Primary-care crisis means women aren't getting timely cancer screening, says doctor

Women in central Newfoundland are waiting too long for cervical cancer screening, says a primary-care physician working at a health hub in Grand Falls-Windsor — with dire consequences in some cases.

Dr. Lynette Powell says there have "definitely" been patients who don't come until they're in the later stage of disease.

"A lot of the women sitting on our wait-list probably were sitting there for a number of months, and many of them were overdue, she told CBC News.

Central Newfoundland has two health hubs — the other one is in Gander — which provide primary health care to residents who don't have a family doctor.

In March, Powell said, there were almost 300 women on the Grand Falls-Windsor health hub's wait-list for cervical cancer screening.

"We put a very strong push on last month, and used some of our registered nurse colleagues who've been trained to do Pap smears, to try to clear some of the backlog. I think our list maybe has 75 women who are waiting now," she said.

Many of the women who were screened hadn't had a Pap test since 2019, said Powell.

"A lot of them were pre-COVID when they had their last Pap done."

Dr. Lynette Powell holds a young patient in Grand Falls-Windsor. (Peter Cowan/CBC )

In Newfoundland and Labrador, routine Pap testing is recommended for women 21 years old and up who are sexually active. It's recommended women screen annually for three years. If all Pap tests are negative, then screening is recommended every three years.

Screening can find abnormalities early, noted Powell, and keep people from getting cancer.

"Cervical cancer is actually probably one of the most preventable cancers," she said.

"Cervical screening is one of the tests that's very sensitive and it's very important that we catch these cancers early because they're completely preventable."

Powell says the true number of people who need a Pap test is likely much higher than the number of people waiting.

"I live in a small town. People generally know that I'm a physician, and it's a very rare day that I walk out in my community and somebody doesn't ask me about access to medical care. It's amazing how many women will ask me, 'How do I even get a Pap smear done now?'" she said.

"I would say multiple times a week women just spontaneously come up to me and ask, and I think a lot of my colleagues have experienced that as well."

Powell said it speaks to the need for more in-person access in central Newfoundland.

Dramatic drop in number of practising family doctors

Powell, who closed her own practice to work at the health hub and her local hospital a year and a half ago, says she's watched the number of family doctors in central Newfoundland drop dramatically.

"Central has been really a bit of a canary in the coal mine when it comes to the primary-care crisis. For example, in Grand Falls, we had maybe 25 to 30 family doctors in practice in 2019. We're down to about half a dozen now."

WATCH | Don't blame COVID-19 entirely for this medical wait-list, says Dr. Lynette Powell:

She believes that explains why some people aren't getting routine screening for cervical cancer.

"Sometimes we don't remember that we need to have a Pap test done. Sometimes you need prompting. When you had a family physician, your family physician probably would have prompted you or told you you're overdue for screening. So I hope that women are staying on top of when their last Pap smear was," she said.

Powell says Pap tests aren't the only type of cancer screening she fears women aren't receiving in central Newfoundland. Mammography has also become more difficult to get for women without a family doctor, particularly in the central west area, from Grand Falls-Windsor and west to Springdale.

"We're one of the few places that doesn't actually have a breast screening centre like the ones in St. John's or Gander. I understand that the province is working on that but right now women here need a referral from a family doctor to get a mammogram," she said.

In some parts of central Newfoundand women need a referral from a family doctor to get a mammogram. (Kimberly P. Mitchell/Detroit Free Press/AP)

Powell said women who don't have a family doctor in central-west Newfoundland can call the health hub for help ordering a mammogram. She also said women in central Newfoundland who want cervical cancer screening can call 709-292-8404 and leave a message saying they want to be added to the Pap screening list.

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