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How a community health centre boosted cancer screening for its Black and immigrant patients – CBC.ca

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Staff at the TAIBU Community Health Centre knew something needed to be done. 

Located in Scarborough, on the eastern edge of Toronto, the health clinic serves a predominantly Black and immigrant population. But looking at their patients’ charts, staff found the vast majority weren’t up to date with screening and the clinic was far below Ontario’s provincial screening averages.

It was a concerning trend, as research shows that delays in cancer screenings often lead to later diagnosis and a higher risk of death. 

“If the community is experiencing any challenges, the answers are within the community,” said Dr. Onye Nnorom, who was a family doctor at the clinic at the time. 

So back in 2013, the centre started reaching out to the community to find out why.

“One of the concerns that a number of patients mentioned was that they didn’t see any data that told them how their own community was doing with regards to cancer deaths or cancer outcomes,” said Nnorom. 

Other barriers were reported, too, including stigma and fear around cancer, language and cultural barriers, and a lack of education about cancer screening.

After listening to its patients, TAIBU created a task force to address patient concerns and improve its cancer screening rates for breast, colorectal and cervical cancer. 

Over a seven-year period, the clinic had surpassed provincial averages for those cancer screenings, said Nnorom, now an assistant professor at the University of Toronto’s Temerty Faculty of Medicine. 

The rates for breast and colorectal cancer screenings offered tripled from 2011 to 2018, while cervical cancer screening rates also improved. (In Ontario, cancer screening rates are reported as services offered instead of completed.)

TAIBU then conducted a further audit, reviewing more than 700 patient charts for the year 2017-2018 to see if patients who were offered screening actually followed through with the tests. It found 88 per cent of mammograms, 83 per cent of fecal occult blood tests (FOBT) and 99 per cent of Pap tests were completed.

The results of the program were published this month in a study in the medical journal Canadian Family Physician.  

Between 2011-2018, the rates of breast, colorectal and cervical cancer screening offered by TAIBU increased from 17 to 72 per cent, 18 to 87 per cent and 59 to 70 per cent respectively.

The centre credits its success to using an Afrocentric approach built on listening and putting the community first.

Staff developed a range of culturally sensitive materials — such as educational pamphlets featuring their own diverse clinicians and staff, provided information in different languages, had community ambassadors lead outreach efforts and launched an extensive phone-based followup program, where staff took the time to explain and answer questions about screening.

Nnorom said they hope the study provides other health-care providers with ideas on how to approach the issue of cancer screening in non-white and immigrant communities, who tend to be underscreened for cancer.

“Unfortunately, in Canada, we don’t have very good data that tells us more about people’s race or ethnicity or culture or different factors that impact their care and their outcomes,” she said.

‘Screening guidelines might have to be different’

In Canada, data on race or ethnicity and cancer isn’t collected, though Nnorom and other doctors say it’s needed to address gaps in our health-care system.

Such information could improve cancer prevention and treatment for Black and ethnic groups in Canada, said Dr. Mojola Omole, a surgical oncologist with Scarborough Health Network.

One stark example is highlighted by U.S. data that shows significant disparities between Black and white women when it comes to breast cancer — particularly when it comes to mortality.

According to the American Cancer Society, Black women in the U.S. have the highest breast cancer death rate, despite a lower incidence rate of the disease compared to white women.

Research in the U.S. and U.K. also shows that Black women tend to have a more aggressive form of breast cancer (triple negative breast cancer) and are often diagnosed at a younger age in comparison to white women.

Dr. Mojola Omole is a breast surgical oncologist and general surgeon at the Scarborough Health Network. (Turgut Yeter/CBC)

Canadian screening guidelines for breast cancer vary from province to province, but often start at age 50, unless the patient is at risk, has a family history of the disease or a known gene mutation.  

Gathering that data here could help inform — or even change — our current screening guidelines in Canada, said Omole.

“I do think our screening guidelines might have to be different, because we know some data that Black women present at an earlier stage,” she said. “So we might have to have a different approach.” 

Black women face other challenges too when it comes to cancer care, she said, like a lack of images to show the difference in scarring after reconstruction surgery on darker skin tones or even access to wigs that match different hair textures, for patients who have hair loss after chemotherapy. 

“All of those things currently aren’t being taken into consideration,” said Omole. 

Enhancing awareness

There are efforts being made to enhance awareness around the impact of cancer on people of colour in Canada. In October, Toronto’s Women’s College Hospital, in collaboration with the organization The Olive Branch of Hope, launched a website, created by Black women with breast cancer to help guide others on their journeys.

Michelle Audoin is the founder of another effort called Uncovered: A Breast Recognition Project, an online resource and photo series that shares the experiences of Black, Indigenous and women of colour with breast cancer. 

Michelle Audoin is the founder of Uncovered: A Breast Recognition Project. After her own diagnosis, Audoin developed the resource to help support Black women and women of colour with cancer. (Turgut Yeter/CBC)

Audoin started the project after her own diagnosis, when she found there was a lack of information about cancer’s impact on women of colour. 

“It could be from a lack of images of scars, like my situation was, to misinformation about what radiation burn looks like on melanated skin,” she said.

The women who have shared their stories for the project ran into similar issues, she said.

“They want to see images like them, of black and brown bodies and their reconstruction scars. They want to have more race-based data. They want to have support groups that reflect their cultural diversity as well,” said Audoin.

Francine Holness poses in front of her portrait for Uncovered: A Breast Recognition Project. The 43-year-old shared her journey with stage 4 metastatic breast cancer and hopes her story will help other women. (Turgut Yeter/CBC)

Francine Holness chose to share her story for the project, hoping to bring more awareness to some of the unique experiences women of colour encounter.

Holness discovered a lump in her breast in October 2020, but due to the pandemic, her diagnosis was delayed until January. She was then diagnosed with stage 4 metastatic breast cancer earlier this year. 

At 43 and with no known history of breast cancer in her family, she had not started regular mammograms.

Holness had a lumpectomy earlier this year and did several rounds of radiation, but the cancer had spread and chemotherapy isn’t an option. Her doctors have her on palliative medication. 

“I’m processing my mortality,” the mother of four said. “I may have 10 years. We don’t know. They’ve given me two to seven.”

She is already talking to her two daughters about their risk of breast cancer and the importance of undergoing genetic testing and screening, she said, so she can prepare them for “what’s ahead for them.”

She says she’s also focused on helping them navigate the health-care system as Black women and hopes her story may help others, too.


For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.

(CBC)

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Study suggests Pfizer COVID-19 vaccine only partially protects against Omicron – Toronto Sun

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The Omicron variant can partially evade protection from two doses of Pfizer and partner BioNTech’s COVID-19 vaccine, the research head of a laboratory at the Africa Health Research Institute in South Africa said on Tuesday.

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But the study showed that blood from people who had received two doses of the vaccine and had a prior infection was mostly able to neutralize the variant, suggesting that booster doses of the vaccine could help to fend off infection.

The Omicron variant, first detected in southern Africa last month, has triggered alarms globally of another surge in infections, with more than two dozen countries from Japan to the United States reporting cases.

The World Health Organization classified it on Nov. 26 as a “variant of concern,” but said there was no evidence to support the need for new vaccines specifically designed to tackle the Omicron variant with its many mutations.

Alex Sigal, a professor at the research institute, said on Twitter there was “a very large drop” in neutralization of the Omicron variant relative to an earlier strain of COVID-19.

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A separate lab test by virologist Sandra Ciesek of the University Hospital Frankfurt painted a somewhat bleaker picture.

Exposing the blood of vaccinated individuals to different virus variants, she found that the ability to mount an antibody response to Omicron in people who had three shots of BioNTech/Pfizer was up to 37 times lower than the response to Delta.

An antibody response to Omicron half a year after a two-shot regimen of Pfizer/BioNTech, Moderna or a mixed course of AstraZeneca/BioNTech was not even measurable, Ciesek added.

She posted only selected findings on Twitter, not including the number of samples, and the university said the paper had not yet been published.

“The set of data underscores that it makes sense to develop a vaccine that is adapted to Omicron,” Chiesek tweeted, adding that no conclusion could be drawn about protection against severe disease.

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WHO’s chief scientist, Soumya Swaminathan, said a large drop in the antibody response of vaccinated people to Omicron had been expected.

“This does not mean the vaccine will not work – T-cell immunity (is) likely to persist,” she said on Twitter, referring to a cellular immune response that is believed to prevent severe disease as a second line of immune defence.

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Researchers including Carsten Watzl of the German Society of Immunology and Penny Ward, visiting professor at King’s College London, said the findings underscored the need to get booster shots because a three-shot course would likely continue to protect against severe disease.

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Sigal’s lab tested blood from 12 people who had been vaccinated with two doses of the Pfizer/BioNTech vaccine, according to a manuscript posted on the website for his lab. The preliminary data in the manuscript has not yet been peer reviewed.

Blood from five out of six people who had been vaccinated as well as previously infected with COVID-19 still neutralized the Omicron variant, the manuscript said.

“These results are better than I expected. The more antibodies you got, the more chance you’ll be protected from Omicron,” Sigal said on Twitter.

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He said the lab had not tested the variant against blood from people who had received a booster dose, because they are not available in South Africa yet.

According to the manuscript, the lab observed a 41-fold decline in levels of neutralizing antibodies against the Omicron variant.

Sigal said on Twitter that figure is likely to be adjusted after his lab does more experiments.

While neutralizing antibodies are an indicator of the body’s immune response, scientists believe other kinds of cells such as B-cells and T-cells are also stimulated by the vaccines and help protect against the effects of the coronavirus.

The preliminary data does not indicate that the vaccine is less able to prevent severe illness or death. While lab tests are under way, BioNTech CEO Ugur Sahin said last week “we think it’s likely that people will have substantial protection against severe disease caused by Omicron.”

There is not significant data yet on how vaccines from Moderna, Johnson & Johnson and other drugmakers hold up against the new variant. All the manufacturers, including Pfizer and BioNTech, are expected to release their own data within weeks.

BioNTech’s Sahin told NBC News on Tuesday that the drugmaker has data coming on Wednesday or Thursday.

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Seven Omicron variant cases in Simcoe County linked to travellers from Nigeria – BayToday.ca

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The Simcoe Muskoka District Health Unit says it is investigating a household cluster in Simcoe County with seven confirmed COVID-19 cases that have a strong probability of being the Omicron variant of concern. All the cases are currently isolating at home.

“The cluster is linked to travellers who arrived in Simcoe County from Nigeria in late November,” says a news release.

The Simcoe Muskoka Health Unit borders the North Bay Parry Sound District Health Unit to the immediate south.

“Although the health unit is awaiting whole genomic sequencing of the samples which should be available in the next 7 to 14 days, given the travel history and the preliminary laboratory screening results, the likelihood of an Omicron cluster is very high.”

The Unit’s case and contact management team is currently following up with each case to identify close contacts regarding isolation and testing.

“Scientific data about the Omicron variant is still emerging,” said Dr. Charles Gardner, Medical Officer of Health. “Early evidence suggests that the variant might be more transmissible. While we continue to closely monitor this local situation, I urge all residents to remain vigilant about following public health measures, to monitor themselves for symptoms of COVID-19 and seek testing immediately if any should develop, and get vaccinated if they have not already done so.”

The rate of COVID-19 infection among the unvaccinated vaccine-eligible Simcoe Muskoka population is seven times higher than it is for the fully vaccinated population and the rate of COVID-19 hospitalizations is 15 times higher says Gardner. Getting the vaccine can lower the risk of serious illness, hospitalization, and death.

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Eating disorder symptoms and self-harm linked to higher levels of depression and anxiety during COVID-19 pandemic – Medical Xpress

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Timeline of ALSPAC assessments. NEET Not in education, employment or training. Gray text indicates the name of the ALSPAC questionnaire. Credit: DOI: 10.1186/s40337-021-00510-9

Young adults with previous self-harm or eating disorders reported higher levels of depression and anxiety during the pandemic, even when restrictions had eased, according to new research.

The study, led by the University of Bristol and funded by Elizabeth Blackwell Institute, Medical Research Council and Medical Research Foundation, has been published in the Journal of Eating Disorders. It looked at questionnaire information for 2,657 individuals from world-renowned health study Children of the 90s (also known as the Avon Longitudinal Study of Parents and Children) before and during the COVID-19 pandemic.

Researchers analyzed the relationship between previous reports of eating disorder symptoms and before the pandemic, and (symptoms of depression and anxiety) and mental wellbeing during the COVID-19 pandemic. The study also assessed whether , such as more sleep, relaxation techniques, or visiting green space, could be linked to and wellbeing in young adults with and without previous eating disorder symptoms or self-harm.

Researchers studied questionnaire data from 2017, when the participants were then aged 25 years, as well as data taken during the pandemic in 2020.

At age 25, 32 percent of the 2,657 young adults reported at least one eating disorder , 9 percent reported self-harm, and 5.5 percent reported both an eating disorder symptom and self-harm in the last year.

During the pandemic, those with previously reported eating disorder symptoms and/or self-harm had more symptoms of depression and anxiety, and worse mental wellbeing, compared to individuals without previous symptoms. This remained the case after adjusting for their pre-pandemic levels of depression, anxiety and mental wellbeing.

Lifestyle changes appeared to have little effect on the increased risk for mental health problems in those with prior eating disorder symptoms or self-harm.

Lead author Dr. Naomi Warne, Senior Research Associate at the University’s Centre for Academic Mental Health, said: “Eating and self-harm are common and troubling mental health problems among . In the UK, approximately 1.25 million people are living with an eating disorder and almost 1 in 15 adults report self-harm.

“Our research has highlighted individuals with prior self-harm and eating disorder symptoms are key risk groups and further longitudinal research is needed to understand their ongoing mental health as well as risk and protective factors.

“Individuals with previous eating disorder symptoms and self-harm should be considered vulnerable to depression and anxiety throughout the pandemic and beyond. Funding for rapid and responsive service provision is essential to reduce the impact of the on those with mental health problems.”


Explore further

One in four adults with depression or anxiety lacked mental health support during pandemic


More information:
Naomi Warne et al, Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: a UK-based birth cohort study, Journal of Eating Disorders (2021). DOI: 10.1186/s40337-021-00510-9

Citation:
Eating disorder symptoms and self-harm linked to higher levels of depression and anxiety during COVID-19 pandemic (2021, December 8)
retrieved 8 December 2021
from https://medicalxpress.com/news/2021-12-disorder-symptoms-self-harm-linked-higher.html

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part may be reproduced without the written permission. The content is provided for information purposes only.

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