Immigrant Women, Preventive Health and Place in Canadian CMAs

Cervical cancer is a disease that affects women of all ages (Health Canada 2002). It is one of the most common malignant diseases in women (Duarte-Franco and Franco 2003), with an estimated 9,900 potential years of life lost due to this disease in Canada in 2003 (National Cancer Institute of Canada 2007). Given its slow progression, identifiable cytological precursors and effective treatments, cervical cancer is also one of the most preventable human cancers (Leyden et al. 2005). With routine cervical cancer screening, the disease is preventable and curable when detected at an early stage (Fehringer et al. 2005; Johnston et al. 2004; Yi 1994). The recent introduction of the HPV vaccine is expected to also have significant health benefits. Cervical cancer screening commonly uses a Papanicolaou test or smear (referred to subsequently within this paper as Pap test) for early detection. Early detection provides the opportunity to observe any signs of pre-cancerous changes and eliminate abnormal cells before these they become cancerous. According to the Canadian Task Force on Preventive Health Care (formerly the Periodic Health Examination) and guidelines from the National Workshop on Screening for Cancer of the Cervix (Miller et al. 1991; Morrison 1994), screening is recommended following the initiation of sexual activity or at age 18. After two normal smears, routine Pap testing is advised every 3 years until the age of 69.