Breast cancer screening in Canada: 2021/2022

Strategies to improve screening for First Nations, Inuit and Métis

According to the limited data available, participation rates for breast screening are much lower among First Nations, Inuit and Métis than non-Indigenous people in Canada. The data also indicates considerable variation in screening participation across geographic location.

Screening programs in ten provinces and one territory report work with First Nations, Inuit and/or Métis to increase participation and improve the screening experience. This work includes engaging First Nations, Inuit and Métis in decision-making and informing approaches to culturally appropriate screening and program resources, such as social media campaigns and engaging with and educating healthcare providers working directly with First Nations, Inuit, and Métis communities. Dedicated mobile visits have been implemented into several screening programs in order to better reach First Nations, Inuit, and Métis communities.

Strategies to improve screening for First Nations, Inuit and Métis

P/T Intended audiences Strategies used Strategy co-developed with community? Description of activities to improve screening for First Nations, Inuit, and Métis
NT · First Nations
· Inuit
· Métis
· Education
· Media (small and mass)
· Client reminder
· Recall system
· Patient navigation
· Healthcare provider cultural competency training
All: ✓ · Breast Cancer Screening awareness kits were developed and distributed to the community health representatives in all community health centres to promote education at a local level
· Social media posts created and launched on the Northwest Territories Health and Social Services social media platforms (Twitter, Facebook, Instagram)
· Reminder letters mailed to patients
· Recall system for patients in place
· 1:1 health education available with HCP’s in primary care clinics and community health centres
BC · First Nations · Website
· Print resources
· Peer support materials
· Provider materials
· Mobile screening First Nations communities
· Community-based outreach
· Patient videos
All: ✓ · BC Cancer is partnering with First Nations Health Authority to co-design interventions and promotional activities to engage First Nations population in BC. Breast screening services are also delivered to First Nations communities via the mobile mammography service.
AB · First Nations
· Inuit
· Métis
1. Education (one on one and group)
2. Client invitation and reminders
3. Media (small and mass)
4. Provider assessment and feedback
5. Mobile screening clinics
6. Healthcare provider cultural competency training
7. Development of culturally safe materials and resources
8. Direct community engagement to co-design programs
1. ✓
3. ✓
5. ✓
6. ✓
7. ✓
8. ✓
· Partner with Indigenous representatives to conduct screening disparities evaluations and use findings to inform strategies to improve screening in Indigenous populations.
· Share evidence and learnings with service providers to provide culturally safe care.
· Work with Indigenous partners to develop and provide culturally appropriate information.
SK · First Nations
· Métis
· First Nations and Métis Cancer Surveillance strategy All: ✓ · Outreach manager and program coordinators working with communities to identify needs and gaps in care
· Adjusting mobile route to serve the communities when it works best for them
· Educating staff on cultural safety and competency
· Working with communications to develop culturally safe materials and resources
MB · First Nations
· Métis
· Comprehensive letter campaigns
· Informative web site
· Interpreter service available
· Accessibility – 2 mobile clinics, 4 fixed locations
· Social media (Facebook) promoting mobile clinics
· Culturally sensitive appointment booking processes
· Program arranges and funds group flights for communities without road access to mammogram clinics
All: ✓ · Community engagement and outreach through Prevention and Screening Program
· Partnerships with Regional Health Authorities, Nursing Stations, Health Directors, tribal councils, Wellness Centers, healthcare providers and valued stakeholders
· Partnership with Community Engagement Liaisons
· Mobile screening vehicles hosted on First Nation community
ON* · First Nations
· Inuit
· Métis
· Group education
· Mass media
· Development of culturally safe materials and resources
· Provider reminders (Sioux Lookout area only)
· Mobile screening clinics (North West only)
· Providing transportation to screening services (for First Nations through Non-Insured Health Benefits [NIHN])
· Promotion of health literacy
· Direct community engagement to co-design programs
All: ✓ · Through the Indigenous Cancer Care Unit (ICCU), Regional Indigenous Cancer Leads and regional teams, communities are engaged to inform programs/initiatives to improve education and awareness of cancer screening.
· The ICCU is currently engaged in a study to investigate current correspondence and identify methods to enhance participant reminders. Ontario Health (Cancer Care Ontario) sends reminders following cancer screening invitation and recall letters to all eligible people in Ontario.
· A grant received by Dr. Jill Tinmouth and Dr. Amanda Shephard (“Catching Cancer Early how well do Ontario screening programs perform for First Nations and Métis persons?”) will provide Ontario Health (Cancer Care Ontario) with strategies to improve participation for First Nations and Métis people and may inform cancer screening recommendations in these populations
· Continued ICCU support for the Cancer Screening Fact Sheets, Toolkit, and awareness postcards/posters which were designed and tailored with and for each First Nation, Inuit and Métis population.
· Cancer 101 Video: Ontario Health (Cancer Care Ontario) made this video for First Nations people. The video gives basic cancer information and answers many common questions about cancer. Other groups that helped make the video are CAREX Canada, the Occupational Cancer Research Centre and the Canadian Cancer Society.
· The Screening Activity Report (SAR) is an online report, which provides screening data to help family doctors improve their cancer screening rates and appropriate follow-up. The report allows family doctors to quickly find specific cancer screening information for each patient, including those who are overdue or have never been screened. In June 2018, the SAR was expanded to the Sioux Lookout Zone, which consists of several First Nations communities, providing non-patient enrollment model physicians and nurses access to their community data. This SAR was developed specifically for the Sioux Lookout municipality and the 27 First Nation communities that reside in the Sioux Lookout Zone.
· The ICCU continues to raise awareness with regional and community partners of medical transportation coverage available to eligible First Nations through the First Nations and Inuit Health Branch Non-Insured Health Benefits (NIHB) for breast cancer screening
· The ICCU and Northwestern Regional Cancer Program in partnership with communities jointly plan community events to provide access to screening through a mobile screening coach in the North West region.
· Through the relationships developed and fostered by the ICCU, regional teams have been able to continue working with communities as guided through the First Nations, Inuit, Métis and urban Indigenous Cancer Strategy
QC · First Nations
· Inuit
· Métis
· Mobile screening clinics
· Providing transportation to screening services
NB · First Nations
· Métis
1. Group education
2. Leverage learnings from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’
1. ✓ (based on invitation to participate)
· The program offers group presentations upon request from First Nations Communities based on education needs for targeted audience.
· Plan to leverage the recommendations from the ongoing underscreening population project being conducted in NB.
NS^ · First Nations · Patient Navigator · Patient navigator maintains community engagement with First Nations Health Directors.
PE · First Nations · Health fairs
· Social media ads
· Educational clinics
· Promotional items
· Participation in educational sessions (individually) at health fairs as well as group educational presentations, reminder letters & recall letters
NL   · Cancer Screening Program regularly presents to the FNIM initiatives
· We are currently working on establishing a satellite breast screening centre – Labrador-Grenfell Health Region

ON: *Listed activities are not inclusive for all First Nations, Inuit and Métis populations. More information about the First Nations, Inuit, Métis and urban Indigenous Cancer Strategy can be found here:
NS: ^Due to the COVID-19 pandemic, health fairs at First Nations communities that the Patient Navigator would have attended, were cancelled.