CSCC Priority 1 CSCC Priority 1 Priority 1: Decrease the risk of people getting cancer Action 1 Help people to stop smoking or not start in the first place and live healthier lives Keeping people smoke-free Maintaining healthy body weight placeholder text Action 2 Adopt proven practices known to reduce the risk of cancer Increasing HPV vaccination Implementing HPV screening for cervical cancer Increasing genetic testing placeholder text Action 3 Action 3 action 3 subtitle placeholder text See detail for: Overview British Columbia Alberta Saskatchewan Manitoba Ontario Quebec (Not Ready) New Brunswick Nova Scotia Prince Edward Island Newfoundland and Labrador Northwest Territories (Not Ready) Nunavut (Not Ready) Yukon (Not Ready) Keeping people smoke-free Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. See the technical specifications for more details. Also, references for the Canada-wide information are also available. Why we are focusing on smoking rates Smoking causes 45,000 deaths in Canada each year, 16,000 of them from lung cancer.1 Quitting smoking is the single most important thing someone can do to reduce their risk of cancer and other chronic diseases.1 Smoking rates in Canada have steadily decreased as a result of comprehensive commercial tobacco control efforts. Currently, 15 per cent of people (4.7 million people) smoke—the lowest rate to date. Smoking is more common among males (17.3 per cent among males, 12.3 per cent among females) and young adults.2-4 The likelihood of someone smoking is related to social determinants of health and other factors, including the influence of the tobacco industry. People who experience health inequities are likely to face more barriers to quitting and require additional supports. Smoking is more common among people with lower levels of education and income and LGBTQ2S+ people.4 For many First Nations and Métis, traditional or sacred tobacco is used in ceremonial or sacred rituals for healing and purifying and is highly revered. However, commercial tobacco (e.g., cigarettes) was introduced after European contact and its use has become widespread: 37 per cent of First Nations individuals living off-reserve smoke (either daily or occasionally), as do 55 per cent of Inuit and 32 per cent of Métis.5-7 14 per cent of people with cancer smoke, similar to the rate in the general population.8 For people diagnosed with cancer, quitting can improve effectiveness of treatment and likelihood of survival.1 Smoking cessation support is now offered in 87 per cent of cancer care centres across the country.9 Smoking costs the Canadian economy a total of $16.2 billion each year, including $6.5 billion in direct healthcare costs.10 What we want to achieve Canada’s smoking rate reduced to five per cent of the population (or lower) by 2035,11 through strategies that: Protect people from exposure to commercial tobacco smoke Warn people about the dangers of commercial tobacco (which can include smoking or chewing tobacco) Enforce bans on tobacco advertising, promotion and sponsorship Encourage people to stay smoke-free by increasing taxes on cigarettes and other tobacco products Offer people help to quit using commercial tobacco Ensure equity in access to culturally safe smoking cessation supports for First Nations, Inuit and Métis Address the underlying mental health concerns of people who smoke What this would mean for people in Canada If Canada achieves the national target of reducing the percentage of the population that smokes to five per cent by 2035, there could be: 31,000 fewer people diagnosed with lung cancer12 20,000 fewer people dying from lung cancer12 Reducing and preventing smoking will lower the number of future cancer cases, including bladder, breast, cervical, colorectal, esophageal, kidney, liver, lung, ovarian, pancreatic, stomach and ureter cancers.13 Maintaining healthy body weight Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. See the technical specifications for more details. Also, references for the Canada-wide information are also available. Why we are focusing on obesity rates 7.2% of all incident cancers can be associated with excess body weight.14 By 2042, it will be the second leading preventable cause of cancer in Canada.10 Excess body weight is associated with increased risk of a number of cancers, including cancer of the liver, kidney, esophagus and stomach.15 In Canada, more than one in two adults and one in five youth (age 12-17) are overweight/obese.16 Obesity is complex, and people often experience stigma and negative societal messages related to body image. Many factors contribute to excess body weight. For example: If people do not have access to affordable, nutritious and culturally appropriate food; If people do not have sufficient cooking skills, knowledge, and time to cook; If neighbourhoods are not designed to support walking and biking and other forms of physical activity; and If people do not have affordable, convenient and safe opportunities for physical activity. For First Nations, Inuit and Métis, the lasting effects of colonialism have led to inequities in social determinants of health (e.g., food security, access to safe and healthy physical environments), which in turn contribute to higher rates of obesity.17-19 Where people live, learn, work and play appears to have a great deal to do with how active they are. One in two people in Canada remain sedentary during their leisure time (3-6 hours) every day—which is linked with having excess body weight.20,21 What we want to achieve People empowered to live healthier lives by making healthy choices the easiest choice Governments make healthy living easier for all people in Canada through policies that:22 Make the environments where children live, learn and play more supportive of physical activity and healthy eating Identify the risk of obesity in children and address it early Increase the availability and accessibility of nutritious foods and decrease the marketing to children of foods and beverages that are high in fat, sugar or sodium Underlying mental health concerns that lead to overeating and excess body weight (e.g., depression, eating disorders, anxiety and substance use) addressed by improving access to mental health services23 What this would mean for people in Canada 110,000 fewer cases of cancer by 204224 if more Canadians have a healthy body weight Up to 4,000 fewer cancer cases by 204221 if Canadians reduce their leisure-time sedentary behaviour by 50 per cent Keeping people smoke-free Where we are today Percentage of individuals (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey Click here to see all data and data limitations, including any additional stratifications. Our goal Work toward achieving Canada’s Tobacco Strategy goal of less than 5% of the population using tobacco by 2035. Continue to reduce the proportion of British Columbians who smoke. Increase the number of British Columbians participating in smoking cessation programs. Current situation In 2020, all six cancer centres in British Columbia offered outpatients support to quit smoking, including culturally appropriate supports for First Nations, Inuit and Métis patients with cancer. Approximately 11% of British Columbians aged 12 or older report they smoke daily or occasionally. The prevalence of smoking in British Columbia is lower than the national average. The BC government has a Smoking Cessation Program to support residents who want to quit smoking. New efforts The BC Cancer Smoking Cessation Program offers the following smoking cessation support to ambulatory patients with cancer: Patients are screened for smoking status on intake forms. Nurses follow up with patients who smoke, advise them of the benefits of quitting and refer patients to the provincial quitline, QuitNow, for cessation services. Free nicotine replacement therapy (NRT) is available for all residents, and subsidized smoking cessation prescription medications are available to eligible residents. Indicator: Percentage of individuals (aged ≥ 12) classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of people living with obesity or overweight (aged ≥ 18) Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey Click here to see all data and data limitations, including any additional stratifications. Our goal Reduce the risk of cancer by creating supportive environments for healthy eating and physical activity/active living. Create social and environmental conditions that lead to improved health and well-being for all children and youth, while also reducing vulnerabilities, risks and health disparities. Support healthy behaviours through building knowledge about healthy choices and creating supportive environments for physical activity, healthy eating and positive mental health. A healthy weight is one that contributes to your overall health, well-being and quality of life. It is different for each individual. Your weight is not simply a result of what you eat or how active you are. Genetics, health conditions, stress, sleep quality and other factors can also influence your weight. Current situation British Columbia generally has lower rates of people self-reporting living with overweight or obesity compared to the Canadian average. Child Health BC, the BC Ministry of Health and the Canadian Obesity Foundation have developed British Columbia’s Continuum for the Prevention, Management, and Treatment of Health Issues Related to Overweight and Obesity in Children and Youth. The BC Government’s HealthLinkBC website helps British Columbians find the resources they need on healthy eating, remaining physically active and maintaining a healthy weight. New efforts In British Columbia, there are currently multiple efforts to create supportive environments that increase access to physical activity and healthy eating where children live, learn and play. Indicator: Percentage of people living with obesity or overweight (aged ≥ 18) Keeping people smoke-free Where we are today Percentage of individuals in AB (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Notes: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Work toward achieving Canada’s Tobacco Strategy goal of less than 5% of the population using tobacco by 2035. Current situation Alberta Quits (www.albertaquits.ca website and Helpline) supports people trying to reduce or quit commercial tobacco use. Cancer patients are offered smoking cessation supports. The Keep Tobacco Sacred Collaborative is led by First Nations and identifies culturally safe approaches for commercial tobacco prevention and cessation. The Tobacco and Vaping Reduction Act was passed in Alberta. The QuitCore group offers cessation services to adults within Alberta and has specific offerings for individuals with cancer, as well as a culturally-based approach with the Métis Nation of Alberta. The QuitCore program offers people with BlueCross cards up to $500 of coverage for medications such as nicotine replacement therapy and other prescriptions to help with tobacco cessation. New efforts Work is underway to include quitting smoking as part of routine cancer screening. The Tobacco, Vaping and Cannabis Program of Alberta Health Services offers culturally safe cessation supports. Indicator: Percentage of individuals who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals (aged ≥ 18) classified as overweight or obese Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Support adult Albertans who are not achieving moderate to vigorous aerobic physical activities on most days of the week (at least 150 minutes per week) to start and maintain an active lifestyle. Evidence shows that participating in regular physical activity and reducing sedentary behaviour can help to prevent chronic diseases, including obesity. Current situation Albertans with higher income are more likely to have excess body weight than those with lower incomes, and men are more likely to have excess body weight than women. New efforts Coming soon. Indicator: Percentage of individuals (aged ≥ 18) classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals in SK (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Notes: This indicator was reported using the Canadian Community Health Survey (CCHS). Overall smoking rates are reported using 2020 data. Individuals who did not respond to the required CCHS questions regarding smoking status were not included in the analysis. The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal A provincial goal has not been set. Canada’s Tobacco Strategy has a goal of less than 5% of the population using tobacco by 2035. Current situation The Northern Healthy Communities Partnership’s Northern Tobacco Strategy gathers a network of organizations working to improve the health of northern Saskatchewan residents by building environments that are resistant to commercial tobacco through education and awareness in school and community settings. The Northern Inter-Tribal Health Authority’s Northern Saskatchewan Breathe Easy initiative helps reduce commercial tobacco use. The Saskatchewan Prevention Institute educates on the risks of second-hand smoke and smoking during pregnancy. Community pharmacists can prescribe smoking cessation aids. People with cancer can be referred to a community pharmacist or Quitline for cessation support. Nicotine replacement (e.g., nicotine gum, patches) is available to cancer patients for free. LungSask delivers lung health and commercial tobacco education and awareness messaging for a variety of audiences, alongside facilitating smoking cessation support groups. Canadian Cancer Society’s Talk Tobacco quit-line provides specific cessation support for First Nations and Métis, alongside their other cessation supports, such as the Smoker’s HelpLine, and education and awareness campaigns. Cancer patients are being offered virtual smoking cessation counselling during the pandemic. New efforts The Saskatchewan Cancer Agency is currently focused on developing a provincial lung cancer screening program. Throughout the development of a provincial lung cancer screening program, a component of program development will focus on increasing community outreach and strengthening current cessation efforts in the province. Indicator: Percentage of individuals who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in SK (aged ≥ 18) classified as overweight or obese Data source: Canadian Community Health Survey Notes: This indicator was reported using the Canadian Community Health Survey (CCHS) and is based on self-reported data. Overall obesity and overweight percentages are reported using 2019 data. Percentages by income quintile and/or sex are reported using 2017-2018 data. Individuals who did not respond to the required CCHS questions to derive the BMI classifications were not included in the analysis. The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal A provincial goal has not been set. The national goal is to improve population health and wellness by promoting healthy weights and reducing obesity. Current situation Healthy food choices must be available in schools and group homes in Saskatchewan. There are policies to support the marketing of local fruits and vegetables. Saskatchewan has a variety of initiatives and policies to encourage physical activity. The Northern Healthy Communities Partnership (NHCP)’s Healthy Eating and Active Communities Teams work with northern communities to promote physical activity and healthy food environments. Indicator: Percentage of individuals who are classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Notes: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal CancerCare Manitoba (CCMB): Reinvigorate cancer prevention efforts and increase the number of non-smokers in Manitoba. CCMB programs will focus on public awareness and understanding of modifiable cancer risk factors. Province of Manitoba: Prevent youth from taking up tobacco products, protect Manitobans from second-hand smoke, support people who want to quit smoking, de-normalize tobacco products and their use to eventually move towards a province free of lung disease caused by first or second-hand smoking. Current situation CancerCare Manitoba (CCMB): The Quit Smoking Program (QSP) has been available at CCMB since January 2012. The program provides personalized tobacco cessation support to patients, staff and family members of patients and staff. The program is free-of-cost and includes the provision of individual counselling, assessment, on-going support and relapse prevention activities, education, and access to smoking cessation aids such as nicotine replacement therapy and cessation medications for as long as needed. Cultural competency training is completed by all QSP staff and staff respect the role of sacred tobacco. Strengthening our program, we have completed some outreach work at the Kivalliq Inuit Center (a housing agency for Inuit who travelled to Winnipeg for cancer treatment). Recent analyses have shown survival benefits and lower overall healthcare costs associated with becoming a QSP participant after a cancer diagnosis in Manitoba. Overall, the CCMB QSP contributes to the overall reduction of smoking rates in Manitoba. Province of Manitoba: Manitoba’s smoking rates are consistent with the national average. While we did observe a decrease in smoking rates during the pandemic, we suspect this is largely due to the lower response rate during that time. We predict 2022 rates will match pre-pandemic levels. The percentage of people who smoke was generally higher for people with lower income as compared to higher income. Please see supplementary data. An education gradient was observed for smoking rates in both males and females. For example, the smoking rate was highest for those with less than a secondary school education and decreased with higher levels of education. Please see supplementary data. The highest smoking rates for both males and females were found in the lowest income quintile. Please see supplementary data. Individual or group smoking cessation assistance is available in Northern & Prairie Mountain Regional Health Authorities (RHAs) (The Tobacco Dependence Program in Brandon). The Winnipeg RHA offers a free course on techniques to stop smoking called “Commit to Quit” (available to all) and a “Pulmonary Rehabilitation Program,” which offers free smoking cessation support for people with lung disease. Manitoba’s Non-Insured Health Benefits Program (NIHB) provides eligible First Nation and Inuit clients with free smoking cessation products. Manitoba Tobacco Reduction Alliance (MANTRA) and Manitoba Lung Association act as coordinators for tobacco reduction activities in Manitoba. Our Own Health Centre offers group and individual smoking cessation counselling for the 2SLGBTQ+ community. Talk Tobacco is a free smoking cessation support program for First Nation, Inuit, Métis and urban Indigenous communities. Though this is a Canada-wide program, a Manitoba-based coordinator is part of the core team. The Tobacco Quit Card and Counselling Program is managed by Shared Health and provides nicotine replacement therapy (NRT) to low-income Manitobans who have no other coverage options for NRT, and counselling sessions to help them quit smoking. Up to $300 in NRT support is provided to participants and is delivered through primary care. The Quit Smoking with your Manitoba Pharmacist Social Impact Bond is a three-year program that offers Manitobans support to quit smoking through their local pharmacist with counselling sessions and a $100 subsidy for smoking cessation products. New efforts CCMB: To maintain ongoing awareness about CCMB’s QSP, resources are made available in all CCMB waiting rooms (TV/posters/brochures/business cards), through the CCMB Community Oncology Program or via a toll-free number to ensure equal access across the province. Pre-implementation for a lung cancer screening program is currently underway to support smoking cessation counselling and low-dose CT scans for the eligible population. This includes efforts to build educational opportunities for staff related to Certified Tobacco Educator training. CCMB monitors numerous cancer-related indicators via its System Performance reports. These provide trends-over-time for various cancer risk factors (including smoking) and inform CCMB’s public messaging. Indicator: Percentage of individuals who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals (aged ≥ 12) classified as overweight or obese Data source: Canadian Community Health Survey Notes: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal CancerCare Manitoba (CCMB): Raise public awareness that excess weight, lack of access to healthy foods and a sedentary lifestyle are cancer risk factors. Future programs will also target high risk populations in Manitoba that experience higher rates of obesity. Current situation Province of Manitoba: Dial-a-Dietician is a Manitoba-wide service that connects individuals to a registered dietician. The service is available in French, English and numerous other languages (via over-the-phone interpreters). The Winnipeg Regional Health Authority Metabolic and Bariatric Surgery Program was established in 2012 and is available by referral to eligible Manitobans whose BMI falls between 40-55, or 35-40 if pre-existing health conditions exist. The Wellness Institute (Seven Oaks Hospital) in Winnipeg offers a clinically managed in-person “Weight Loss Clinic” and most recently an online “Weight Loss for Health” program. New efforts CCMB: CCMB monitors numerous cancer-related indicators via its system performance reports. These provide trends-over-time for various cancer risk factors (including obesity) and inform CCMB’s public messaging. CCMB Prevention & Screening is developing a public education campaign about modifiable risk factors of cancer. The campaign includes the primary message, “Maintain a healthy weight,” to address the role of obesity in cancer. This campaign and associated education materials are in both English and French. CCMB hosts webinar events on modifiable cancer risk factors, including excess weight and sedentary lifestyle. Indicator: Percentage of individuals who are classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals (aged ≥ 12) in ON classified as daily or occasional smokers in 2019 Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Screen 70% of people diagnosed with cancer to examine current tobacco use.* Support people with cancer who use tobacco by having 28% accept a referral for smoking cessation support.* Protect people in Ontario, especially children and youth, from the harmful effects of smoking, vaping, and nicotine. *These targets have been lowered in an effort to support regional cancer centres as they adjusted their resources to respond to the COVID-19 pandemic. Current situation The percentage of daily or occasional smokers was slightly lower in Ontario compared with the Canadian average. The percentage of people who smoke was generally higher for people with lower household income compared to those with higher income. The percentage of people who smoke was highest for those with less than a secondary school education level and decreased with higher levels of education (such as secondary and post-secondary). The percentage of people who smoke was higher for males compared to females across all income levels and levels of education. Regional cancer centres offer on-site or community-based smoking cessation support for people newly diagnosed with cancer. Smoking and vaping cessation services are provided by the Ministry of Health through the Centre for Addiction and Mental Health, Canadian Cancer Society, Lakehead University, University of Ottawa Heart Institute and Health811. Tobacco, cannabis, e-cigarettes, vaping and vaping-related illnesses are monitored by the Ministry of Health to assess how their use may impact addiction. The government took urgent action to address the issue of youth vaping. As of January 1, 2020, the Smoke-Free Ontario Act prohibits the promotion of vapour products in retail establishments that are not specialty vape stores or cannabis retail stores. Specialty vape stores and cannabis retail stores are only open to people aged 19 years and over. As of July 2020, The sale of flavored vapour products (except for menthol, mint and tobacco flavours) is limited in places other than specialty vape or cannabis retail stores. The sale of products with high amounts of nicotine is limited in places other than specialty vape stores. Specialty vape stores must ensure that the display and advertising for their products are not visible from the outside of the store. New efforts Smoking cessation programs in regional cancer programs are expanding beyond new ambulatory patients to include new audiences and new settings. Patient-reported smoking cessation outcomes will be evaluated. The Ministry of Health is also pursuing the following non-regulatory measures to address the issue of youth vaping: Health811 offers services to help people quit vaping. Ensuring online retailers will only sell vapour products to people aged 19 and above. Mental health and addiction services will help with vaping and nicotine addictions. Indicator: Percentage of individuals (aged ≥ 12) in ON who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in ON (aged ≥ 18) classified as overweight or obese Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Reducing obesity will be achieved by encouraging healthy eating, physical activity, addressing sedentary behaviours and the built environment. Current situation The percentage of people classified as overweight or obese was the same in Ontario and Canada. The percentage of people classified as obese or overweight was higher for males compared to females. The percentage of males classified as obese or overweight was higher for males with higher household income compared to those with lower income. The percentage of females classified as obese or overweight was higher for females with lower income compared to those with higher income. The Local Food Act encourages local food production and supports marketing of local fruits and vegetables. Health Connect Ontario is available to provide healthy eating information. The Healthy Menu Choices Act, 2015 requires that calories are displayed on menu boards in regulated food premises to allow people to make healthy decisions. Nutrition standards have been set for food and beverages sold in schools. Schools provide elementary students with at least 20 minutes of physical activity each day. Nutritious foods are offered to school-aged children and youth during breakfast and lunch through the Student Nutrition Program. Long-term care homes are required to provide food according to Canada’s Food Guide. New efforts The Ministry of Health intends to capitalize on lessons learned and investments made during the COVID-19 pandemic to inform chronic disease prevention policies and programs. Indicator: Percentage of individuals (aged ≥ 18) classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals in NB (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Notes: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal The vision of New Brunswick’s Tobacco-Free Living Strategy 2019-2023 is a tobacco- and smoke-free province. Enhance tobacco control efforts in NB, by increasing the number of people who quit smoking through cessation. Current situation Horizon Health Network is strengthening tobacco cessation programs in outpatient cancer centres by improving access and delivery of evidence-based clinical smoking cessation support for cancer patients. Regional Health Authorities (Vitalité Health Network and Horizon Health Network) continue to facilitate and strengthen implementation of the Ottawa Model for Smoking Cessation. The percentage of youth who report daily or occasionally smoking is continuing to decline, although the percentage of youth who are susceptible to try cigarette smoking is increasing. Nicotine vaping has increased among non-smokers, youth and young adults. Studies have shown that youth who vape are four times more likely to start smoking cigarettes. Smoking is the leading risk factor of lung cancer and the primary cause of chronic obstructive pulmonary disease (COPD). Smoking is causally linked to 12 different types of cancer and is the only risk factor common to the top four noncommunicable diseases. New Brunswick’s Tobacco-Free Living Strategy (nbatc.ca) was developed to support and enhance tobacco control efforts in NB. One of the goals is to increase the number of people who quit smoking through cessation. New Brunswick’s Tobacco-Free Living Strategy aligns its efforts with and contributes to Canada’s Tobacco Strategy. New efforts In an effort to increase compliance, vapour shops require a licence to operate as of April 1st, 2022. The sale of all flavoured vaping products is banned as of September 1, 2021 to reduce their appeal to youth. New Brunswick’s telephone-based cessation support service will offer easier access through chat, text and an enhanced website. Indicator: Percentage of individuals in NB (aged ≥ 12) classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in NB (aged ≥18) classified as overweight or obese Data source: Canadian Community Health Survey Notes: In 2019, 74.5% of New Brunswickers 18 and older were classified as overweight or obese, one of the highest rates in Canada. The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Improve population health and wellness by promoting healthy weights and reducing obesity. Current situation New Brunswick’s Wellness Strategy provides a comprehensive framework for action on the determinants of health and promoting wellness in New Brunswick. Rates of obesity in New Brunswick are among the highest in Canada. Social supports, income, education and early life experiences are some of the determinants that influence population health. New efforts Work is underway to review and renew of New Brunswick’s Wellness Strategy and the Healthy Families, Healthy Babies program. New Brunswick is working to implement the Baby-Friendly Initiative best practice Efforts are being made to partner with other Government of New Brunswick departments to promote healthy food policies and programs. Indicator: Percentage of individuals in NB (aged ≥18) classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals in NS (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Notes: This indicator was reported using the Canadian Community Health Survey (CCHS). Individuals who did not respond to the required CCHS questions regarding smoking status were not included in the analysis. The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Cancer Care Program perspective: Alignment with the Pan-Canadian Action Framework for Tobacco Cessation in Cancer Care. Culturally appropriate cessation support programs are accessible and meet the needs of First Nations in Nova Scotia. Cessation aids such as pharmacotherapy and Nicotine replacement therapy (NRT) are free and accessible to all people in Nova Scotia. Lung cancer screening has sustained evidence-based tobacco cessation support embedded into the program. Current situation Cancer Care Program perspective: Nova Scotia Health Cancer Care Program’s tobacco cessation policy embeds the Ask, Advise and Act model to screening, advising and referring new patients to evidence-based cessation support. Full implementation of the policy has been impacted by the pandemic and continues to be a work in progress. A quality improvement project on the provision of free nicotine replacement therapy has been approved and is in progress at the Cape Breton Cancer Centre. Smoke-Free Nova Scotia continues to actively advocate for tobacco control policy. Nicotine concentration in e-liquids is capped at 20 mg/mL. Flavoured e-cigarette products were banned April 1, 2020. Taxes have been increased on both vaping devices and e-liquid products. New efforts Cancer Care Program perspective: The Nova Scotia Cancer Care Program is implementing the Tobacco Cessation in Cancer Care Policy. Nova Scotia will achieve “Our goal” through collaborative action with key partners such as Smoke-Free N.S., The Mi’kmaq Cancer Care Strategy, Department of Health and Wellness, Tobacco-Free N.S., Primary Health Care, and Mental Health and Addictions. The Nova Scotia Community Cancer Matrix data will inform opportunities for targeted tobacco control interventions, ensuring a focus on health equity. The Cancer Prevention Potential in Atlantic Canada research project has received funding and will build on the NS Community Cancer Matrix providing insight into risk factors at the level of community environs in each of the four Atlantic provinces. The Nova Scotia Health Cancer Care Lung Screening Program will launch in 2023. Smoking cessation support is a core element of this program. Nova Scotia Health Cancer Care Program will work towards the sustained provision of nicotine replacement therapy for patients with cancer as defined in the Action Framework for Tobacco Cessation in Cancer Care. The goals for smoking reduction are provided from the perspective of the Nova Scotia Health Cancer Care Program (NSH CCP). Initiatives mentioned in “Current situation” and “New efforts” are examples of initiatives the NSH CCP is aware of and is not a complete list of initiatives occurring throughout the province by other organizations. Indicator: Percentage of individuals in NS (aged ≥ 12) who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in NS (aged ≥ 18) classified as overweight or obese Data source: Canadian Community Health Survey Notes: This indicator was reported using the Canadian Community Health Survey (CCHS). Individuals who did not respond to the required CCHS questions to derive the BMI classifications were not included in the analysis. The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Cancer Care Program perspective: Integrate exercise programming as the standard of care for people with cancer and survivors. Current situation Cancer Care Program perspective: Unhealthy foods are limited in schools to encourage healthy eating among children. Nova Scotia has a policy that supports marketing of local fruits and vegetables. Let’s Get Moving Nova Scotia is an action plan to create a more active, inclusive and healthier population. The Nova Scotia Alliance for Healthy Eating and Physical Activity is in the process of establishing priorities and action plans for the future. UpLift is a partnership which supports the wellbeing of students, through health promotion within schools. Research into the development of population health indicators is underway through the Dalhousie Population Health Institute. Charting the Course, the Primary Health Care Wellness, Chronic Disease Prevention and Management Strategy has just been completed. This integrated strategy identifies shifting the focus to wellness, risk factor management and chronic disease prevention for all Nova Scotians as one of four aims. New efforts Cancer Care Program perspective: The Nova Scotia Community Cancer Matrix research project will inform opportunities for targeted community-level interventions ensuring a focus on health equity. The Prevention Potential in Atlantic Canada research project will measure how cancer risk may relate to a community SES profile and prevalence of cancer modifiable risk factors across communities in Atlantic Canada including 300 in Nova Scotia. Work is underway to align the ACCESS/EXCEL programs and Let’s Get Moving programs to enhance access to care for Nova Scotians living with cancer. The goals for reducing obesity are provided from the perspective of the Nova Scotia Health Cancer Care Program (NSH CCP). Initiatives mentioned in “Current situation” and “New efforts” are examples of initiatives the NSH CCP is aware of and is not a complete list of initiatives occurring throughout the province by other organizations. Indicator: Percentage of individuals in NS (aged ≥ 18) who are classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals in PE (aged ≥ 12) classified as daily or occasional smokers Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Prince Edward Island is working towards achieving Canada’s Tobacco Strategy goal of less than 5% of the population using tobacco by 2035. Current situation As of March 1, 2020 the minimum age for purchasing tobacco (and nicotine vaping products) increased to age 21. Prince Edward Island is the only Canadian jurisdiction where the minimum legal sale age is 21. The universal nicotine replacement therapy/medication program was launched in 2019 to help those who smoke quit. The program is offered through Primary Care Networks and will be monitored for uptake. Cancer centres provide support to patients with cancer, including tobacco cessation counselling, free quit-smoking medications and follow-up. The Ottawa Model for Smoking Cessation is implemented provincially for inpatient, primary care and chronic disease, and mental health and addiction services. Vapes are only sold in specialty stores and there is a ban on the sale of flavoured vape products in PEI. New efforts Enhancing educational prevention efforts to reduce the use of tobacco/vaping products and support nicotine addiction with a focus on priority populations (e.g., youth, Indigenous people, LGBTQ2S+). Enforcing retailer compliance of tobacco and vaping products (for example, to prevent sales to minors). Creating smoke and vape-free environments through strengthened policy/legislation. Indicator: Percentage of individuals who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in PE (aged ≥ 18) classified as overweight or obese Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Promote healthy eating and obesity prevention across the province by leveraging existing tools, including Canada’s Food Guide and Obesity Canada’s Clinical Practice Guidelines. Current situation PEI’s provincial cancer care plan includes a focus on the promotion of healthy eating and a physical activity program. Public health and family nutrition programming is in place. Through Go PEI!, seven regions offer healthy living programs. PEI currently bans the sale of highly processed foods within schools and uses the “serve least/serve sometimes/serve most” framework. The PEI School Food Program is available to all students in a pay-what-you-can cost to families. Work is underway to establish a non-profit to take over management of the school food program and to update the School Food Policy. New efforts A scan of food environments in recreational facilities is underway as first step to inform change in these settings. PEI is working with partners across the country to develop additional healthy eating guidelines for educational and long-term care settings. Indicator: Percentage of individuals who are classified as overweight or obese Keeping people smoke-free Where we are today Percentage of individuals in NL (aged ≥ 12) classified as daily or occasional smokers in 2020 Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Newfoundland and Labrador is working towards achieving Canada’s Tobacco Strategy goal of less than 5% of the population using tobacco by 2035. Current situation The Smoking Cessation Service in the Provincial Cancer Care Program offers people with cancer support in quitting smoking. This is achieved through clinical support, behavioral support through the provincial smoker’s helpline and provision of pharmacotherapy such as the nicotine replacement therapy (NRT) patch and medication. The Newfoundland and Labrador Smokers’ Helpline offers web-, text-, email- or telephone-based support and provides information about other available resources. Pharmacists can write prescriptions for nicotine replacement therapies. All outpatients with cancer are offered help to quit smoking, including smoking cessation counselling and free quit smoking medications. Newfoundland is looking at policies used by other provinces to address smoking among youth through education. Patients with cancer are offered smoking cessation counselling by phone and mail-out of quit smoking medications. This accessibility has increased program adherence. New efforts In January 2021, the Newfoundland and Labrador Alliance for the Control of Tobacco released a Tobacco and Vaping Reduction Strategy that provides direction regarding the development and implementation of tobacco and vaping control actions. Indicator: Percentage of individuals in NL (aged ≥ 12) classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in NL (aged ≥ 18) classified as overweight or obese in 2019 Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal The Health Accord for Newfoundland and Labrador is under development and will address residents’ physical health through a holistic approach. Current situation Western Health recently implemented a pilot project to introduce locally grown foods into the food served at the hospital in Corner Brook. To encourage healthy eating among children, Newfoundland requires healthy food choices in childcare centres, provides guidelines for healthy foods in schools and uses a “serve least/serve sometimes/serve most” framework to improve food choices in schools. The Cancer Care Program offers nutrition services, where a registered dietician can give patients advice and support. New efforts Dial-a-Dietitian is a free, confidential service that connects callers to a registered dietitian for nutrition advice. Newfoundland and Labrador government recently launched a Health Care Provider Physical Activity Kit. The kit includes resources, tools and information to assist health care providers and administrative staff on the frontlines with increasing physical activity, reducing sedentary behavior and improving sleep behaviour among clients 18+ to enhance the overall physical, mental and emotional health. Indicator: Percentage of individuals in NL (aged ≥ 18) classified as overweight or obese See detail for: Overview British Columbia Alberta Saskatchewan Manitoba Ontario Quebec (Not Ready) New Brunswick Nova Scotia Prince Edward Island Newfoundland and Labrador Northwest Territories (Not Ready) Nunavut (Not Ready) Yukon (Not Ready) Increasing HPV vaccination Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. See the technical specifications for more details. Also, references for the Canada-wide information are also available. Why we are focusing on HPV vaccination Each year, 1,300 people in Canada are diagnosed with cervical cancer; over 400 die from the disease.1 Most cervical cancer is caused by the human papillomavirus (HPV). HPV vaccines can prevent more than 90 per cent of cervical cancer cases, as well as some high-risk types of HPV that can lead to penile and head and neck cancers.1,2 Cervical cancer is more common among people living in rural or remote areas, people with lower income and First Nations, Inuit and Métis.1 First Nations, Inuit and Métis3-5 may experience numerous barriers to HPV vaccination, including historical mistrust of the healthcare system, prior negative experiences with health care, lack of resources and services where they live, and community sensitivities about sexual health promotion. In Canada, children are vaccinated against HPV through school-based programs. Rates of vaccination vary across the country. The World Health Organization has called for the elimination of cervical cancer worldwide within the century. Canada’s Action Plan aims to make this a reality by 2040. The COVID-19 pandemic has created disruptions to the school-based vaccination programs in most jurisdictions; a coordinated catch-up effort will be required in future years to reach children who missed out. These catch-up approaches vary by jurisdiction. What we want to achieve At least 90 per cent of 17-year-olds in Canada vaccinated by 20251 Strategies to increase HPV vaccination uptake for all youth, integrated within school-based and other publicly funded programs First Nations, Inuit, and Métis partners and agencies supported to make sure strategies to increase HPV vaccination are culturally safe What this would mean for people in Canada Increasing vaccination uptake from 67 per cent to 90 per cent in children could: prevent 1400 people with a cervix from getting cervical cancer6 avoid 300 cervical cancer deaths in total by 20506 HPV vaccination, together with HPV-based screening programs and better access to timely follow-up and treatment, will help eliminate cervical cancer in Canada by 2040 Implementing HPV screening for cervical cancer Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. See the technical specifications for more details. Also, references for the Canada-wide information are also available. Why we are focusing on HPV screening Cervical cancer is preventable and treatable when found early. Yet each year, 1,300 people in Canada are diagnosed with cervical cancer and over 400 die from the disease.1 Cervical cancer is more common among people living in rural or remote areas, people with lower income and First Nations, Inuit and Métis.1 Most cervical cancer is caused by the human papillomavirus (HPV). The Pap test screens for cervical changes that may result from HPV infection, but it doesn’t screen specifically for HPV. HPV primary screening is preferable because it looks for the presence of high-risk HPV types in cervical cells, which can be detected even before the cellular changes that can be picked up on a Pap test. Currently, cervical cancer screening is a Pap test every two to three years. Replacing this with oncogenic HPV screening will modernize cervical cancer screening and benefit individuals and the cancer-care system. HPV screening has to be done only once every five years, is more cost-effective and prevents more cancers than the Pap test. HPV screening also provides the possibility of self-sampling, in which someone collects their own sample from their vagina using a swab from a screening kit. This can be done at home or in a clinic setting. Self-sampling supports equitable access to screening for those without easy access to health providers, and allows people to take the test in a way that supports their need for privacy, comfort and confidentiality. The World Health Organization has called for the elimination of cervical cancer worldwide within the century. Canada’s new Action Plan aims to make this a reality by 2040. What we want to achieve At least 90 per cent of eligible individuals regularly screened for HPV by 2030 No less than 80 per cent of eligible individuals in any identifiable group up to date with cervical cancer screening Pap tests replaced with HPV testing and self-sampling within organized screening programs across the country, and organized cervical screening programs created where they do not currently exist Strategies to increase screening participation among First Nations, Inuit, and Métis co-designed and implemented with First Nations, Inuit, and Métis partners and agencies to make sure the strategies are culturally safe What this would mean for people in Canada Shifting to HPV primary screening could: prevent over 3000 women from getting cervical cancer6 avoid 1000 cervical cancer deaths in total by 20506 Screening will be required less frequently and could lead to 27 million fewer cervical cancer screens (a 25 per cent drop) by 2050 and significant savings for the healthcare system HPV screening, together with HPV vaccination and better access to timely follow-up and treatment, will help eliminate cervical cancer in Canada by 2040 Increasing genetic testing Each province and territory has provided their own content and measures this indicator differently. Because of these differences, data cannot be compared across jurisdictions. See the technical specifications for more details. Also, references for the Canada-wide information are also available. Why we are focusing on genetic testing for breast, ovarian and colon cancer Genetic testing is a way to identify people who have inherited a higher risk for breast, ovarian or colon cancer. A blood test shows whether someone has the mutated genes that can cause these cancers. Genetic testing can help people take steps to reduce their chance of developing cancer. For example, knowing they are genetically at risk of developing a certain cancer may mean they get screened for cancer more often or have preventative surgery. Treatment approaches may be different for someone with a hereditary cancer. In Canada, genetic testing is used for specific groups of people at high risk: People with a family history of breast and ovarian cancer may be tested for the BRCA-1 or BRCA-2 genes. People with a family history of colon cancer may be tested for Lynch syndrome. People with Lynch syndrome are more likely to get colorectal and other cancers, and at a younger age (before age 50). Availability of genetic counselling and testing is not consistent across the country and depends on one’s home province/territory. Access is also more limited for people living in rural and remote areas. What we want to achieve Increased availability of genetic testing for those who should have it Genetic testing for BRCA genes and genetic counselling consistently offered to people with a family history of breast and ovarian cancer Increased awareness of risk and available options among families with a genetic risk of cancer Healthcare teams have access to a patient’s genetic information to provide tailored and effective cancer care Supports available for patients and primary care providers to help them better understand and make decisions based on test results What this would mean for people in Canada Family members become aware of their own risk and need for genetic testing People at higher risk of breast or ovarian cancer can be identified sooner and monitored for early signs of disease, increasing the chance of a better outcome People with Lynch syndrome can be identified sooner and monitored for early signs of colon cancer. If they develop cancer, treatments are tailored, where appropriate, based on their genetic information, increasing the chance of a better outcome. Increasing HPV vaccination Where we are today Percentage of Grade 6 students who received two doses of HPV vaccination, by sex Data source: Provincial cancer agencies and programs Click here to see all data and data limitations, including any additional stratifications. Our goal British Columbia is committed to achieving the goal of Canada’s Action Plan to Eliminate Cervical Cancer by 2040. This Action Plan has three goals: improving HPV immunization rates, implementing HPV primary screening and improving follow-up of abnormal screening results. Current situation Since 2018, both males and females are eligible for HPV vaccination and it is available to students as part of routine vaccine provision in Grade 6. New efforts BC Cancer has piloted at-home HPV testing and will shortly implement HPV testing as the primary cervical screening tool in BC. Indicator: Percentage of Grade 6 students who received two doses of HPV vaccination, by sex Increasing genetic testing Where we are today Percentage of patients diagnosed with breast, colorectal and ovarian cancers who were referred for and received genetic testing results within 6 months of diagnosis Data source: Provincial cancer agencies and programs Notes: Wait-times reflect waits for those patients diagnosed and referred for testing. Patients who have diagnoses but that are not referred for testing are not captured within these statistics. The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Our goal All people with cancer who desire genetic testing have results in less than six months. Individuals who need information for treatment receive their results in less than one month. Current situation Genetic counselling is offered to individuals in British Columbia with a family history of breast, ovarian or colorectal cancer. There is currently a 2-3 year wait list for non-urgent hereditary cancer genetic counselling and testing in British Columbia due to increased demand and a shortage of resources. New efforts Implementing innovative services such as group counselling, mainstream genetic testing and patient portals Implementing universal tumour screening for Lynch syndrome Implementing genetic testing on tumour tissue at time of diagnosis Indicator: Percentage of patients diagnosed with breast, colorectal and ovarian cancers who were referred for and received genetic testing results within 6 months of diagnosis Increasing HPV vaccination Where we are today Percentage of people who received a full course of HPV vaccination Data source: Provincial cancer agencies and programs Notes: A full course of HPV vaccination was considered two doses by age 12 in 2019 but was changed to two doses by age 13 in 2020. The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Our goal 90% of students will receive their vaccines in Grades 6 through 9. Alberta is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. Current situation School-based HPV vaccination began in 2008 for girls and 2014 for boys. HPV vaccination is offered to all students in Grade 6. People not vaccinated in school are eligible to receive free “catch-up” vaccination up to and including age 26. The Enhancing HPV Vaccination in First Nations Populations in Alberta (EHVINA) study led by Dr. Greg Nelson, University of Calgary, is supporting increased uptake of HPV vaccinations for First Nations in Alberta. New efforts The HPV vaccination program was expanded in 2020 to include all individuals up to age 26. Alberta will continue to work with providers outside of Public Health (such as post-secondary institutions and physician offices) to vaccinate people aged 18-26. Indicator: Percentage of people who received a full course of HPV vaccination Implementing HPV screening for cervical cancer Where we are today Data source: Provincial cancer agencies and programs Notes: All steps may not apply to a given jurisdiction as pathways to implementation are unique to each jurisdiction. Alberta currently does not have any HPV primary screening activities, and entirely uses liquid based cytology and reflex HPV testing for cervical cancer screening. Click here to see all data and data limitations, including any additional stratifications. Our goal Develop and gain approval of a business case for HPV primary screening in Alberta. Transition to HPV primary screening over the long term. Current situation Alberta currently does not do HPV primary screening; cervical cancer screening is done using the Pap test and HPV reflex testing. New efforts A working group for HPV primary screening has been established. Indicator: Jurisdiction-specific level of implementation status for HPV primary screening to eligible individuals Increasing genetic testing Where we are today Percentage of female patients in AB diagnosed with breast or ovarian cancer who received genetic testing within 9 months of diagnosis Data source: Provincial cancer agencies and programs Notes: Some patients may seek private genetic testing to guide treatment. Private genetic testing data is not available. The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Our goal Ensure all people with cancer who are eligible are offered timely genetic testing and are supported in their decision-making. Current situation People who are eligible for prostate, ovarian, pancreatic or breast cancer genetic testing are offered the service. Universal tumour screening for Lynch syndrome is implemented for all endometrial and colon cancers. The Alberta Hereditary Cancer Provincial Guidance Committee was established in 2020, aiming to expand the genetic testing criteria and offer it to more people with cancer who may benefit from such testing. This committee has the following four core aims: Expand genetic testing criteria Universal tumour screening for Lynch syndrome Expand and sustain the mainstreaming model Coordinate tumour genetic testing to help determine eligibility for specific treatments New efforts The Alberta Hereditary Cancer Provincial Guidance Committee aims to expand genetic testing, and support screening coordination for Lynch syndrome among pathology, oncology and genetics. Indicator: Percentage of patients diagnosed with breast or ovarian cancer who received genetic testing within 9 months of diagnosis Increasing HPV vaccination Where we are today Percentage of female Grade 6 students in SK who received final dose of HPV vaccination in the 2017 school year Data source: Provincial cancer agencies and programs Click here to see all data and data limitations. Our goal A provincial goal has not been set. A national goal is the elimination of cervical cancer by 2040. Current situation School-based HPV vaccination began in 2008 for girls and 2017 for boys. HPV vaccination is offered to all genders in Grade 6. People not vaccinated in school can receive free “catch-up” vaccination until age 27. Social media is being leveraged to address vaccine hesitancy. New efforts Saskatchewan is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. Indicator: Percentage of female Grade 6 students in SK who received final dose of HPV vaccination in the 2017 school year Increasing HPV vaccination Where we are today Percentage of individuals who completed 1+ or 2+ HPV vaccination doses by age 17 through Manitoba’s school-based vaccination program, by sex Data coming soon. Data source: Provincial cancer agencies and programs Note: The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Our goal The Government of Canada has set a target that by 2025, 90 per cent of 17-year-olds are vaccinated against HPV. CancerCare Manitoba (CCMB) have committed to support and promote HPV vaccination. Long term goals include: Increasing the number of Manitobans who are vaccinated against HPV Reducing the overall number of cervical cancer cases Detecting cervical abnormalities earlier Current situation CCMB: CCMB’s website provides educational content on the HPV vaccine. HPV vaccination campaign materials are in both English and French. CCMB and CCMF have run a public education campaign on the topic of HPV vaccination for the past three years. Province of Manitoba: The HPV vaccination program was implemented for girls in 2008 and boys in 2016. Manitoba has a “once eligible always eligible” policy, which means that young people who missed school-based immunizations can still get vaccinated. New efforts CCMB and the CCMF are lending their voice to assist with the larger public health issue. In partnership with Manitoba Health, various promotional programs relating to HPV vaccination are in place. CCMB Prevention and Screening are implementing a project aiming to increase HPV vaccination rates through mailout reminders targeting individuals who remain unvaccinated but eligible. CCMB Prevention and Screening are working to support knowledge mobilization for healthcare providers across Manitoba through webinars highlighting HPV vaccine eligibility and the vaccination process. Indicator: Percentage of individuals who completed 1+ or 2+ HPV vaccination doses by age 17 through Manitoba’s school-based vaccination program, by sex Increasing genetic testing Where we are today Percentage of breast/ovarian and colon cancer patients who were eligible and received a hereditary cancer screen (10- or 12-gene panel), and percentage of colorectal cancer patients diagnosed within a two-year period who had a completed tumour tissue screen for Lynch Syndrome (MMR testing). Select type of genetic testing: data graph Hereditary genetic screeningLynch Syndrome Screening Data source: Provincial cancer agencies and programs Note: The COVID-19 pandemic may have affected service provision. Eligibility for hereditary cancer screens include patients with no known pathogenic familial variant and who meet panel testing criteria. Individuals who do not meet this eligibility criteria include those with a familial mutation who will receive genetic testing for the mutation of interest only or those who do not meet full criteria for the 10- or 12-gene panel but may have other genetic testing panels completed (e.g., individuals meeting specific ethnic requirements for variants common in that population). Click here to see all data and data limitations, including any additional stratifications. Our goal Align Manitoba’s genetic cancer screening with known best practices. Align hereditary genetic screening eligibility criteria with available opportunities. Streamline communication between clinical and diagnostic services. Expand genetic testing services to include additional target genes (informed by research) that predispose to breast/ovarian/colon cancers. Expand the availability of genetic testing to individuals with other forms of cancer. Current situation In Manitoba, genetic testing for hereditary cancers is available for individuals diagnosed with cancer and individuals with a strong family history of cancer. Hereditary genetic screening: Completed through Shared Health Diagnostic Services; however, some gene-panels that cannot be completed in-house are sent to Mount Sinai Hospital in Toronto. In 2020, Diagnostic Services updated the hereditary breast cancer panel to contain 10 genes (instead of six) for breast/ovarian cancer. Tumour genetic screening: Manitobans diagnosed with colorectal, endometrial or ovarian cancer will be screened for Lynch Syndrome [with MMR testing, e.g., immunohistochemistry (IHC) or microsatellite instability (MSI-High)] depending on their age and family history. The results of this screen stratify the risk of having Lynch Syndrome and identifies individuals needing subsequent hereditary genetic testing. Abnormal results from the Lynch Syndrome screen are automatically forwarded to the Hereditary Cancer Clinic. New efforts Lynch Syndrome Screening program expanded its screening criteria in 2016/17 to include all endometrial cancers diagnosed ≤ age 60. In partnership with Shared Health, a new Genome Sequencing Laboratory at CancerCare Manitoba opened in March 2021 to provide enhanced and streamlined services relating to tests for predisposition to hereditary cancers and tumor expression profiles. Indicators: Percentage of breast/ovarian and colon cancer patients who were eligible and received a hereditary cancer screen Percentage of colorectal cancer patients diagnosed within a two-year period who had a completed tumour tissue screen for Lynch Syndrome Increasing HPV vaccination Where we are today Percentage of Grade 7 students in ON who received final dose of HPV vaccination in the 2017-2018 school year, by sex Data source: Provincial cancer agencies and programs Click here to see all data and data limitations, including any additional stratifications. Our goal Elimination of cervical cancer using HPV vaccination as a key mechanism Current situation HPV vaccines are offered to all students in Grade 7. Youth can receive their second HPV vaccine up until the end of Grade 12. People at high risk of HPV are offered vaccines. School-based vaccine programs were paused temporarily due to COVID-19 but have since resumed. New efforts Efforts are underway to resume vaccination and provide extensions for people to receive a missed dose. Ontario is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. Indicator: Percentage of Grade 7 students in ON who received final dose of HPV vaccination in the 2017-2018 school year, by sex Implementing HPV screening for cervical cancer Where we are today Data source: Provincial cancer agencies and programs Note: All steps may not apply to a given jurisdiction as pathways to implementation are unique to each jurisdiction. Click here to see all data and data limitations, including any additional stratifications. Our goal Reduce the risk of Ontarians developing or dying from cervical cancer through the implementation of HPV testing in cervical screening and screening-related colposcopy in Ontario. Current situation Ontario currently has a cytology-based organized cervical screening program that will continue until the transition to HPV testing. In parallel, Ontario is planning for the implementation of HPV testing in screening and colposcopy (follow-up procedure for investigation, treatment and management of abnormal screening result). New efforts Activities underway include: Developing cervical screening and colposcopy recommendations based on literature reviews, environmental scans, Ontario data analyses and input from an international expert panel that includes public representatives Planning a stakeholder engagement and communication strategy to support health care providers and public with the transition Working with Regional Cancer Programs to support regional implementation of the HPV test Planning for required changes to program processes and infrastructure to support HPV test implementation Indicator: Jurisdiction-specific level of implementation status for HPV primary screening to eligible individuals Increasing genetic testing Where we are today Number of individuals aged 30 to 69 years in ON diagnosed with breast cancer, per 1,000 individuals who underwent genetic testing prior to cancer diagnosis, by age group Data source: Provincial cancer agencies and programs Note: The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Current situation People aged 30-69 who are considered high risk are recommended to be screened once a year via the High Risk Ontario Breast Screening Program (OBSP). People can be considered high risk by either direct entry (based on the screening program’s eligibility criteria) or by genetic assessment. For individuals undergoing genetic testing through the High Risk OBSP, the breast cancer rate was the highest among those aged 30-39 and lowest among those aged 60-69. The rate of breast cancer for individuals undergoing genetic testing have increased in 2020 (18.9 per 1,000) compared to the rate in 2018 (16.7 per 1,000) and 2019 (14.8 per 1,000). The increased rate of breast cancer in individuals undergoing genetic testing may be impacted by the pandemic. Fewer people had genetic testing in 2020 compared to 2019 (3,552 vs 4,190), and those who were confirmed to be at high risk for breast cancer were prioritized for breast screening in accordance with provincial guidance. New efforts A large-scale study will be conducted on screening for breast cancer based on individual risk. For future work, the OBSP may use this information to support the evaluation of the feasibility, accessibility and uptake of genetic testing within the High Risk OBSP. Hereditary cancer genetic testing can provide important information for accurate cancer risk assessment as well as diagnosing, treating and preventing cancer. On April 1, 2021, Ontario Health announced the implementation of Provincial Hereditary Cancer Genetic Testing for Adults, improving access to genetic testing across a number of disease sites. Building on the experience in cancer genetic testing and services, Ontario Health has now established a Provincial Genetics Program to ensure the provision of comprehensive, coordinated and evidence-based genetic services across the province. The Provincial Genetics Program will encompass genetic testing for all rare and inherited diseases, including hereditary cancer, and clinical genetic services. Indicator: Number of individuals aged 30 to 69 years in ON diagnosed with breast cancer, per 1,000 individuals who underwent genetic testing prior to cancer diagnosis, by age group Increasing HPV vaccination Where we are today Percentage of Grade 7 students with complete HPV series in 2019-2020 school year, by sex Data source: Provincial cancer agencies and programs Click here to see all data and data limitations, including any additional stratifications. Our goal Eliminate cervical cancer by 2040. Current situation A school-based HPV Immunization program began in 2008 for female students in Grade 7 and 8, and continued for female students in grade 7. As of 2017, the HPV Immunization program was expanded to include male students in Grade 7. New Brunswick is aligned with the goals of the National Immunization Strategy and the 2025 Vaccine Preventable Disease Reduction Targets. New efforts New Brunswick is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. NBCN has completed recommendations to begin work on implementation of HPV primary testing for cervical cancer screening program. Indicator: Percentage of Grade 7 students in NB with complete HPV series in 2019-2020 school year, by sex Implementing HPV screening for cervical cancer Where we are today Data source: Provincial and territorial cancer agencies and programs Click here to see all data and data limitations. Our goal Implement HPV primary cervical cancer screening with the potential for sample self-collection. Current situation Currently, the Pap test is used as the primary screening test in NB. Despite a decline in cervical screening rates during the COVID-19 pandemic, current cervical screening rates mirror those seen pre-COVID and awareness campaigns and correspondence are ongoing. Standardized Cervical Cancer Screening Program invitations and reminders to healthcare professionals and participants and awareness campaigns are ongoing. Recommendations have been developed to support HPV testing implementation based on literature reviews, environmental scans and NB data analyses. Indicator: Jurisdiction-specific level of implementation status for HPV primary screening to eligible individuals Increasing HPV vaccination Where we are today Percentage of Grade 7 students in NS in the 2018-2019 school year who received both doses of HPV vaccination prior to January 1, 2020 Data source: Provincial cancer agencies and programs Note: The sex of 26 students is unknown. These students are included in the overall data, but not in the Male and Female data, resulting in slightly lower percentage in the overall category. Click here to see all data and data limitations, including any additional stratifications. Our goal 90% target rate for school-based HPV vaccination. Current situation HPV vaccination is offered to all genders in Grade 7. School-based HPV vaccination began in 2007 for girls and 2015 for boys. Individuals not vaccinated in school can receive free “catch-up” vaccination up to age 18. Projects are underway to reduce barriers to HPV vaccination in schools and across communities. Discussions are underway for a “once covered, always covered model” which would allow individuals in Mi’kmaq communities who missed the school vaccine to receive free HPV vaccination at any time. New efforts Nova Scotia is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. Indicator: Percentage of Grade 7 students in NS in the 2018-2019 school year who received both doses of HPV vaccination prior to January 1, 2020 Implementing HPV screening for cervical cancer Where we are today Indicator data not available at this time. Data source: Provincial cancer agencies and programs Notes: Wait-times reflect waits for those patients diagnosed and referred for testing. Patients who have diagnoses but that are not referred for testing are not captured within these statistics. The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Our goal Coming soon. Current situation Planning is underway for province-wide roll-out of primary HPV-based screening. New efforts Coming soon. Indicator: Jurisdiction-specific level of implementation status for HPV primary screening to eligible individuals Increasing HPV vaccination Where we are today Percentage of students aged 12 completely vaccinated* for HPV in PE *Complete vaccination = Three doses for ages 12+ before 2015. From 2015, only two doses = Complete vaccination. Data source: Provincial cancer agencies and programs Note: The COVID-19 pandemic may have affected service provision. Click here to see all data and data limitations, including any additional stratifications. Our goal Achieve an HPV vaccination uptake rate of 90% in adolescents. Reduce all morbidities associated with HPV. Current situation School-based HPV vaccination began in 2007 for girls and 2013 for boys. HPV vaccination is offered to Island students in Grade 6. HPV vaccination is available to Islanders through PEI Public Health Nursing. All missed vaccines can be “caught up” at Public Health Nursing. PEI was the first province to vaccinate boys in schools, starting at age 12 in 2013, for HPV. There has been excellent uptake of the HPV vaccine among boys, with 78% of the first cohort of boys vaccinated in the province now being fully protected. New efforts PEI is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. PEI is planning to move from screening with a Pap test to HPV testing in 2023. Indicator: Percentage of students aged 12 completely vaccinated for HPV in PE Implementing HPV screening for cervical cancer Where we are today Data source: Provincial and territorial cancer agencies and programs Notes: Prince Edward Island is in the process of piloting/partially implementing HPV primary screening; this program is being piloted in certain sites or for certain populations across the province. All steps may not apply to a given jurisdiction as pathways to implementation are unique to each jurisdiction. Click here to see all data and data limitations, including any additional stratifications. Our goal By 2030, all eligible individuals in PEI will: Have barrier-free HPV vaccination access 90% of 17-year-olds will be fully vaccinated for HPV Participate in HPV screening (90% of individuals will be up-to-date with screening) Have access to coordinated, high quality follow-up care for cervical screening (90% of individuals will have timely access to colposcopy services) Current situation PEI will implement HPV as the primary screening tool province-wide in 2023. Pilot program using HPV test for screening starts in April 2023. Work is underway to standardize and support clinical pathways for early detection of cervical cancer, including follow-up of abnormal HPV screening results and colposcopy services. The province continues to offer school-based HPV vaccination to all grade six students and to monitor uptake. New efforts PEI will pilot self-sampling HPV screening in 2023. Laboratory-required equipment has been procured for HPV testing and Liquid-Based Cytology. Health PEI is developing clinical practice guidelines and provider education to support implementation of HPV as the primary screening tool for cervical cancer. Indicator: Jurisdiction-specific level of implementation status for HPV primary screening to eligible individuals Increasing genetic testing Where we are today Percentage of PE patients with breast, colorectal and ovarian cancer who received genetic testing in 2019 Data source: Provincial cancer agencies and programs Note: According to the guidelines for genetic testing, all women with ovarian cancer are eligible for genetic testing, while only a subgroup of women with breast cancer and a subcategory of people with colorectal cancer are eligible for genetic testing. Click here to see all data and data limitations, including any additional stratifications. Our goal Ensure people with breast, ovarian or colorectal cancer who qualify for genetic testing are tested for other cancers and their family members are informed of their own potential increased risk of cancer. Educate people with cancer to help them make an informed decision regarding consent for testing. Increase access to genetic testing for all who qualify. Current situation People with cancer, who qualify, are offered genetic testing for specific genes by a specialist. All testing is done by a specialized genetic testing service in Halifax. The necessary samples for genetic testing are collected at labs on PEI, followed by virtual appointments with the regional genetic counselling clinic in Nova Scotia. New efforts Efforts are underway to increase referrals for genetic testing for people with cancer who qualify, particularly for people with ovarian cancer (all people with ovarian cancer qualify to have genetic testing appointments). Efforts are recently focused on genetic testing for people with breast cancer who are under 40 years. Indicator: Percentage of patients with breast, colorectal and ovarian cancer who received genetic testing in 2019 Increasing HPV vaccination Where we are today Percentage of Grade 6 students in NL who received a final dose of HPV vaccination in the 2018-2019 school year Data source: Provincial cancer agencies and programs Click here to see all data and data limitations, including any additional stratifications. Our goal Eliminate cervical cancer by 2040. Current situation School-based HPV vaccination is offered to students in Grade 6. This began in 2007 for girls and 2017 for boys. Females not vaccinated in school can receive free “catch-up” vaccination up to age 26. There is currently no catch-up program for males. Newfoundland and Labrador has very high rates of HPV vaccination. However, it is hard to identify those in the school system who have not received the vaccine. The province hopes to link the vaccine registry with the province’s cancer screening database. New efforts Newfoundland and Labrador is working towards Canada’s Action Plan to Eliminate Cervical Cancer by 2040. Indicator: Percentage of Grade 6 students in NL who received a final dose of HPV vaccination in the 2018-2019 school year Implementing HPV screening for cervical cancer Where we are today Data source: Provincial and territorial cancer agencies and programs Click here to see all data and data limitations. Our goal Plan to submit a business case by June 2023 to health authorities’ executive team and the NL Department of Health to move towards HPV primary screening. Current situation Newfoundland and Labrador currently uses the liquid-based cytology Pap test for cervical cancer screening. However, HPV reflex testing is used for women over age 30 who have a mildly abnormal Pap test. The HPV test is done in the lab on the specimen already collected. Women with negative HPV results return to routine screening; women with positive HPV results are referred to a gynecologist for further assessment. Screening may stop at age 69 if women have a history of regular and negative Pap tests. New efforts Regional Cancer Screening Coordinators and the Cervical Screening Medical Director are providing education to primary health providers regarding HPV primary screening. Indicator: Jurisdiction-specific level of implementation status for HPV primary screening to eligible individuals Increasing genetic testing Where we are today Percentage of patients in NL under 40 years of age diagnosed with colorectal cancer in 2017-2019 who received genetic testing within one year of diagnosis Data source: Provincial cancer agencies and programs Click here to see all data and data limitations, including any additional stratifications. Our goal Ensure all people with cancer who are eligible are offered timely genetic testing and are supported in their decision-making. Current situation People with cancer are referred to genetic counsellors by their oncologist or family doctor if there is suspicion of hereditary cancer. Genetic counsellors then decide whether genetic testing is appropriate. New efforts Due to lack of resources, genetic counsellors have switched to a group format for initial informative sessions. This group environment has stimulated discussion and allowed for increased patient support and involvement. Indicator: Percentage of patients under 40 years of age diagnosed with colorectal cancer in 2017-2019 that received genetic testing within one year of diagnosis See detail for: Ontario For Testing only Action 3 - Ontario Where we are today Percentage of individuals (aged ≥ 12) in ON classified as daily or occasional smokers in 2019 Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Screen 70% of people diagnosed with cancer to examine current tobacco use.* Support people with cancer who use tobacco by having 28% accept a referral for smoking cessation support.* Protect people in Ontario, especially children and youth, from the harmful effects of smoking, vaping, and nicotine. *These targets have been lowered in an effort to support regional cancer centres as they adjusted their resources to respond to the COVID-19 pandemic. Current situation The percentage of daily or occasional smokers was slightly lower in Ontario compared with the Canadian average. The percentage of people who smoke was generally higher for people with lower household income compared to those with higher income. The percentage of people who smoke was highest for those with less than a secondary school education level and decreased with higher levels of education (such as secondary and post-secondary). The percentage of people who smoke was higher for males compared to females across all income levels and levels of education. Regional cancer centres offer on-site or community-based smoking cessation support for people newly diagnosed with cancer. Smoking and vaping cessation services are provided by the Ministry of Health through the Centre for Addiction and Mental Health, Canadian Cancer Society, Lakehead University, University of Ottawa Heart Institute and Health811. Tobacco, cannabis, e-cigarettes, vaping and vaping-related illnesses are monitored by the Ministry of Health to assess how their use may impact addiction. The government took urgent action to address the issue of youth vaping. As of January 1, 2020, the Smoke-Free Ontario Act prohibits the promotion of vapour products in retail establishments that are not specialty vape stores or cannabis retail stores. Specialty vape stores and cannabis retail stores are only open to people aged 19 years and over. As of July 2020, The sale of flavored vapour products (except for menthol, mint and tobacco flavours) is limited in places other than specialty vape or cannabis retail stores. The sale of products with high amounts of nicotine is limited in places other than specialty vape stores. Specialty vape stores must ensure that the display and advertising for their products are not visible from the outside of the store. New efforts Smoking cessation programs in regional cancer programs are expanding beyond new ambulatory patients to include new audiences and new settings. Patient-reported smoking cessation outcomes will be evaluated. The Ministry of Health is also pursuing the following non-regulatory measures to address the issue of youth vaping: Health811 offers services to help people quit vaping. Ensuring online retailers will only sell vapour products to people aged 19 and above. Mental health and addiction services will help with vaping and nicotine addictions. Indicator: Percentage of individuals (aged ≥ 12) in ON who are classified as daily or occasional smokers Maintaining healthy body weight Where we are today Percentage of individuals in ON (aged ≥ 18) classified as overweight or obese Data source: Canadian Community Health Survey Note: The COVID-19 pandemic had major impacts on the data collection operations and response rates for this survey. Click here to see all data and data limitations, including any additional stratifications. Our goal Reducing obesity will be achieved by encouraging healthy eating, physical activity, addressing sedentary behaviours and the built environment. Current situation The percentage of people classified as overweight or obese was the same in Ontario and Canada. The percentage of people classified as obese or overweight was higher for males compared to females. The percentage of males classified as obese or overweight was higher for males with higher household income compared to those with lower income. The percentage of females classified as obese or overweight was higher for females with lower income compared to those with higher income. The Local Food Act encourages local food production and supports marketing of local fruits and vegetables. Health Connect Ontario is available to provide healthy eating information. The Healthy Menu Choices Act, 2015 requires that calories are displayed on menu boards in regulated food premises to allow people to make healthy decisions. Nutrition standards have been set for food and beverages sold in schools. Schools provide elementary students with at least 20 minutes of physical activity each day. Nutritious foods are offered to school-aged children and youth during breakfast and lunch through the Student Nutrition Program. Long-term care homes are required to provide food according to Canada’s Food Guide. New efforts The Ministry of Health intends to capitalize on lessons learned and investments made during the COVID-19 pandemic to inform chronic disease prevention policies and programs. Indicator: Percentage of individuals (aged ≥ 18) classified as overweight or obese Our Priorities Priority 1 Decrease the risk of people getting cancer Priority 2 Diagnose cancer faster, accurately and at an earlier stage Priority 3 Deliver high-quality care in a sustainable, world-class system Priority 4 Eliminate barriers to people getting the care they need Priority 5 Deliver information and supports for people living with cancer, families and caregivers Priority 6 Culturally appropriate care closer to home Priority 7 Peoples-specific, self-determined care Priority 8 First Nations-, Inuit- and Métis-governed research and data systems
