Cancer survival is improving in Canada owing to earlier detection and treatment advances. Despite publicly funded health care in Canada, access inequities can prevent Black patients from achieving the full benefits of these advances in care. According to the most recent analysis of Canadian Cancer Registry (CCR) data from 2006 to 2016, linked to race and ethnicity data from the Canadian Census, mortality from breast, colorectal, prostate and pancreatic cancers is higher in Black patients than in white patients. (1) In general, however, the impact of ethnicity on cancer incidence and mortality is infrequently studied in Canada because Canadian registries do not routinely collect race and ethnicity data, unlike databases in the United Kingdom and the United States. Studies from the UK have shown that Black African and Caribbean men are more likely to develop prostate cancer, and survival is prolonged when access to cancer treatment is equalized. (2) We examine key areas where access inequities exist in Canada, and discuss mechanisms to improve access to cancer care for Black patients, based on a targeted search for evidence as outlined in Appendix 1, available at www.cmaj.ca/ lookup/doi/10.1503/cmaj.212076/tab-related-content.
What is known about gaps in access to care for Black patients with cancer in Canada?
In Canada, a lack of routine collection of race-based data by provincial and territorial cancer registries limits our understanding of how access to various cancer services affects racialized populations. Despite this limitation, some studies have linked Census data to provincial registry data to learn how ethnicity affects cancer screening, incidence and mortality. (1) Some provincial databases also use geography and socioeconomic status as imperfect surrogates for race and ethnicity. These approaches are inadequate and Canadian data on how race and ethnicity affect access to cancer clinical trials, hematopoietic stem cell transplantation (HSCT) and uptake of personalized medicine are lacking.
Detecting cancer at an early stage leads to better outcomes, including reduced morbidity and mortality, and improved survival. (3) Population-based screening programs for breast, cervical and colorectal cancers have been implemented across Canada, but Black and immigrant populations are disproportionately underrepresented in regular screening. (4) A population study of immigrant women in Ontario found that lack of cervical cancer screening was significantly associated with not having a female physician, not having a primary care provider at all, or coming from low-income households. (5) Thus, Black patients may experience additional barriers to cancer screening programs, and these barriers could limit uptake of screening services.
Clinical trials study novel tests and treatments for cancer to establish standards of care. Research that results in new standards of care should be representative of the population who will benefit, and under-representation can threaten the external validity of results. Clinical trials can also provide an opportunity to access breakthrough tests and treatments. The negative experiences of Black participants in the Tuskegee Syphilis Study introduced mistrust of health care systems. (6) Despite the international ethical codes that have been established in the past 50 years to prevent unethical research and combat institutional racism, ongoing public...