Cancer Awareness: Ready for Education & Screening (CARES) Program

Sometimes it’s just not as simple as making an appointment. In order to get screened for cervical cancer, Ramira needs to arrange care for her two children, cover transit costs and try to access information in her own language. On top of that, she’s concerned about ensuring that the test is done by a female practitioner.

Research has shown that more than half of women diagnosed with new cases of cervical cancer have never or seldom been screened.

We know that cervical cancer screening and mammography save lives, so it’s crucial to reach out to those who have not been screened or who are behind in screening. The CARES project (Cancer Awareness: Ready for Education & Screening) is reaching out to women who are homeless, under-housed, low income, immigrants or refugees, as well as people who identify as lesbian, bisexual, transgender or queer.

Funded by Cancer Care Ontario, CARES takes education and outreach into the community to provide on-site educational sessions at agencies that provide services to these target groups. The project is a collaboration between Women’s College Hospital, St. Michael’s Hospital and more than a dozen community-based agencies within the Toronto Central LHIN. The goal of this collaboration is to improve breast and cervical cancer screening rates.

Its wide scope is one of the unique aspects of CARES; it targets many different groups of under- or never-screened women. “Usually this type of intervention is focused on a single group,” says CARES project and research manager Catherine Moravac. “Our project aims to reach a wide cross-section of people.”

The program aims to reduce barriers that may prevent women from getting screened. For example, the concept of preventive health care may not resonate with all cultural groups, and many women have obstacles like child care, transit costs and language barriers. The program provides socially and culturally appropriate education materials and systematically breaks down barriers to screening by:

• arranging child care during the presentations

• providing TTC tokens so women can attend the presentation and get to screening appointments

• presenting the information and resource materials in different languages

• using multilingual peer educators

• providing female health-care professionals for screening procedures

• bringing care to the places that underscreened women already frequent

CARES ensures that women have the opportunity to have same-day Pap testing after the education session, as well as the opportunity to book a future Pap or mammography appointment. Peer educators also accompany groups of women to mammography appointments to provide support and help with things like filling out forms in English.

The CARES project has a dedicated nurse practitioner who will perform Pap tests and follow up with women. Some of the community partners are Community Health Centres which are also able to provide on-site Pap testing. At other sites, CARES has arranged for the use of a mobile bus with Pap-testing facilities, so the test can be done where it’s most convenient and discreet for women.

The project also includes a research component that will collect and analyze data on the impact of the program on screening rates, changes in knowledge, attitudes, susceptibility and screening behaviour before and after the program.

“As an ambulatory care facility, it’s important for Women’s College Hospital to be out in the community,” says Dr. Sheila Dunn, research director at the Family Practice Health Centre at Women’s College Hospital. “It’s breaking down the walls within the health-care system and delivering real solutions to the patients who need them most.”

Catherine Moravac
CARES Project and Research Manager
Women’s College Hospital
Dr. Sheila Dunn
Research Director of the Family Practice Health Centre
Women’s College Hospital


Ontario’s Action Plan for Health Care, Ministry of Health and Long-Term Care

“Ontario ranks among the best in the world with our cancer survival rates. However, we must be relentless in maintaining our efforts to save lives and early detection is fundamental to this effort.”