Using geographic methods to inform cancer screening interventions for South Asians in Ontario, Canada

Aisha K Lofters,Piotr Gozdyra,Rebecca Lobb

doi:10.1186/1471-2458-13-395

Abstract

BackgroundLiterature suggests that South Asians in Ontario, Canada are under-screened for breast, cervical and colorectal cancer. Accordingly, we are involved in a community-engaged multi-phase study aimed at increasing cancer screening for this vulnerable group. In the work described in this manuscript, we aimed to use visual displays of spatial analyses to identify the most appropriate small geographic areas in which to pilot targeted cancer screening interventions for Ontario’s South Asian community.MethodsWe used Geographic Information Systems (GIS), including Local Indicators of Spatial Association (LISA) using GeoDa software, and population-level administrative data to create multi-layered maps of: i) rates of appropriate cancer screening, ii) the percentage of residents of South Asian ethnicity, and iii) the locations of primary care practices and community health centres by census tract in the Peel Region of Ontario (population: 1.2 million). The maps were shared with partner health service and community service organizations at an intervention development workgroup meeting to examine face validity.ResultsThe lowest rates of appropriate cancer screening for census tracts across the region were 51.1% for cervical cancer, 48.5% for breast cancer, and 42.5% for colorectal cancer. We found marked variation both in screening rates and in the proportion of South Asians residents by census tract but lower screening rates in the region were consistently associated with larger South Asian populations. The LISA analysis identified a high-risk area consisting of multiple neighbouring census tracts with relatively low screening rates for all three cancer types and with a relatively large South Asian population. Partner organizations recognized and validated the geographic location highlighted by the LISA analysis. Many primary care practices are located in this high-risk area, with one community health centre located very nearby.ConclusionsIn this populous region of Ontario, South Asians are more likely to reside in areas with lower rates of appropriate breast, cervical and colorectal cancer screening. We have identified a high-risk area appropriate for both patient- and provider-focused interventions. Geographic Information Systems, in particular LISA analyses, can be invaluable when working with health service and community organizations to define areas with the greatest need for interventions to reduce health inequities.

Highlights

Literature suggests that South Asians in Ontario, Canada are under-screened for breast, cervical and colorectal cancer
In Phase II, we are working with a community advisory group, consisting of primary care providers, community service agency representatives, and representatives of public health and health service organizations who all function in Peel, to select evidence-informed intervention strategies to address these barriers
Using GIS, we have identified a particular area in Peel Region which has a large South Asian population as well as consistently low screening rates for each of breast, cervical, and colorectal cancer

Summary

Introduction

Literature suggests that South Asians in Ontario, Canada are under-screened for breast, cervical and colorectal cancer. In Ontario, Canada’s largest province, a growing body of literature suggests that South Asians (i.e. people from India, Pakistan, Bangladesh and Sri Lanka) are vulnerable to under-screening for breast, cervical and colorectal cancer. Both breast and cervical cancer screening rates have been found to be lower among women who live in lowincome or high-immigration areas [1,2,3]. We are currently involved in a multi-phase communityengaged research collaboration whose ultimate aim is to institute a sustainable and effective breast, cervical and colorectal cancer screening intervention for Ontario’s South Asian community. Selected strategies will be piloted on a small scale and formatively evaluated to assess reach, acceptability and feasibility

Objectives

Methods

Results

Discussion

Conclusion