When and how screening is resumed should be based on local factors, such as:
- Availability and impact on resources (e.g. PPE, staffing, and physical space)
- Local trends of COVID-19 infection, including public health recommendations and specific local vulnerability to infection (e.g., new infections in remote or isolated populations)
- Provincial and territorial government decisions and health system service resumption and infection control guidelines
Building resilient screening services requires collaborative decision-making across a complex set of health and social settings, but can be challenged by changing or limited data.
- Screening programmatic data can be leveraged to provide a history of test volumes, abnormal detection rates and cancer detection rates, which can be used to develop jurisdiction-specific strategies.
- Community-level data can be leveraged to understand local variations in screening services (e.g. ability to assess wait times for screening or access to primary care by socio-demographic
variables, geographic variables, and/or deprivation indices).
Embedding equity to develop resilient screening services and programs
Prevalent inequities in access to high-quality, timely, and safe screening across the country can be exacerbated during times of particular pressure on the health system. Recognizing that the COVID-19 pandemic has meant that some populations, such as older adults, racialized populations, LGTBQ2S+ persons, people living with disabilities and women, are at greater risk of experiencing poor health outcomes, efforts to support screening resilience should be centered on addressing these inequities. In an effort to address disparities, and not further the divide, the following equity principles are offered as a guide to embed a health equity approach to screening pandemic preparedness, response, and recovery.
Equity guiding principles
Understanding the needs of underserved populations requires engagement with those individuals, communities, and representative organizations.
- It is important to reflect on how one’s own power and privilege may be both perceived and enacted when communicating with individuals who are eligible for screening.
- Working closely with communities provides a better understanding of their needs, jointly moves towards workable solutions, and improves trust in the healthcare system, as a result, culturally safe and appropriate approaches to care can be developed and can help improve screening uptake.
- Enabling screening participants to make informed contribution to care and treatment decisions can ensure health services are provided in a holistic, dignified, and respectful manner.
- It is important to recognize the different inequities that may exist across communities – urban, rural, and remote.
- Travel restrictions that have been put into place in response to the COVID-19 pandemic, should be considered when assessing the provision of screening services to people who reside in rural and remote areas.
It is important to recognize that providing access to self-sampling methods and mobile cancer screening can enable care in or closer to the community, but it may not address all systemic barriers such as infrastructure (including information and supply/distribution systems), as well as systemic racism and other personal and intergenerational experiences with trauma.
For more information and references, download the guidance document Management of Cancer Screening Services During the COVID-19 Pandemic and Building Resilient, Safer & Equitable Screening Services.
COVID-19 resources are available to support and optimize screening restoration.