Preventive care, such as cancer screenings, has the potential to save lives. However, equitable access to this care is hindered by several barriers, including limited access to primary care, difficulties in attending appointments, healthcare distrust and discriminatory practices within the health system.
A diverse team of clinicians across Canada collaborated to release a comprehensive set of 16 preventive care recommendations. These guidelines, published in Canadian Medical Association Journal, are designed to advance health equity for individuals who have been historically marginalized due to racism, sexism and other types of discrimination.
“We wanted to focus on health equity as it’s often an afterthought,” says Dr. Aisha Lofters, family physician at Women’s College Hospital and co-author of the study. “Most guidelines are developed for the entire population and don’t often focus on the needs of disadvantaged individuals.”
The recommendations call for colorectal cancer screening outreach to begin at age 45 instead of the current age of 50. They also suggest using a blood test, rather than a multi-visit skin test, for screening latent tuberculosis, as well as self-testing for cervical cancer screening.
British Columbia has launched a pilot project for HPV self-testing kits, while in Australia, all women can collect their own cervical cancer screening test samples. This approach enhances patient accessibility and promotes increased screening rates.
“Doctor’s office hours may not align with patients’ needs or accessing a provider could be challenging,” she explains. “People are recognizing that they can do this and that they’re capable of it. Let’s take this one step further and provide people with the option to do their own vaginal sample.”
Additional recommendations include screening for depression in adolescents and adults, screening for social risk factors like poverty and access to connect with resources, and streamlining access to primary care through automatic enrollment, like the process of enrolling children in school.
The guideline is grounded in the most current evidence and includes insights from individuals with diverse lived experiences through a patient-partner panel.
“We’re asking health leaders to think purposefully about their patients who are facing disadvantages,” says Dr. Lofters. “This goes back to the golden rule and the basic principles we learned in nursery school. If people are experiencing unfair treatment, it behooves us all to care.”
The team also developed www.screening.ca, which can assist primary care professionals in prioritizing individuals for preventive care.
Thank you to Dr. Lofters and the team for bringing health equity to the forefront of care.