Abstract
Background Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening. Methods We conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two- year period of 2010-2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables. Results 64 % of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95 % CI 0.85 -0.88 for new immigrants and 0.90, 95 % CI 0.89-0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low- income neighborhoods, having a male physician, having internationally- trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22 % less likely to be screened compared to those who were (ARR 0.78, 95 % CI 0.77-0.79). Conclusion To enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.
Highlights
Breast cancer is one of the leading cause of mortality and morbidity in Canada
Data sources Data for this study was based on the following linked databases: The Citizenship and Immigration Canada (CIC) database, Ontario Cancer Registry (OCR); Ontario Breast Screening Program (OBSP); Registered Persons Database (RPDB); Ontario Physicians’ Claims Database – OHIP Claims; Institute for Clinical Evaluative Sciences (ICES) Physician Database (IPDB); Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD), The Client Agency Program Enrolment (CAPE) tables; the OHIP Corporate Provider Database (CPDB), and 2006 Canadian Census
Breast cancer screening rates increased with increasing neighborhood income, greater utilization of health services, and higher number of co-morbidities, having a periodic health exam, having a primary care physician, patient enrolment models Family Health Teams (FHT), Family Health Organizations (FHO) and Family Health Networks (FHN), having a female physician, and having a Canadian-trained physician (Tables 4 and 5)
Summary
Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. Despite extensive progress and effort in treatment, breast cancer remains one of the most life threatening conditions among women worldwide. Screening mammography is the most promising approach in early detection and treatment of the disease. Based on the 2008 Canadian Community Population Health Survey, 57 % of recent immigrants (residing in Canada
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