Health equity evaluation of a Canadian breast cancer screening program

Cancer screening programs can sustain or widen health inequities if services do not reach lower-income groups or recent immigrants who experience greater barriers to screening. The province-wide Canadian breast cancer screening program targets women ages 50-69 years for mammography, provides reminders to promote timely rescreening, and offers assistance to complete follow-up after abnormal findings. Seventy-two percent of women in this age group report mammography completion but only half are program participants. The remaining half complete mammography outside the program (non-participants) and do not receive program services. To assess whether participation in the Ontario program is disproportionately low among vulnerable groups, Cancer Care Ontario, responsible for implementing the breast program in Ontario, partnered with researchers to conduct a health equity evaluation that will: compare rates of mammography use by area income and recency of immigration; compare rates of mammography use for program participants and non-participants by area poverty and recency of immigration; and, compare rescreening rates within 30 months of a previous mammogram for program participants and non-participants by area poverty and recency of immigration. The sample includes female registrants in the Ontario Registered Person Database ages 50-69 years, with a mammography claim on file in the Ontario Health Insurance Plan or Ontario Breast Screening Program (OBSP) during January 1, 2001 - December, 31, 2008, without history of breast cancer. Findings from this study will contribute to research on health equity evaluations, and provide the OBSP with practical information to identify opportunities to increase participation and evaluate program performance.