Exploring indigenous and visible minority women’s access to preventive breast and cervical cancer screening in Canada: a narrative review

Abstract

Canada’s health care system is founded on the principles of need rather than ability to pay, priding itself for its decentralized, publicly-funded health care system that provides firstdollar coverage for preventive services across all provinces and territories (Allin et al. 2020; Kumachev et al. 2016). Despite best efforts through federal sharing and the indisputable evidence for early preventive mammography and Pap smear screening, profound disparities are found in service availability, utilization and accessibility for Indigenous and Visible Minority women in Canada (Amankwah et al. 2009; Demers et al. 2015; Ferdous et al. 2020). The purpose of this narrative review is threefold: to explore the incidence of breast and cervical cancer amongst Indigenous and Visible Minority populations in Canada, to explore potential barriers associated with the uptake of mammograms and Pap smear tests by these two populations; and to explore achievable interventions to improve access to cancer preventive services for Indigenous and Visible Minority women. This review uses the WHO Social Determinants of Health framework (SDOH) (World Health Organization 2010) rooted in equity to guide the review of the literature, and the Five Dimensions of Accessibility of Healthcare Services (Levesque et al. 2013) to guide the thematic analysis of intervention models. An initial literature search was conducted using Google Scholar and Science Direct databases for articles published from 2000 to 2022, yielding 8,462 articles. After screening for irrelevant titles, and non-Canadian studies, 97 publications remained. After 71 duplicates and publications that did not meet the search criteria were removed, a manual search was performed, yielding a total of 34 publications that were included in the narrative review. Of these 34 articles, 17 articles concerned Visible Minority populations and 17 articles, Indigenous populations. The articles included in this review covered four provinces: (1) British Columbia, (4) Manitoba, (13) Ontario and (2) Quebec, with the remaining 14 referencing Canada as a whole. The studies shared similar trends in breast and cervical cancer incidence and screening uptake for Indigenous and Minority women, with Pap smear uptake being lower than the national threshold and mammography uptake being lower in these populations compared to the rest of the Canadian population. Through thematic analysis, the most common barriers influencing accessibility and underutilization of preventive breast and cervical cancer were found to include socioeconomic status, culture and communication, education, lack of appropriate health care providers, and societal beliefs and attitudes towards cancer screening amongst both populations. Finally, possible interventions were identified in the literature that may inform strategies to achieve more equitable access to healthcare services tailored to Canada’s multicultural society.