Colorectal cancer screening in Canada: 2021/2022

Strategies to improve access to screening for rural and remote populations

Rural and remote populations face a variety of barriers in accessing preventative care, including longer travel times, higher costs and fewer available healthcare resources, and thus may be less likely to access or participate in cancer screening. Learn more about barriers in colorectal screening for people who live in rural and remote areas.

Seven provinces and one territory have strategies which they employ to improve access to screening in these populations. Most of the strategies have been co-developed with the community, and many include integrating colorectal cancer screening tests and education into breast or cervical mobile screening clinics.

Strategies to improve access to screening for rural and remote populations*

P/T  Strategies used Strategy co-developed with community?  Description of activities to improve screening access for rural and remote populations 
YT  · Improving access closer to home · Considering mobile screening
· Considering HPV self-testing
AB  · Media (small and mass)
· Provider assessment and feedback
· Mobile screening clinics
· Expand provider scope of practice
All: ✓ · Pilot nurse practitioner led integrated mobile screening services (mammogram, Pap, and FIT).
MB  · Comprehensive letter campaign sent to all eligible persons
· Cross program promotion
· Invitations, recalls, and reminders are actively sent to eligible persons.
· Two mobile breast screening clinics offer education on colon cancer screening and provide information on accessing test kits.
ON  1. Some nursing station accept FIT sample drop off
2. Expedited mail to support timely return of FIT kits
3. Mobile screening coach
4. Pilot program to improve access to the Fecal Immunochemical Test (FIT) in Sioux Lookout Zone First Nations communities
1. ✓
3. ✓
4. ✓
· People who live in First Nations communities can contact their nursing station to drop off their completed FIT at a nursing station rather than mailing the kit.
· People who have requested a FIT kit and live in rural postal codes in Ontario receive envelopes for expedited mail to support timely return of FIT kits to the lab following sample collection.
· Mobile coaches in select regions (North West, Hamilton Niagara Haldimand Brant) provide screening services to people who do not have a PCP or face barriers accessing existing screening services (e.g., transportation).
· Ontario Health (Cancer Care Ontario) is conducting a pilot to explore access to FIT and improve colorectal cancer screening participation in Sioux Lookout Zone First Nations communities by having FIT kit inventory available at nursing stations and health centres.
NB  1. Direct mailing of program correspondence and screening test to participants
2. Awaiting results from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’.
2. ✓
· Program invitations, reminders and at-home screening tests are mailed directly to participant regardless of area of residence.
· Leverage learnings from the project ‘Developing Strategies for Underscreened Populations through Community Engagement’.
NS  · Home screening FIT kit mailed to all Nova Scotians aged 50-74 · Removed barrier of access to FIT by mailing directly to all eligible Nova Scotians. Kit includes a postage-paid envelope for returning the test to the lab.
PE^  · Mail kits to the individuals home address.
NL  · Collaboration with primary care providers, regional networks and community groups to share regional data, provide education and promote program.
· Development of wordless instructions to be used throughout the screening program
· Provision of program promotional and education materials to encourage program participation

*Quebec does not have an organized screening program available so there are no concerted strategies in place. Each health institution is responsible for implementing the appropriate strategies to reach out to the population it serves.
PE: ^PE is the most densely populated province in Canada. A hospital or community health centre can be reached within 45 minutes or less by car.