Low income women less likely to be screened for cancer in Ontario

www.ices.on.ca/Aug 20 2009

Researchers find gap in cancer screening in Ontario based on income

Less than half of Ontario women with abnormal Pap tests receive recommended and potentially life-saving follow-up care, according to a new women's health study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES). What's more, low-income women are less likely to be screened for cancer compared to their high-income counterparts.

"Cervical cancer is one of the most preventable forms of cancer, yet in Ontario more than one million women have not been screened, and a disproportionate number of these are women living in lower-income communities," says Dr. Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the Project for an Ontario Women's Health Evidence-Based Report (POWER). "We need to make special efforts to reach women who are screened, but do not receive the necessary follow-up and may eventually fall through the cracks. To improve surveillance and treatment, we need a system that ensures all abnormal Pap tests are followed-up so that Ontario women can receive the best care possible," added Dr. Bierman, a researcher at ICES.

The joint study titled POWER (the Project for an Ontario Women's Health Evidence-Based Report), from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES), is the first in the province to provide a comprehensive overview of women's health in relation to gender, income, education, ethnicity and geography. The findings are detailed in the report titled Cancer - the second to be released this year as part of the study. Findings can be used by policymakers and health-care providers to improve access, quality and outcomes of care for Ontario women. Dr. Monika Krzyzanowska, a medical oncologist at Princess Margaret Hospital/University Health Network is the lead author on the cancer chapter. The POWER Study is funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.

According to the study, less than 50 per cent of women who had a Pap test that showed a low-grade abnormality had the appropriate follow-up care within the recommended time frame, including either a repeat test or colposcopy (a medical procedure that examines a woman's cervix and vagina). This is usually the group at greatest risk of eventually developing cervical cancer and therefore in greatest need of appropriate care. Timely follow-up of abnormal results is essential for cancer screening to work appropriately.

"According to the Cancer System Quality Index, between 2005-2007, 56 per cent of eligible women in Ontario completed all the cancer screening recommended for their age group," said Dr. George Pasut, vice president, Prevention and Screening, Cancer Care Ontario. "We need to continue to work to reach underscreened populations. This includes focused approaches to improve awareness of screening and access to screening and follow-up services."

The study found screening rates in Ontario for both breast and cervical cancers remain below provincial targets, despite the existence of long-standing screening programs for both cancers.

Women from lower-income neighbourhoods were at risk with consistently lower rates of screening for breast, colorectal and cervical cancer than women living in higher-income neighbourhoods. While the overall rate of cervical cancer screening in Ontario women was 69 per cent in the study, only 61 per cent of low-income women were screened compared to 75 per cent of high-income women.

"The findings are compelling," says Pat Campbell, CEO of Echo. "Clearly, the challenge for our health-care system is to help lower-income women and men, get early access to screening, diagnosis and treatment. This will require more patient-oriented services and understanding and removing the barriers that limit participation in health-care programs."