Not enough South Asian women in Peel get pap tests — and it could be a matter of 'life and death' - CBC.ca | Canada News Media
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Not enough South Asian women in Peel get pap tests — and it could be a matter of 'life and death' – CBC.ca

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A Brampton nurse is sounding the alarm that an increasing number of South Asian women are at high risk for cervical cancer because not enough of them are getting pap smears done. 

The Papanicolaou test, also known as a pap test or pap smear, is a method to screen the cervix for any precancerous or cancerous cells that can develop and cause cervical cancer. The test can detect cell changes before an individual experiences cancer symptoms and can lead to earlier interventions. 

Despite this — and despite the city’s booming population — Brampton’s cervical cancer screening rate is the lowest in the Greater Toronto and Hamilton Area at 48 per cent, according to a January report from Cancer Care Ontario. 

That’s well behind the provincial target of at least 80 per cent of eligible women getting a pap smear every three years. 

Testing has been declining among women between the ages of 21 and 24, per the report, dropping from 66 per cent in 2007-2009 to 39 per cent in 2019-2021.

Cancer Care Ontario says a lot of that decline was in the low income or “materially deprived” Peel region. 

Slides show colourized human cervical cell samples collected through Pap tests. Normal results (left) compared to abnormal results (right), as seen under a microscope. (Supplied by Catherine Brown/The Michener Institute of Education at the University Health Network)

Even though cervical cancer is treatable, the situation has become “a matter of life and death,” said Janine Herrmann-McLeod, co-chair of Brampton Caledon Health Coalition.

“It’s deadly because so few people are getting diagnosed early enough for it to be treatable,” she said.

Brampton women’s health advocate Donna Smith says she’s witnessing the impacts of low testing in her practice — and that a lot of the overdue women at high risk that she’s seeing are from the South Asian community.  

“What we see is women that come into the clinic that have lived in Canada for many, many years and they may have had their first pap test after 20 years living here, despite seeing a doctor frequently in the community,” said Smith, who is also a registered nurse with the William Osler Health System.

Brampton’s largest immigrant population is from India, according to the 2021 census. The average national testing rate among women in India is as low as two per cent and cervical cancer is the second leading cause of death, according to a 2023 National Library of Medicine report.

“They don’t know to ask for it once they reach Canada,” said Smith. 

Brampton nurse Donna Smith says she’s increasingly seeing more South Asian women at high risk of cervical cancer. (Submitted by Donna Smith)

Ontario Health runs a cervical cancer screening program under which Cancer Care Ontario sends letters to eligible people inviting them for a pap test, advising them on next steps following a test and reminding them to return for a screening. 

“The program’s goal is to reduce the risk of developing or dying from cervical cancer by increasing the percentage of people with a cervix (women, transmasculine and nonbinary people) who get screened regularly and who have timely and appropriate follow-up of abnormal results,” said the health agency in a statement to CBC Toronto.

The agency said it sends letters to 4.5 million people every year. Its regional screening data shows only 54 per cent of people eligible for testing in Ontario received it in 2020. 

The testing rate gap between the least racially diverse neighbourhoods and the most racially diverse neighbourhoods doubled from 2009 to 2021, according to the provincial cancer report.

William Osler Health System, a network that includes gynaecologists and performs colonoscopies, serves Brampton and North Etobicoke residents. 

Within the next 20 years, the number of all cancer cases in those communities is expected to double, the system says on its website, adding that by 2028, the need for radiation therapy is projected to increase more than 60 per cent. 

No OHIP, family doc shortage adds barriers

Last year, over 1,550 Canadian women were diagnosed with cervical cancer and over 400 women died from it, according to the Canadian Cancer Society. 

There’s a five year survival rate nearing 90 per cent if cervical cancer is caught at the first stage. But that survival rate plummets to about 15 per cent when the cancer is caught during the fourth and final stage. 

Women can get a pap test from their family doctor or at a clinic — but Ontario has an acute shortage of family doctors, and as of January, 2.3 million people didn’t have one, according to the Ontario Medical Association. The association expects the number of people without to double in the next two years.

On top of that, an increasing number of Brampton residents, mostly immigrants, don’t have OHIP because they only have temporary residency, Herrmann-McLeod said. 

The actual number is unknown; 2016 research by the Health Network for Uninsured Clients estimated that over 500,000 people in Ontario did not have OHIP. 

“I find it beyond disrespectful and inhumane,” said Herrmann-McLeod. 

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Smith says there’s “not really anyone” telling the immigrant community in Peel about the available services “so that they don’t get cervical cancer later in life.”

Peel Public Health did not respond to CBC Toronto’s questions about these concerns, but it did say in an email that its role “is more along the lines of monitoring/data collection.” 

$300 on shots a tough sell 

South Asian countries, like Pakistan, do not have vaccine programs to protect people from human papillomavirus (HPV), a sexually transmitted disease, according to the National Library of Medicine, and while India recently introduced a paid HPV vaccine, it does not have a national vaccination program.  

In Ontario, Ontario’s cancer agency says HPV testing is only available “on a user-pay basis for a cost of about $90 to $100 per test.” 

It notes on its website that, “because this test is not publicly funded and patients have to pay for it, most women do not have access to this test.” 

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In Ontario, kids in grade 7 can get the Gardasil HPV vaccine for free with parental consent. Anyone else needs to purchase it. They’ll need three shots, Smith says, which they are eligible to get between nine and 45 years of age. 

“That’s not really affordable to the majority of the population,” said Smith, pointing out that to eradicate cervical cancer countries will need to meet the World Health Organization’s goal of vaccinating 90 per cent of girls worldwide by the time they turn 15. 

No cancer centre in Brampton yet

In addition to a lack of screening, Brampton has no designated cancer surgery centre or gynaecological oncology centre, according to Ontario Health. 

Brampton is “committed to providing $125 million to support Brampton’s second hospital and build a comprehensive Cancer Care Centre at Brampton Civic Hospital,” city staff said in a statement to CBC Toronto. However, they did not provide a timeline for that plan.

Currently, the closest options are in Mississauga and Toronto, which Herrmann-McLeod says is an additional barrier for patients needing specialist care as “it takes them farther from their families.”

“Gynaecological surgery already makes people feel vulnerable,” Herrmann-McLeod said. 

“There is kind of some societal shame around it. I think having them (the centres) so far apart is not necessarily conducive to people wanting to get the surgery, especially if they’re scared.” 

COVID delayed testing, test results 

Ontario put screening programs for breast, cervical and colorectal cancers on hold in March 2020 in an effort to pool more available resources to deal with the pandemic.

That October, the then-provincial head of the Surgical Oncology Program at Ontario Health told CBC Radio’s As It Happens that cancer screening programs were down 80 per cent —  resulting in more advanced cancer cases. 

“It’s hard to exactly tell you how much we’ve lost,” he said. “We feel frustrated, obviously … The ability to detect cancer early in its stages is absolutely critical.” 

“The pandemic was disruptive both for data sharing and data analysis,” said Peel Public Health in a statement. 

“The team responsible for that work was redeployed for pandemic response so we’re catching up now on a lot of our routine reporting,” the agency said, noting that it only received 2020 data on cancer in the region last year. 

Even once testing resumed, Smith says women had to wait upwards of six months for results. 

“We’re still trying to recover,” she said.

She’s hoping at-home HPV testing — which she expects to be introduced in Ontario in 2025 — will help remove barriers.

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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