Thank you for the opportunity to appear before the committee again.
Joining me is Amanda Sheppard, senior scientist for the indigenous cancer care unit.
When it comes to breast cancer and indigenous women, recent data suggests lower participation in breast cancer screening among first nation persons in Ontario. First nation communities in Ontario have raised concerns about cancer diagnosis at younger than screen-eligible ages and about difficulties accessing screening. The joint Ontario indigenous health committee shared these concerns with our team and provided a recommendation to apply for research funding to learn more, a recommendation we are looking into.
We have found that trends in getting and dying from breast cancer have improved over time for first nation women in Ontario. However, once a first nation person has breast cancer, they have a lower chance of surviving compared to other Ontarians. Specifically, first nation women are 41% more likely to die 10 years after their cancer diagnosis. Descriptive data also reveals that first nation women are diagnosed with breast cancer four years younger than other women in Ontario and that the interquartile range starts at age 48.
Research data has highlighted the breast cancer experience of first nation women in the context of screening for those aged 50 to 74. We do not have data to describe the benefit of screening commencing at age 40. Therefore, research is required to learn about breast cancer prognosis among indigenous women aged 40 to 49 and to better understand how a cancer screening program can be tailored to best provide equitable access to screening in this age group.
As outlined in my November 18 presentation to the committee, the Ontario breast 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 group is people aged 50 to 74 who are at average risk for breast cancer, which was expanded to include people aged 40 to 49 as of October 8, 2024. The other group is people aged 30 to 69 who are at high risk for breast cancer.
Indigenous adults are often underscreened or never screened when it comes to cancer screening. There are many reasons for this, including intergenerational trauma and social determinants of health. Some reasons specific to health and cancer care are stereotypes and prejudice, communication barriers, the need for translation services, a lack of trust for the medical system, no primary care provider, poor coordination of care, jurisdictional issues between the federal and the provincial governments, racism in the health care system, transportation issues, not having a valid OHIP and many others. We need to do everything we can to ensure that indigenous women have the same health outcomes as other women in Canada.
Recently, members of my team were invited to two remote first nation communities in northern Ontario to talk about cancer screening and preventative health care. Almost every single person they met in those communities had been personally affected or had a first degree relative affected by cancer. The major issue flagged was that community members do not have access to health care in a timely manner.
The non-insured health benefits program provides medical transportation for eligible first nations clients and Inuit clients who are travelling out of the community for a range of health benefits, including breast cancer screening and follow-up. We have heard directly from community members that issues with NIHB medical transportation are one of the main factors in accessing health care in a timely manner.
Lately, there have been significant delays in booking travel for appointments, including mammograms and associated follow-up, which cause patients to miss appointments. This is especially a concern when the appointment is for a mammogram and leads to a later missed cancer diagnosis or for a specialist appointment that the community member will have to wait six to 12 months to reschedule. We heard from community members that when they have to wait such a long time for a rescheduled appointment, they often choose to just not go. As a result of all this, as we heard from one community, people they know are being diagnosed at later stages and are choosing not to get treated.
There's also a large Inuit population in Nunavut; however, there is no breast screening in the territory. The current process is for Inuit women to be flown to Ottawa for mammograms. As a result of this, it was noted that mammograms are typically only requested when an Inuit woman finds a lump. At this point, the woman would be sent for diagnostic testing and not for a mammogram. Early detection should be easier to access to ensure that indigenous women can access breast screening at a younger age so we can catch cancers early.
To reduce barriers and support first nations, Inuit, Métis and urban indigenous adults in accessing cancer screening in Ontario, we have developed an indigenous cancer patient navigator program, mobile cancer screening coaches and a Sioux Lookout and area FIT kits on-hand program to screen for colon cancer. These first nation, Inuit, Métis and urban indigenous cancer strategies are developed in collaboration with first nations, Inuit, Métis and urban indigenous partners.
Thank you.