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

Ryan R. Woods,Colin Mar,Lisa Kan,Janette Sam,Erich V. Kliewer,Arminee Kazanjian,Kimberlyn M. McGrail,John J. Spinelli

doi:10.1002/cam4.1608

Ryan R. Woods, Colin Mar + Show 6 more

Open Access

https://doi.org/10.1002/cam4.1608

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Abstract

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.

Highlights

Programmatic breast cancer screening with mammography is offered across Canada in an effort to detect tumors at earlier stages and reduce mortality from breast cancer
Our study demonstrates that screening mammography participation rates in British Columbia (BC) are lower for some immigrant subpopulations compared to nonimmigrant women
We identified variation in participation rates when women are grouped by both world region of birth and by individual countries of birth

Summary

| INTRODUCTION

Programmatic breast cancer screening with mammography is offered across Canada in an effort to detect tumors at earlier stages and reduce mortality from breast cancer. 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]. The objectives of our study were: (1) to assess both screening participation and retention rates among BC’s most common immigrant sub-populations defined by country of birth; (2) to compare screening rates in these populations to those of nonimmigrant women; (3) to assess how breast screening rates vary with socio-demographic and health-related variables within these populations; and (4) to offer a specific focus on screening-eligible recent immigrant (

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Findings

| DISCUSSION