The Canadian Partnership Against Cancer is an independent, not-for-profit organization funded by the Canadian government to facilitate action on cancer control in Canada. The Partnership works with cancer experts, other charitable organizations, all levels of government, cancer agencies, national health organizations, cancer patients and survivors, and others to implement the Canadian Strategy for Cancer Control. The Partnership's work ranges from prevention and screening, research, supportive care, knowledge transfer, public engagement, and analysis of the cancer system. It uses a collaborative approach that is mindful of patient perspectives, and strives to be responsive to the needs of priority populations, including First Nations, Inuit and Métis peoples, rural and remote communities, and others facing barriers accessing health care in Canada..
Background:Breast cancer is the most commonly diagnosed cancer among women in Canada. Breast density substantially influences breast cancer risk and mammography performance. However, OncoSim-Breast, a Canadian microsimulation model representing breast cancer control, including cancer onset, screening, and survival, has not previously explicitly accounted for breast density. This study describes the incorporation of density-specific parameters into the OncoSim-Breast model. Data and methods:Breast density-specific inputs were integrated into OncoSim-Breast using data from five Canadian provinces. Three key parameters - prevalence, relative risk of breast cancer, and digital mammography performance (sensitivity and specificity) - were estimated by age group and breast density category, following the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) classification (categories A to D). Calibration experiments and internal validations were conducted to ensure the updated OncoSim-Breast model aligned with observed data from the Canadian Cancer Registry. Results:The prevalence of dense breasts declined with age: BI-RADS categories C and D accounted for 58% of women younger than 50 years and 26% of those aged 70 and older. Digital mammography sensitivity also decreased with increasing density: among women younger than 50 years, sensitivity was 88% for Category A and 69% for Category D. The updated OncoSim-Breast model accurately replicated age-specific incidence, age-adjusted incidence, and stage distribution based on historical data from the Canadian Cancer Registry (2010 to 2019). Interpretation:Incorporating breast density-specific parameters substantially improved the accuracy and policy relevance of OncoSim-Breast. The updated model provides a validated tool to inform screening policy decisions for Canadian women, allowing consideration for the effect of the variability of breast density among women.
BACKGROUND:Over the past two decades, Canada's public health system has undergone transformative structural changes that may impact chronic disease prevention (CDP). PHORCAST is a unique national study of CDP organizations in Canada that documents trends in organizational characteristics, funding, and priorities across the public health system. METHODS:PHORCAST conducted national censuses of CDP organizations in 2004, 2010, and 2023, including governmental and non-governmental organizations (NGOs) that develop and deliver CDP activities (classified as "resource" and "user" organizations, respectively). A standardized questionnaire captured organizational characteristics, populations served, staffing, funding, and activities. Descriptive statistics and stratified analyses were used to describe 20-year trends. RESULTS:Data from 258 organizations in 2004 (92% response), 239 in 2010 (90%), and 267 in 2023 (89%) revealed: (i) a shift toward more centralized delivery of CDP activities, with fewer organizations serving local populations and more serving provincial/territorial or national jurisdictions; (ii) a growing role of NGOs, the presence of which increased from 39 to 62% among resource organizations and from 36 to 51% among user organizations; (iii) declining prioritization of CDP especially among governmental user organizations (from 43% in 2004 to 26% in 2023); (iv) reduced reliance on federal/provincial funding and increased reliance on municipal and private sources; (v) persistent gaps in evaluation with only 19-22% of resource organizations reporting adequate staffing or budget; and (vi) a broadened CDP focus, particularly among NGOs, to include mental health and underserved populations. CONCLUSIONS:Canada's CDP landscape has become more centralized, increasingly NGO-driven, and financially unstable, with shrinking government prioritization despite rising chronic disease burdens. Strengthening system-wide capacity, evaluation infrastructure, and stable, equity-oriented funding models will be essential for building a resilient and effective CDP system.
Engaging knowledge users, including patient partners and health-system partners, in embedded health services research is increasingly recognized as essential for strengthening the relevance of research and improving the quality and equity of health services and is foundational to the success of team science. Existing engagement frameworks, however, often capture experiences at single time points and do not fully reflect relational dimensions over time such as trust, reciprocity, shared decision-making, and equity which can impact the outputs and outcomes of partnered research. There remains limited evidence describing how engagement unfolds or what conditions support or hinder meaningful, equitable partnerships in research. This study will address this gap by examining the ripple effects of a long-standing researcher–knowledge user partnership and identifying the relational and structural factors that sustain it. This qualitative, participatory study will be guided by critical patient-oriented research (cPOR), an approach that centres equity, shares power, and structurally situates lived/living experiences throughout the research process. In alignment with cPOR principles, patient partners and health-system partners are co-researchers across all stages of the study from inception through to development of data collection tools and will partner in analysis and interpretation. The study will be conducted within the Lung Health Equity Advisory Committee, a partnership co-established to address inequities in lung health, where patient partners, clinicians, policymakers, program implementers, and researchers have worked together since 2020. Data collection will be informed by patient engagement tools, such as the Engaging with Purpose Patient Engagement Framework, to assess experiences across five pillars: Co-Build, Support, Mutual Respect, Inclusiveness, and Impact, using document analysis and annual surveys. Analysis will be guided by the theoretical concept of ripple effects, to explore how engagement processes, outputs, and outcomes accumulate and influence subsequent phases of work. Data will be analysed using combined deductive–inductive content analysis, with triangulation across all data sources. Preliminary findings will be synthesized with partners through Ripple Effects Mapping (REM), a participatory approach that supports collective interpretation, visualization of impact pathways, and opportunities for continuous improvement. This study offers a novel approach to understanding the experiences and impact of long-standing research-knowledge user partnerships that are not bound by a specific project or timeline. By exploring this relational approach to engagement, we will generate nuanced insights into how knowledge-user engagement is built, experienced, and adapted over time within an equity-oriented partnership. The exploration of ripple effects is expected to strengthen real-time learning and partnership dynamics while offering a transferable model for other research teams seeking to embed iterative, partner-guided improvement into engagement practices that are sustained over time. Working closely with patients, community members, and people who plan and deliver healthcare helps make research more useful and can improve the quality and fairness of care. However, most ways of exploring engagement practices capture people’s experiences as snapshots at different points in time, and do not adequately unpack how aspects such as trust, shared decision-making, and fairness may impact long-standing relationships. This study will help fill this gap by looking at how engagement is experienced over time in a long-standing partnership and by identifying the relationship and system factors that help support meaningful and impactful partnerships. This study will use an approach that focuses on equity, shared decision-making, and lived/living experiences. Patient partners and health-system partners who have been working together since 2020 in the Lung Health Equity Advisory Committee to improve lung health outcomes for all have co-designed this study and research approach. They will help analyse and understand the results. We will collect information from project documents and surveys and work together to create a ripple effects map that visually traces how engagement activities, relationships, and collective decision-making contribute to outcomes and development of novel projects over time. This study will help us better understand how sustained partnerships are built, experienced, and can be improved over time. It will also provide a model that other research teams can use to understand and sustain how they work with partners for greater impact.
Cervical cancer is highly preventable and treatable but continues to affect thousands in Canada each year. Inspired by the World Health Organization's global elimination goal, Canada has committed to eliminating cervical cancer by 2040. The Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 outlines key strategies to increase human papillomavirus (HPV) vaccination, implement HPV primary screening, and improve follow-up care. It also prioritizes equity by embedding First Nations-, Inuit-, and Métis-specific actions and addressing systemic barriers faced by equity-denied populations. Provinces and territories have made progress, but more needs to be done to improve vaccination and screening rates. Recent advances, such as reduced HPV dosing schedules and HPV self-screening, offer promising opportunities to accelerate progress. Achieving elimination will require coordinated action to improve access, foster culturally safe care, and enhance data collection to identify and address inequities. This commentary highlights the need for intensified efforts and shared accountability to ensure all people in Canada benefit from cervical cancer prevention and care. With bold and inclusive action, Canada can become one of the first countries in the world to eliminate cervical cancer.
