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Correlates of non-adherence to breast, cervical, and colorectal cancer screening among screen-eligible women: a population-based cohort study in Ontario, Canada

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Abstract

Purpose

Breast, cervical, and colorectal cancers are cancers that can be detected early through screening. Despite organized cancer screening programs in Ontario, Canada participation remains low among marginalized populations. Although extensive research has been done about factors contributing to under-screening by cancer site, the predictors of under/never screened conjointly for all three types of cancer remain unknown.

Methods

Using provincial-level linked administrative data sets, we examined Ontario women who were screen-eligible for all three types of cancer over a 36-month period (i.e., April 2014–March 2017) and determined how many were up to date on 0, 1, 2, and all three types of screenings. Multivariate logistic regression was utilized to examine individual and structural predictors of screening with the group overdue for all screening being the reference group.

Results

Of the 1,204,551 screen-eligible women, 15% were overdue for all. Living in the lowest income neighborhoods (AOR 0.46 [95% CI 0.45–0.47]), being recent immigrants (AOR 0.54 [95% CI 0.53–0.55]), having no primary care provider (AOR 0.17 [95% CI 0.16–0.17]), and having no contact with health care services (AOR 0.09 [95% CI 0.09–0.09]) significantly increased the likelihood of being overdue for all versus no screening type.

Conclusions

Considering that more than 15% of screen-eligible women in Ontario were overdue for all types of cancer screening, it is imperative to address structural barriers such as lack of a primary care provider. Innovative interventions like “one-stop shopping” where screening for different cancers can be offered at the same time could promote screening uptake.

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Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Acknowledgments

This study was supported by funding from the Toronto Central Local Health Integration Network. Additional support was provided through the Ontario Ministry of Health and Long-Term Care, St. Michael’s Hospital, and the MAP Centre for Urban Health Solutions at St. Michael's Hospital. This study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. Dr. Aisha Lofters is supported by a New Investigator Award from CIHR. Dr. Aisha Lofters and Dr. Richard Glazier are supported as Clinician Scientists in the Department of Family and Community Medicine at the University of Toronto, and Dr. Glazier is supported as a Clinician Scientist in the Department of Family and Community Medicine at St. Michael's Hospital. Dr. Aisha Lofters is supported by a Chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital in Partnership with the Canadian Cancer Society.

Funding

Ontario Ministry of Health and Long-Term Care (MOHLTC).

Author information

Authors and Affiliations

  1. Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, M5B 2K3, Canada

    Mandana Vahabi

  2. ICES, Toronto, ON, Canada

    Mandana Vahabi, Aisha K. Lofters, Alexander Kopp & Richard H. Glazier

  3. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Aisha K. Lofters & Richard H. Glazier

  4. Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada

    Aisha K. Lofters & Richard H. Glazier

  5. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Aisha K. Lofters & Richard H. Glazier

  6. Dalla Lana School of Public Health, Toronto, ON, Canada

    Aisha K. Lofters & Richard H. Glazier

  7. Women’s College Hospital Research Institute, Toronto, Canada

    Aisha K. Lofters

Authors
  1. Mandana Vahabi
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  2. Aisha K. Lofters
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  3. Alexander Kopp
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  4. Richard H. Glazier
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Contributions

AK extracted the data based on specification provided by MV, AL, and RG. MV processed and analyzed the data and drafted the article. AL and RG reviewed the article critically for intellectual content. All the authors gave final approval of the version to be published and agreed to serve as guarantors of the work.

Corresponding author

Correspondence to Mandana Vahabi.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The Research Ethics Board of St. Michael’s Hospital in Ontario provided ethics approval for the study.

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Vahabi, M., Lofters, A.K., Kopp, A. et al. Correlates of non-adherence to breast, cervical, and colorectal cancer screening among screen-eligible women: a population-based cohort study in Ontario, Canada. Cancer Causes Control 32, 147–155 (2021). https://doi.org/10.1007/s10552-020-01369-y

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