Breast cancer screening disparities among immigrant women by world region of origin: a population‐based study in Ontario, Canada

Vahabi, Mandana; Lofters, Aisha; Kumar, Matthew; Glazier, Richard H.

doi:10.1002/cam4.700

Cited by 70 publications

(84 citation statements)

References 36 publications

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“…Our participation results are consistent with prior Canadian studies that have reported lower breast cancer screening rates among immigrant women and specific immigrant subpopulations 9, 10, 11, 24. Recent data from Ontario, Canada9 demonstrated that among immigrant women, South Asians had the lowest breast screening utilization rate with the age 60‐69 group demonstrating lower screening than those aged 50‐59 years.…”

Section: Discussionsupporting

confidence: 92%

“…Geopolitical changes that have taken place over the immigration dates covered by this data file necessitated combining some countries into single groups: countries of the former Union of Socialist Soviet Republics (USSR) were assembled into a “Former USSR State” group; countries of the former Yugoslavia were aggregated into “Former Yugoslavia”; women from the People's Republic of China, Macau, Hong Kong, and Taiwan were combined into a single group labeled “CMHT” in all tables and figures. We created world regions based primarily on groupings of countries used by the World Bank19 and consistent with other recent Canadian studies 9, 20. Immigrant women from countries with <100 total women were pooled into an “Other Immigrant” group within each world region.…”

Section: Methodsmentioning

confidence: 99%

“…Disappointing breast screening participation rates as well as a desire to assess potential health inequities in cancer screening have motivated several recent investigations into potential screening disparities among socio‐demographic groups in Canada 4, 5, 6, 7, 8, 9, 10, 11, 12. Studies that have specifically examined breast screening have found screening disparities among immigrant subpopulations, as well as associations between mammography rates and duration of residence in Canada, primary care physician characteristics, primary care contacts, and other health and socio‐demographic variables 8, 9, 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

“…Studies that have specifically examined breast screening have found screening disparities among immigrant subpopulations, as well as associations between mammography rates and duration of residence in Canada, primary care physician characteristics, primary care contacts, and other health and socio‐demographic variables 8, 9, 10, 11, 12. Research in Ontario, Canada identified disparities in screening rates among immigrant groups defined by world region of birth, including that South Asians had the lowest breast screening rates among all groups examined 9. Further research from the same population suggests that South Asian women may have more advanced breast tumors at the time of diagnosis 13, 14.…”

Section: Introductionmentioning

confidence: 99%

“…The world region categorization used in prior Canadian studies8, 9, 11 pooled women from a diverse set of countries, all of which have sizeable populations in Canada. For example, the East Asia/Pacific group included Filipino, Chinese, Korean, and Japanese immigrants.…”

Section: Introductionmentioning

confidence: 99%

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Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population‐based study

et al. 2018

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Breast cancer screening programs operate across Canada providing mammography to women in target age groups with the goal of reducing breast cancer mortality through early detection of tumors. Disparities in breast screening participation among socio‐demographic groups, including immigrants, have been reported in Canada. Our objectives were to: (1) assess breast screening participation and retention among immigrant and nonimmigrant women in British Columbia (BC), Canada; and (2) to characterize factors associated with screening among screening‐age recent immigrant women in BC. We examined 2 population‐based cohorts of women eligible for breast screening participation (537 783 women) and retention (281 052 women) using linked health and immigration data. Breast screening rates were presented according to socio‐demographic and health‐related variables stratified by birth country. Factors associated with screening among recent immigrant women were explored using Poisson regression. We observed marked variation in screening participation across birth country cohorts. Eastern European/Central Asian women showed low participation (37.9%) with rates from individual countries ranging from 35.0% to 49.0%. Participation rates for immigrant women from the most common birth countries, such as China/Macau/Hong Kong/Taiwan (45.7%), India (44.5%), the Philippines (45.9%), and South Korea (39.0%), were lower than the nonimmigrant rates (51.2%). Retention rates showed less variation by birth country; however, some disparities between immigrant and nonimmigrant groups persisted. Associations between screening indicators and study factors varied considerably across immigrant groups. Primary care physician visits were consistently positively associated with screening participation; this variable was also the only predictor associated with screening within each of the groups of recent immigrants. Our study provides unique data on both screening participation and retention among Canadian immigrant women compiled by individual country of birth. Our results are further demonstration that screening disparities exist among immigrant populations as well as in comparison with nonimmigrant women.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population‐based study

et al. 2018

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Cancer Screening Disparities Before and After the COVID-19 Pandemic

Lofters,

Wu,

Frymire

et al. 2023

JAMA Netw Open

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ImportanceBreast, cervical, and colorectal cancer–screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic.ObjectiveTo assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income.Design, Setting, and ParticipantsThis population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country’s most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed.ExposuresNeighborhood income quintile, immigrant status, and primary care model type.Main Outcomes and MeasuresFor each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years.ResultsThe overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, −9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, −3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was −1.16 (95% CI, −1.56 to −0.77); for immigrant vs nonimmigrant, the β estimate was −1.51 (95% CI, −1.84 to −1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was −1.29 (95% CI, 16 −1.53 to −1.06); for immigrant vs nonimmigrant, the β estimate was −1.41 (95% CI, −1.61 to −1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models.Conclusions and RelevanceIn this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.

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Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada

et al. 2019

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BackgroundColorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population‐based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants.MethodsWe conducted a population‐based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50‐74 who were eligible for FOBT from 1 April 2013 to 31 March 2015.ResultsWe found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim‐majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90‐0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim‐majority countries.ConclusionsThese findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information.

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Breast cancer screening disparities among immigrant women by world region of origin: a population‐based study in Ontario, Canada

Cited by 70 publications

References 36 publications

Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population‐based study

Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population‐based study

Cancer Screening Disparities Before and After the COVID-19 Pandemic

Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada

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