Six Important Facts About Colorectal Cancer Screening and Equity

As we work collectively in cancer care to prevent and treat colorectal cancer – which is the second-leading cause of cancer death in Canada – we’re looking at who is being screened, who isn’t, and the role that equity plays.

1. Colorectal cancer is one of the most treatable cancers if it’s caught soon enough.

Colorectal cancer is sneaky. Often, early warning signs such as bloating or changes in bowel habits can be dismissed or ignored. That is why regular screening is so important if you are over 50, even if you don’t have a personal or family history of the disease and you’re feeling fine.

Screening is a relatively simple process involving a self-administered fecal test that looks for hidden blood in your stool. Easy and non-invasive, it can be done at a time and location that you’re comfortable with. Not only can this test find cancers at early stages when there are more options for successful treatment and cure, it can also help to prevent cancer by finding early growths in the colon.

Right now every province and territory either has an organized colorectal cancer screening program, or is actively working toward putting one in place, which is good news for all people in Canada.

2. Fewer than half of eligible people are being screened for colorectal cancer.

Unfortunately, not everyone who is eligible is getting screened. In fact, even where screening rates are highest, only 55 per cent of those eligible have completed a fecal test as part of an organized cancer screening program. Where rates are lowest, just 18 per cent of the eligible population participate in organized screening.

However, this is changing. Experts in jurisdictions across Canada are coming together to monitor, report and learn from each another to support equitable access and increase participation in quality colorectal cancer screening programs.

As an example, many organized colorectal cancer screening programs send invitations to eligible people to participate, but each province or territory has a different approach to this. Each jurisdiction monitors its own results and shares the findings to support continuous improvement across the country.

You can read more about colorectal cancer screening rates here.

3. Increasing colorectal cancer screening rates to 60 per cent could save 130 lives each year.

Canada’s colorectal cancer screening community has set a target of screening 60 per cent of eligible individuals. If we could reach that goal, 250 people could avoid colorectal cancer and 130 deaths could be prevented each year.

In many cases, being screened is an issue of equity. If you are living on a low income, for instance, you are 14 per cent less likely to have been screened than someone with a high income.

Nearly two-thirds of immigrants who have been in Canada for less than 10 years said they hadn’t been screened because they didn’t know the fecal test existed or was needed. Aggregated pan-Canadian data show that immigrant groups from the Middle East, Western Asia and North Africa have the lowest screening rates.

However, immigrants from the Caribbean and Latin America have the highest screening rates – higher even than Canadian-born individuals. In addition, people who speak primarily English and/or French at home have higher screening rates than those who speak other languages.

4. We have evidence-based approaches that can close the colorectal cancer screening gap and there is amazing action underway.

Partners across the country are collaborating to implement strategies that support quality, equitable colorectal cancer screening for all people in Canada. This includes approaches such as:

• Supporting programs that help people access a regular healthcare provider, and working to ensure that all providers have the information and training they need to enable their patients to make informed decisions about colorectal cancer screening.
• Working together with communities on culturally appropriate approaches to colorectal cancer screening programs, particularly among First Nations, Inuit and Métis communities, recognizing the impact that experiences of racism in healthcare, the need for culturally safe service delivery and communication, lack of access, jurisdictional issues, and competing health issues have on screening participation.
• Collaborating with community groups on culturally appropriate programs and initiatives. For example, Alberta is working with groups like Calgary’s Punjabi Community Health Services to recruit participants for online focus groups to problem-solve together. International medical graduates serve as community liaisons, providing live language translation for the sessions and culturally appropriate information on cancer screening.
• Making it easier to access colorectal cancer screening, for instance by mailing fecal tests directly to those eligible. The flexibility of this self-administered test allows people to self-screen at home without interacting directly with the healthcare system, supporting continued screening during times of disruption and uncertainty such as the COVID-19 pandemic.

5. We have a strategy for improving colorectal cancer screening rates in Canada.

No single approach works for all groups.

The Canadian Partnership Against Cancer has released a report called Equity-focused interventions to increase colorectal cancer screening that includes recommendations for strategies that are co-created with communities to address their specific needs – everything from better data to better collaboration to better use of technology.

These recommendations support the implementation of the Canadian Strategy for Cancer Control, which calls for system-level changes to:

• Improve how services are adapted to the specific needs of different population groups
• Support practical research to gain a better understanding of barriers
• Offer training to enable cancer care providers to deliver culturally appropriate care to everyone.

6. Supporting equity is showing promising results. We can improve colorectal cancer screening participation.

The Canadian Partnership Against Cancer has invested $1.5 million in a multi-year initiative to help provinces and territories better identify populations which are under-screened for colorectal cancer and to work with local communities to find innovative ways to raise screening participation levels. Results so far are promising.

In the northern-most region of Northwest Territories, for instance, which includes some of Canada’s most remote communities, screening participation rates have doubled thanks to community-informed strategies. This increase happened during the pandemic, a time when rates declined in some other jurisdictions, and provides a positive example of the effectiveness of innovative local approaches.

At the same time, New Brunswick is working with food banks to reach individuals with lower incomes and learn what prevents them from participating in screening and what can be done to remove those barriers. This will help to inform the development of strategies to increase cancer screening uptake in regions throughout the province.

Take a moment to review our Equity-focused interventions to increase colorectal cancer screening report and learn more about the work underway to break down barriers to access, prevent more cases of colorectal cancer and save lives.

Be sure to consider your own personal health and take steps to get screened for colorectal cancer if you’re eligible. Talk to your friends and relatives to encourage them to get screened, too. Remember that colorectal cancer is one of the most treatable cancers if it’s caught soon enough – and screening can make all the difference.