Thank you.
Good morning. My name is Alethea Kewayosh, and I am the director of the indigenous cancer care unit and indigenous health equity and coordination unit for Ontario Health. Joining me today is Amanda Sheppard, senior scientist, indigenous cancer care unit. Thank you for the opportunity to appear before the committee.
Ontario Health is an agency of the Government of Ontario with a mandate to integrate and transform Ontario's health care system. Ontario Health connects and coordinates the health system to make transitions into care easier for Ontarians, with a focus on driving value and ensuring equitable access to high-quality care when and where it is needed.
Indigenous people are the original inhabitants of Canada. Indigenous peoples are not a cultural group to Canada, but are distinct, constitutionally recognized peoples with aboriginal treaty rights. There are over 400,000 indigenous people in Ontario. This estimate undercounts the true number of first nations, Inuit and Métis people in Ontario.
Retrospective cohorts of females for first nations and other Ontarians were examined to assess breast cancer incidence, mortality and survival. First nations females had significantly lower incidence and mortality. However, once diagnosed with breast cancer, first nations females were significantly more likely to die, compared to other Ontarians.
In a matched cohort design comparing first nations to non-first nations women diagnosed with breast cancer in Ontario, survival was more than three times poorer for first nations women diagnosed at stage 1 than for non-first nations women. Furthermore, the risk of death after a stage 1 breast cancer diagnosis was about five times higher among first nations women with a comorbidity other than diabetes and was more than five times greater for women with diabetes than for those without a comorbidity. Therefore, having a pre-existing comorbidity was the most important factor in explaining the observed survival disparity among first nations women.
Improving care at breast cancer screening could increase their survival after early-stage breast cancer diagnosis.
There are very few cities that have examined breast screening uptake in Inuit and Métis.
The Ontario breast cancer screening program is a province-wide screening program that aims to reduce breast cancer deaths through regular screening. The program offers screening to two different groups of people who qualify for breast cancer screening. One is people aged 50 to 74 who are at average risk. OBSP recently expanded the program to people aged 40 to 49. The other group is people aged 30 to 69 at high risk.
Indigenous adults are often under-screened or never screened when it comes to cancer screening. There are many reasons for this, including intergenerational trauma and social determinants of health, and, specific to health and cancer care, stereotypes and prejudice, communication barriers and lack of translation, lack of trust for the medical system, having no family physician and poor coordination of care and jurisdictional issues.
There is no terminology for cancer in most first nations languages. In some first nations communities, cancer is a taboo subject that is surrounded in secrecy and fear, because historically, cancer was rare among first nations people.
The historical and cultural contexts have contributed to unique views and a generally pessimistic attitude toward cancer. When asked what they thought of cancer, the response was usually, “It's a death sentence.”
These views may impact the receptiveness to cancer education, prevention and delivery of care. Traditional spirituality, which is important to many indigenous people, may contribute to beliefs about cancer.
Ontario Health aims to improve cancer care for first nations, Inuit, Métis and urban indigenous people in Ontario. The indigenous cancer care unit strives to reduce inequities in care and access to cancer services to ultimately improve cancer outcomes. We do this by collaborating with regional, provincial and national indigenous and non-indigenous partners and organizations to develop and implement indigenous cancer strategies. Working together with the regional cancer programs and indigenous partners, the ICCU ensures that proposed programs and strategies are relevant and have the potential to be highly effective at the individual, family and community levels through the development of regional indigenous cancer plans.
One of the strategic priorities within the indigenous cancer strategy is cancer screening. The main objectives are to improve access and participation in cancer screening, improve coordination and integration of cancer screening services and support specific initiatives to improve organized cancer screening programs.
I would like to say I also share and appreciate the comments of the speaker prior to me.
Thank you for your time. I look forward to any questions that may come forward.
Meegwetch.