Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
cancer programme in 1988. Two years later, the province of Ontario began
to provide population-based breast cancer screening for women aged 50 or
older. Following this, the Canadian Breast Cancer Screening Initiative was
launched with funding support from Health Canada, and a pan-Canadian
breast screening surveillance database was established based on provincial data.
Organized breast cancer screening is now the norm rather than the exception in
Canada (Cancer Care Ontario, 2010; PHAC, 2011). It is estimated that screening
contributed to roughly half of the reduction in breast cancer mortality in
Canada between 1986 and 2005 (Wadden, 2005). Cervical cancer screening
and surveillance followed a very similar trajectory in the 1990s.
In the 2000s, there has been a major effort to improve and extend screening
for colorectal cancer, the second leading cause of cancer mortality in Canada.
By 2004, clinical guidelines had been established for colorectal cancer testing.
In 2007, based on the success of an earlier pilot project, the government of
Ontario established a province-wide, population-based colorectal cancer
screening programme, the same year that the Government of Manitoba set
up its own organized screening pilot project. One year later, a large sample of
Canadians was asked if they had received the recommended colorectal cancer
testing to determine the impact of population-based as opposed to physicianbased
screening (Table 5.1). Although self-reported results must be treated
cautiously, they did indicate substantially higher levels of screening in Ontario
and Manitoba and will most likely encourage other provinces to institute
population-based screening for colorectal cancer.
All provincial and territorial ministries of health also devote resources to
communicable and infectious disease control. However, given the geographical
reach of such diseases and the rapidity with which they spread, the federal
government has begun to play a larger role in both control and surveillance. The
SARS (severe acute respiratory syndrome) outbreak in 2003 and the advisory
report that followed in its wake were the catalysts for a policy change, which
many public health advocates considered overdue (Health Canada, 2003). One
year later, PHAC was established with a mandate to monitor, prepare for and
respond to disease outbreaks in addition to other public health functions.