, everywhere, matters.
Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.