The COVID-19 pandemic has deepened health disparities in breast and colorectal cancer screening in Ontario. That’s according to new research from a team led by a Women’s College Hospital researcher.
The findings also highlight the role family medicine plays in cancer screening uptake and how increasing access to team-based primary care could improve screening rates, especially among some marginalized communities.
“We were aware that immigrants and those living with low income were less likely to be up to date on breast, cervical and colorectal screening before the COVID-19 pandemic. But it was unclear what impact, if any, the pandemic had had on these disparities,” says Dr. Aisha Lofters, Medical Director and Chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital and first author on the paper.
Cancer screening services were halted in the early days of the pandemic, leading to a backlog in cancer screening. Primary care providers in Ontario were encouraged to consider prioritizing people who had not had regular screenings or had never been screened for cancers when services resumed.
But as Dr. Lofters notes, “It’s possible that barriers to screening, such as a lack of knowledge or effective communication, were heightened during the pandemic for those already underrepresented. With this study, we wanted to find out if changes in screening from the pre-pandemic era to the current day varied by income or immigration status.”
To do this, researchers carried out a population-based cross-sectional study, first figuring out the screen-eligible population for breast, cervical and colorectal cancers. Next, they looked at whether the eligible population was up to date on screenings at two different points in time, March 31, 2019, and March 31, 2022.
The study, published in JAMA Network Open, found that overall, the number of people up to date for screening in Ontario decreased across all three cancer types, while screening uptake for people living in low-income neighbourhoods and for immigrants dropped significantly for both breast and colorectal screening.
Researchers also found that the lowest screening rates, both pre and post-pandemic, were for people who did not have family doctors. While patients of interprofessional team-based primary care models had significantly smaller drops in post-pandemic screening compared to other primary care patients.
Examples of team-based primary care in Ontario include Community Health Centres. These non-profit organizations provide primary care and health promotion services to patients and communities, with a focus on people experiencing marginalization. These teams typically include doctors, nurse practitioners, social workers, dietitians and other allied health staff. However, they serve only 2 per cent of the province’s population and have traditionally been least available in areas where the need is greatest. Another example of team-based care is Family Health Teams, such as the Women’s College Hospital Family Practice Health Centre.
“Our findings suggest that not only access to primary care but the type of primary care model that people have access to will play a crucial role in cancer screening recovery post-pandemic, says Dr. Lofters. “In interprofessional teams, non-physician providers may play a role in identifying patients overdue for screening, screening outreach, screening education, and performing or ordering screening tests.”
Dr Lofters argues that the study’s findings make a compelling argument for expanding access to such interprofessional primary care teams to increase cancer screening uptake province-wide.
“Policymakers should investigate the value of prioritizing and investing in improving access to team‐based primary care,” she says, “however, any such efforts must centre on health equity, prioritizing immigrants and people living with low income.”