Alberta Cancer Foundation

Screening and Stigma

Illustration by Andrew Benson.

The earlier we can detect, diagnose and treat cancer, the higher the chance of survival. The best way to identify some of the most common forms of cancer early is through regular screening to detect it before the patient has any symptoms. Today, thanks largely to screening, survival rates in patients diagnosed with early breast cancer, for example, are as high as 95 per cent.

Unfortunately, reaching the people who most benefit from screening is not always straightforward. In Alberta, which has provincial programs that screen for breast, cervical and colorectal cancer in eligible people, there may be cultural barriers and stigma attached to getting screened. Where a person lives or comes from might also mean they are sometimes less likely to access potentially life-saving screening services.

Thankfully, doctors, screening technologists and Alberta Health Services (AHS) are working together to dispel stigmas and bring equity to cancer screening to ensure all Albertans have access.

Cultural Barriers

When brain and breast cancer specialist Dr. Gloria Roldan Urgoiti first started practicing in Canada, she began to notice several patients who presented with very advanced breast cancer. This was somewhat unusual given the strides made in breast cancer screening over the past couple of decades, but there appeared to be a common theme among these cases: many were immigrants to Canada.

“I’m an immigrant, so I see myself reflected in every patient that comes to Canada. You notice the inequity, and it hurts,” says Roldan Urgoiti, who works as an oncologist at the Tom Baker Cancer Centre. “I started trying to find reasons why patients that immigrate from other countries could present with such advanced cancers that could have been detected earlier.”

Roldan Urgoiti, who is originally from Uruguay, began thinking about what kind of barriers might keep people from different backgrounds from getting screened.

“It’s very multifactorial,” she says. “When somebody is new to the country, there are so many things that take priority — such as putting food on the table, finding a job and learning the language — that sometimes health is more secondary.”

But she also identified cultural barriers that went beyond the realities of starting life in a new country. These barriers may be harder to see but can be a big obstacle to getting screened and detecting cancer early.

Roldan Urgoiti says the concept of screening for something like breast cancer, even if a physican recommends it, might be unfamiliar to new Canadians, making them less likely to get screened. Stigma around the disease and the challenges of talking about breast health can also keep patients from disclosing an issue.

“When a doctor asks about breast health a patient might say everything is fine, even if it isn’t,” says Roldan Urgoiti. “It can be difficult to tell this to a male family doctor or even to a female family doctor.” She adds that acknowledging this difficulty, instead of assuming patients will easily disclose breast health issues, is important for health-care providers to recognize.

After witnessing the inequity in screening first-hand Roldan Urgoiti joined the advisory committee for the Creating Health Equity in Cancer Screening (CHECS) project. Led by AHS, this pilot program began in 2018 and includes a multidisciplinary team of experts exploring who faces barriers to screening and how those barriers might be overcome. Initial research by the project team has identified communities in Calgary with low screening rates, including in the east, upper northeast and lower northeast parts of the city, and, coincidentally, these communities are very multicultural.

Next, the CHECS project will be conducting focus groups in areas with high numbers of new Canadians to identify and better understand barriers to screening with support from the Canadian Partnership Against Cancer through a community engagement grant. The project team is also interviewing health-care providers to get multiple perspectives on the issue. Information gathered from this engagement will be used to create a pilot program that will seek to increase awareness of, and ultimately participation in, cancer screening.

“We need to learn more about cultural differences that act as barriers to screening and detecting cancer early, especially in Canada because we receive patients from so many different countries,” says Roldan Urgoiti.

Rural Barriers

While people living in Alberta’s largest cities can face substantial barriers to cancer screening, those barriers take on entirely new dimensions for patients in rural and remote communities. For example, while Edmonton and Calgary have dedicated breast cancer screening clinics, other areas of the province do not have dedicated screening clinics and instead rely on AHS mobile Screen Test clinics.

The two 53-foot trailers roam the province 48 weeks of the year, setting up in small towns and communities to provide breast cancer screening for rural Albertans. Occasionally making use of a community centre or arena parking lot, the mobile clinics can see up to 50 patients a day for screening mammograms, and usually stick around each location for a few days or up to a week depending on demand. The program now serves women in 120 communities across Alberta.

Harmony McRae is the health promotion facilitator for Alberta Health Services Screen Test, which is part of the Alberta Breast Cancer Screening Program. She says that many women in rural communities face unique barriers, such as a lack of transportation or being unable to leave work.

“Sometimes women may have cultural beliefs where they may believe that cancer is a result of something they’ve done, like they deserve to get it,” says McRae. “One of the ways we address that is through survivor stories of women who have come to our program, have been diagnosed and treated, and are back to regular life.”

Misconceptions around the screening process itself can also keep women from taking advantage of the service. McRae says that while mammograms can be a bit uncomfortable, the team shares client comments to show that it’s not as bad as most people think.

The program now serves 26 First Nation and Métis communities. McRae says establishing trust with Indigenous communities, which have not always been well-served by the healthcare system, is crucial to making progress on screening rates.

“In many Indigenous communities, there have been projects that continue for a short time only to leave,” says McRae. “Sometimes it takes several years for us to build trust with communities. The women start to realize we’re not just coming once, we regularly come back.”

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