Cancer Prevention and Screening: Working together in NE Aboriginal Communities

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1 Cancer Prevention and Screening: Working together in NE Aboriginal Communities Amanda Hey MD CCFP FCFP Regional Primary Care Lead, Northeast Cancer Centre; October 12, 2012

2 Source: Cancer Care Ontario Aborignal Cancer Strategy II. 2012

3 North East LHIN Aboriginal Population ~ 10% NE population with Aboriginal identity* First Nations, Métis and Inuit Urban, Rural, Remote First Nations: On-reserve; Off-reserve (~57%)** A young demographic distribution (61% < 30 yrs old)** Métis: Primarily urban-based** DIVERSE Source: *NE LHIN Population Health Profile 2012; **NELHIN: IHSP-Engaging Aboriginal Peoples 2006

4 Cancer Incidence in Ontario First Nations All cancer incidence, Ontario, , ages Females * First Nations All Ontario Males * Age-standardized rate/100,000 * Significant difference between First Nations and All Ontario rates Rates age-standardized to the 1991 Canadian population Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

5 Trends in Cancer Incidence in Ontario First Nations All cancer incidence, Ontario, , ages Age-standardized rate/100, Females Year of diagnosis Males Year of diagnosis Rates age-standardized to the 1991 Canadian population Horizontal bars around First Nations rates indicate 95% confidence limits First Nations All Ontario Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

6 Colorectal Cancer and Ontario First Nations Colorectal cancer incidence, Ontario, , ages Age-standardized rate/100, Females Males Year of diagnosis Year of diagnosis Rates age-standardized to the 1991 Canadian population Horizontal bars around First Nations rates indicate 95% confidence limits First Nations All Ontario Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

7 Lung Cancer and Ontario First Nations Age-standardized rate/100,000 Lung cancer incidence, Ontario, , ages Females Year of diagnosis Males Year of diagnosis Rates age-standardized to the 1991 Canadian population Horizontal bars around First Nations rates indicate 95% confidence limits First Nations All Ontario Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

8 Cancer Prevention Modifiable Risk Factors Commercial tobacco use Alcohol Physical Activity Obesity Diet

9 Percent Modifiable Cancer Risk Factors Ontarians age 30 yr+, Cuurent smoker Alcohol > 2 drinks per day Inactive Obese Aboriginal Identity (off reserve) Non-Aboriginal Identity Source: CCO CSQI 2012

10 Incidence of Common Cancers in Ontario First Nations Incidence of common cancers, Ontario, , ages Colorectum Males Breast Females * Prostate Lung Kidney * Lung Colorectum Lymphoma Lymphoma Cervix Age-standardized rate/100,000 * Significant difference between First Nations and All Ontario rates Rates age-standardized to the 1991 Canadian population Age-standardized rate/100,000 First Nations All Ontario Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

11 Organized Cancer Screening Programs 3 cancer screening programs: Ontario Breast Screening Program ColonCancerCheck Ontario Cervical Screening Program Different stages of development Different information systems

12 Incidence of Common Cancers in Ontario First Nations Incidence of common cancers, Ontario, , ages Colorectum Males Breast Females * Prostate Lung Kidney * Lung Colorectum Lymphoma Lymphoma Cervix Age-standardized rate/100,000 * Significant difference between First Nations and All Ontario rates Rates age-standardized to the 1991 Canadian population Age-standardized rate/100,000 First Nations All Ontario Source: Surveillance & Aboriginal Cancer Care Units, CCO (2007)

13 Aboriginal Breast Cancer Study Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada C J Pub Health 2010 Amanda J. Sheppard 1,2, Anna M. Chiarelli 1,2, Loraine D. Marrett 1,2, Maureen E. Trudeau 1,2,3, E. Diane Nishri 1 Collaborators: Caroline Lidstone-Jones 1, Amanda Hey 4, John Shaw 5, Paul Ferner 6, Norman Boyd 7, Carol Rand 8, Yolanda Madarnas 9, Alison McMullen 10, Vincent Young 11, Joint Cancer Care Ontario Aboriginal Cancer Committee (JOACC) 1) Cancer Care Ontario; 2) University of Toronto; 3) Division of Medical Oncology/Hematology, Sunnybrook Health Sciences Centre; 4) Preventive Oncology and Screening, Sudbury Regional Hospital Cancer Program; 5) Ontario Breast Screening Program (OBSP), Windsor Centre; 6) OBSP London Centre; 7) Campbell Family Institute for Breast Cancer Research; 8) Juravinski Cancer Centre, Hamilton; 9) Cancer Centre of Southeastern Ontario, Kingston; 10) Thunder Bay Regional Health Sciences Centre 11) The Ottawa Hospital Cancer Centre

14 Conclusions 1. First Nations women were diagnosed with a later stage breast cancer more often compared to non-first Nations women. 2. Having a Non-screened detected cancer increased the risk of a later diagnosis 3. Being overweight or obese increased the risk of a later diagnosis 4. Having a co-morbidity at diagnosis was protective against a later diagnosis.

15 Awareness of Cancer Services Aboriginal Cancer Video In Our own Words Released March 27, 2008 To demystify cancer prevention, screening and treatment Address gaps in knowledge in a holistic perspective In the words of real-life Aboriginal cancer survivors Available in several Aboriginal languages

16 Colorectal Cancer Community Learning Series Partners Aboriginal Cancer Care Unit Canadian Cancer Society HRSRH-Regional Cancer Program Reference & Facilitators Manual

17 Community Learning Series Facilitator s Manual

18 North East Under/Never Screened Project: Lending a Hand to Take a Stand

19 Proposal Development Early 2011 Cancer Care Ontario (CCO) called for Letter of Intent to work with Under/Never Screened Populations Partnership approach undertaken with several Northeast Aboriginal communities Focus on breast & colorectal cancer screening Proposal developed, approved and funded to March 2013

20 North East Partners Mamaweswen, North Shore Tribal Council M Chigeeng Health Services Mnaamodzawin Health Services Noojmowin Teg Health Centre Shkagamik-Kwe Health Centre Weeneebayko Area Health Authority Wikwemikong Health Services Northeast Cancer Centre CCO Aboriginal Cancer Control Unit Canadian Cancer Society Northern Ontario School of Medicine Sudbury and District Health Unit Indigenous Health Knowledge Centre

21 Source: Cancer Care Ontario Aborignal Cancer Strategy II. 2012

22 Project Organization UNS Steering Committee UNS Working Group Evaluation Committee UNS Outreach Coordinators

23 Project Focus Establish baseline screening data Patient awareness, education and invitation to screening Health provider engagement Sustainable screening identification and invitation Identification of screening barriers Evaluation

24 Project Outcomes Increase cancer screening rates in partner communities Sustainable cancer screening identification and invitation systems Reduced cancer burden for Aboriginal people in the North East

25 Launch June 25, 2012

26 The Story We Want to Tell.. Strong relationships based on mutual respect and trust will be developed between CCO and FNIMs and other Aboriginal groups Current and comprehensive data on FNIM screening and cancer incidence will be compiled and updated FNIM smoking rates will be significantly reduced Slides 26-34, courtesy of Alethea Kewayosh, Director, Aboriginal Cancer Control CCO 26

27 The Story We Want To Tell.. FNIM will understand the importance of screening and participate in screening programs FNIM people will have the knowledge and understanding of cancer to make informed decisions for themselves and their families The cancer system will address the unique issues and challenges of FNIM with cancer Slides 26-34, courtesy of Alethea Kewayosh, Director, Aboriginal Cancer Control CCO 27

28 Here is how CCO will help make this story come true. Slides 26-34, courtesy of Alethea Kewayosh, Director, Aboriginal Cancer Control CCO 28

29 Strategic Priority 1: Build productive relationships Work with FNIM groups to develop relationship protocol agreements

30 Strategic Priority 2: Research and surveillance Develop screening and cancer incidence data to inform programming initiatives

31 Strategic Priority 3: Prevention Develop and implement a provincial smoking cessation agenda in collaboration with FNIM groups

32 Strategic Priority 4: Screening Implement a province-wide screening blitz, informed by under/never screened projects and FNIM database

33 Strategic Priority 5: Supportive care Help FNIM with cancer navigate the cancer system to improve their cancer journey and health outcomes

34 Strategic Priority 6: Education FNIM peoples knowledge and awareness of cancer is significantly enhanced through education and awareness initiatives

35 How CCO is assisting the NE Cancer Centre NE Cancer Centre has been selected as 1 of 3 LHIN s to establish: A full-time Aboriginal Cancer Patient Navigator A part-time Aboriginal Cancer Primary Care Lead Role descriptions currently being finalized

36 Acknowledgement (for ACS II) CCO for the vision of a cancer system that will help everyone FNIM leaders for their support and wisdom Aboriginal health committees for their guidance and input Regional Cancer Programs Joint Ontario Aboriginal Cancer Committee Colleagues and co-workers Many others who contributed to the strategy Slides 26-34, courtesy of Alethea Kewayosh, Director, Aboriginal Cancer Control CCO 36

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