Not enough South Asian women in Peel get pap tests — and it could be a matter of ‘life and death’
A Brampton nurse is sounding the alarm that an increasing number of South Asian women are at high risk for cervical cancer because not enough of them are getting pap smears done.
The Papanicolaou test, also known as a pap test or pap smear, is a method to screen the cervix for any precancerous or cancerous cells that can develop and cause cervical cancer. The test can detect cell changes before an individual experiences cancer symptoms and can lead to earlier interventions.
Despite this — and despite the city’s booming population — Brampton’s cervical cancer screening rate is the lowest in the Greater Toronto and Hamilton Area at 48 per cent, according to a January report from Cancer Care Ontario.
That’s well behind the provincial target of at least 80 per cent of eligible women getting a pap smear every three years.
Testing has been declining among women between the ages of 21 and 24, per the report, dropping from 66 per cent in 2007-2009 to 39 per cent in 2019-2021.
Cancer Care Ontario says a lot of that decline was in the low income or “materially deprived” Peel region.
Even though cervical cancer is treatable, the situation has become “a matter of life and death,” said Janine Herrmann-McLeod, co-chair of Brampton Caledon Health Coalition.
“It’s deadly because so few people are getting diagnosed early enough for it to be treatable,” she said.
Brampton women’s health advocate Donna Smith says she’s witnessing the impacts of low testing in her practice — and that a lot of the overdue women at high risk that she’s seeing are from the South Asian community.
“What we see is women that come into the clinic that have lived in Canada for many, many years and they may have had their first pap test after 20 years living here, despite seeing a doctor frequently in the community,” said Smith, who is also a registered nurse with the William Osler Health System.
Brampton’s largest immigrant population is from India, according to the 2021 census. The average national testing rate among women in India is as low as two per cent and cervical cancer is the second leading cause of death, according to a 2023 National Library of Medicine report.
“They don’t know to ask for it once they reach Canada,” said Smith.
Ontario Health runs a cervical cancer screening program under which Cancer Care Ontario sends letters to eligible people inviting them for a pap test, advising them on next steps following a test and reminding them to return for a screening.
“The program’s goal is to reduce the risk of developing or dying from cervical cancer by increasing the percentage of people with a cervix (women, transmasculine and nonbinary people) who get screened regularly and who have timely and appropriate follow-up of abnormal results,” said the health agency in a statement to CBC Toronto.
The agency said it sends letters to 4.5 million people every year. Its regional screening data shows only 54 per cent of people eligible for testing in Ontario received it in 2020.
The testing rate gap between the least racially diverse neighbourhoods and the most racially diverse neighbourhoods doubled from 2009 to 2021, according to the provincial cancer report.
William Osler Health System, a network that includes gynaecologists and performs colonoscopies, serves Brampton and North Etobicoke residents.
Within the next 20 years, the number of all cancer cases in those communities is expected to double, the system says on its website, adding that by 2028, the need for radiation therapy is projected to increase more than 60 per cent.
No OHIP, family doc shortage adds barriers
Last year, over 1,550 Canadian women were diagnosed with cervical cancer and over 400 women died from it, according to the Canadian Cancer Society.
There’s a five year survival rate nearing 90 per cent if cervical cancer is caught at the first stage. But that survival rate plummets to about 15 per cent when the cancer is caught during the fourth and final stage.
Women can get a pap test from their family doctor or at a clinic — but Ontario has an acute shortage of family doctors, and as of January, 2.3 million people didn’t have one, according to the Ontario Medical Association. The association expects the number of people without to double in the next two years.
On top of that, an increasing number of Brampton residents, mostly immigrants, don’t have OHIP because they only have temporary residency, Herrmann-McLeod said.
The actual number is unknown; 2016 research by the Health Network for Uninsured Clients estimated that over 500,000 people in Ontario did not have OHIP.
“I find it beyond disrespectful and inhumane,” said Herrmann-McLeod.
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Smith says there’s “not really anyone” telling the immigrant community in Peel about the available services “so that they don’t get cervical cancer later in life.”
Peel Public Health did not respond to CBC Toronto’s questions about these concerns, but it did say in an email that its role “is more along the lines of monitoring/data collection.”
$300 on shots a tough sell
South Asian countries, like Pakistan, do not have vaccine programs to protect people from human papillomavirus (HPV), a sexually transmitted disease, according to the National Library of Medicine, and while India recently introduced a paid HPV vaccine, it does not have a national vaccination program.
In Ontario, Ontario’s cancer agency says HPV testing is only available “on a user-pay basis for a cost of about $90 to $100 per test.”
It notes on its website that, “because this test is not publicly funded and patients have to pay for it, most women do not have access to this test.”
In Ontario, kids in grade 7 can get the Gardasil HPV vaccine for free with parental consent. Anyone else needs to purchase it. They’ll need three shots, Smith says, which they are eligible to get between nine and 45 years of age.
“That’s not really affordable to the majority of the population,” said Smith, pointing out that to eradicate cervical cancer countries will need to meet the World Health Organization’s goal of vaccinating 90 per cent of girls worldwide by the time they turn 15.
No cancer centre in Brampton yet
In addition to a lack of screening, Brampton has no designated cancer surgery centre or gynaecological oncology centre, according to Ontario Health.
Brampton is “committed to providing $125 million to support Brampton’s second hospital and build a comprehensive Cancer Care Centre at Brampton Civic Hospital,” city staff said in a statement to CBC Toronto. However, they did not provide a timeline for that plan.
Currently, the closest options are in Mississauga and Toronto, which Herrmann-McLeod says is an additional barrier for patients needing specialist care as “it takes them farther from their families.”
“Gynaecological surgery already makes people feel vulnerable,” Herrmann-McLeod said.
“There is kind of some societal shame around it. I think having them (the centres) so far apart is not necessarily conducive to people wanting to get the surgery, especially if they’re scared.”
COVID delayed testing, test results
Ontario put screening programs for breast, cervical and colorectal cancers on hold in March 2020 in an effort to pool more available resources to deal with the pandemic.
That October, the then-provincial head of the Surgical Oncology Program at Ontario Health told CBC Radio’s As It Happens that cancer screening programs were down 80 per cent — resulting in more advanced cancer cases.
“It’s hard to exactly tell you how much we’ve lost,” he said. “We feel frustrated, obviously … The ability to detect cancer early in its stages is absolutely critical.”
“The pandemic was disruptive both for data sharing and data analysis,” said Peel Public Health in a statement.
“The team responsible for that work was redeployed for pandemic response so we’re catching up now on a lot of our routine reporting,” the agency said, noting that it only received 2020 data on cancer in the region last year.
Even once testing resumed, Smith says women had to wait upwards of six months for results.
“We’re still trying to recover,” she said.
She’s hoping at-home HPV testing — which she expects to be introduced in Ontario in 2025 — will help remove barriers.
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