November 25, 2020
Read recommendations on how to make cancer screening services more resilient throughout the pandemic and beyond
The first wave of COVID-19 led to a scarcity of healthcare resources, and one measure was the pausing of cancer screening programs across Canada. This disruption will lead to cancers being found at a later stage, resulting in poorer health for many patients. Integrating high value and innovative practices will help to safeguard cancer screening as an essential service, and will support the cancer screening system’s resilience throughout the pandemic, or future pandemics.
To support cancer screening services, the Partnership, in collaboration with the cancer screening community, has identified the best available evidence and expert recommendations for continued service provision and prioritization during future outbreaks or service disruptions in the guidance document Management of Cancer Screening Services During the COVID-19 Pandemic and Building Resilient, Safer and Equitable Screening Services.
Guidance on building resilient screening services and programs
The primary recommendations provided by expert advisors and stakeholders are as follows.
Managing screening programs when dealing with constrained resources
Recommendation 1: Work with partners to develop pathways and prioritization frameworks and to support the sharing of information to ensure equitable screening during periods of constrained resources.
Recommendation 2: Utilize screening program data to inform capacity planning during periods of constrained resources.
Recommendation 3: Consider rationing proactive recruitment and correspondence to manage screening services.
Using evidence to focus screening activities on people who stand to benefit the most
Recommendation 1: Leverage FIT triage to improve colonoscopy access.
Recommendation 2: Implement risk-based management for individuals referred to diagnostic mammograms, colposcopy, and colonoscopy.
Recommendation 3: Develop a centralized referral uptake process (e.g. coordinated points of entry for receiving referrals).
Delivering cancer screening programs in a culture of safety
Recommendation 1: Ensure that masks are worn by patients and staff, and provide hand sanitizing stations.
Recommendation 2: Ensure screening centres are set up to enable patient flow and adequate physical distancing, and maintain a clean environment.
Recommendation 3: Perform pre-screening for COVID-19 symptoms and possible exposures prior to in-person screening tests.
Using digital health to optimize the screening journey
Recommendation 1: Provide virtual care when safe and feasible, especially for those who are immunocompromised and at highest risk for COVID-19 infection.
Increasing access to care closer to home
Recommendation 1: Implement human papillomavirus (HPV) self-sampling for cervical cancer screening, prioritizing populations that are more likely to be affected by COVID-19 related travel restrictions.
Recommendation 2: Continue to schedule mobile breast cancer screening clinics that visit communities so women can access breast cancer screening safely.
Supporting healthcare providers
Recommendation 1: Engage and communicate with primary care providers about cancer screening on an ongoing basis during COVID-19.
Recommendation 1: Partner with members of the multidisciplinary team, subject matter experts, community partners, and members of the public to plan screening services during the pandemic.
Recommendation 2: Build greater cancer awareness of the importance of cancer screening within communities.
Recommendation 3: Partner with screening participants and families as core members of the healthcare team to enable a person-centred approach to care.
Recommendation 4: Create a culture where feedback from patients, families, and public is sought out every day.
Addressing inequities in cancer screening
The COVID-19 pandemic has disproportionately affected some populations in Canada. There is a risk that inequities in access to cancer screening will be exacerbated. Efforts to support screening resilience must address inequities in access to high-quality, timely, and safe screening across the country, and not further deepen the disparities that already exist.
To demonstrate progress towards equitable access to cancer screening services, decision makers are encouraged to:
- Understand the different inequities that exist across communities, the extended marginalization of diverse populations, as well as the impact of systemic racism and other personal and intergenerational experiences with trauma.
- Work with First Nations, Inuit, and Métis and other diverse populations to co-create services, leverage community-based supports and adjust services to meet the needs of communities against the changing face of the pandemic.
- Explore opportunities to provide care closer to home, especially for those living in remote and very remote locations in Canada who experience reduced access to care during the pandemic.
While these recommendations can support planning for continued cancer screening services during the COVID-19 pandemic, and advance efforts to improve access for underserviced populations, there is more work to be done. Leveraging the recommendations in this guidance document on managing cancer screening services will build capacity to respond to healthcare challenges and opportunities afforded by the pandemic, enable focused and co-created interventions to reach those most in need, and improve screening access and health for all people living in Canada.