Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada

Abstract

BackgroundBreast 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.MethodsWe 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.Results64 % 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).ConclusionTo 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.

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

“…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.…”

“…Our results provide additional detail, showing that participation rates are consistently poor among all countries in this regional group. Prior Canadian studies have also noted that breast screening participation is strongly associated with duration of residence in Canada 9, 10, 12, 24. Although we observed this same association within many of the immigrant groups we examined, immigrants from Iran and the UK did not show a clear association.…”

“…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.…”

“…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. Differences in screening rates within the immigrant population by length of residence in Canada have been reported, with much lower participation among more recent immigrants 10, 12…”