Resumen
Background: In Canada, clinical practice guidelines recommend breast cancer screening, but there are gaps in adherence to recommendations for screening, particularly among certain hard-to-reach populations, that may differ by province. We compared stage of diagnosis, proportion of screen-detected breast cancers, and length of diagnostic interval for immigrant women versus long-term residents of BC and Ontario. Methods: We conducted a retrospective cohort study using linked administrative databases in BC and Ontario. We identified all women residing in either province who were diagnosed with incident invasive breast cancer between 2007 and 2011, and determined who was foreign-born using the Immigration Refugee and Citizenship Canada database. We used descriptive statistics and bivariate analyses to describe the sample and study outcomes. We conducted multivariate analyses (modified Poisson regression and quantile regression) to control for potential confounders. Results: There were 14,198 BC women and 46,952 Ontario women included in the study population, of which 11.8 and 11.7% were foreign-born respectively. In both provinces, immigrants and long-term residents had similar primary care access. In both provinces, immigrant women were significantly less likely to have a screen-detected breast cancer (adjusted relative risk 0.88 [0.79-0.96] in BC, 0.88 [0.84-0.93] in Ontario) and had a significantly longer median diagnostic interval (2 [0.2-3.8] days in BC, 5.5 [4.4-6.6] days in Ontario) than long-term residents. Women from East Asia and the Pacific were less likely to have a screen-detected cancer and had a longer diagnostic interval, but were diagnosed at an earlier stage than long-term residents. In Ontario, women from Latin America and the Caribbean and from South Asia were less likely to have a screen-detected cancer, had a longer median diagnostic interval, and were diagnosed at a later stage than long-term residents. These findings were not explained by access to primary care. Conclusions: There are inequalities in breast cancer diagnosis for Canadian immigrant women. We have identified particular immigrant groups (women from Latin America and the Caribbean and from South Asia) that appear to be subject to disparities in the diagnostic process that need to be addressed in order to effectively reduce gaps in care.
| Idioma original | English |
|---|---|
| Número de artículo | 42 |
| Publicación | BMC Cancer |
| Volumen | 19 |
| N.º | 1 |
| DOI | |
| Estado | Published - ene. 9 2019 |
Nota bibliográfica
Funding Information:This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the ICES or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, 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. The BC Cancer Agency and BC Ministry of Health approved access to and use of the data for this study, facilitated by Population Data BC. All inferences, opinions, and conclusions drawn in this paper are those of the authors, and do not reflect the opinions or policies of the data stewards. Immigration data was obtained from the Immigration, Refugees and Citizenship Canada database held at the ICES. AL is supported by a New Investigator Award from the Canadian Institutes of Health Research and as a Clinician Scientist by the University of Toronto Department of Family & Community Medicine. In addition to the authors, the membership of the CanIMPACT Administrative Health Data Group who undertook this work include: Natalie Biswanger, CancerCare Manitoba, Winnipeg, Manitoba; Kathleen Decker, Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba; Cynthia Kendell, Cancer Outcomes Research Program, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia; Monika Krzyzanowska, University Health Network, Toronto, Ontario, Canada; Sharon Matthias, CanIMPACT Patient Advisory Committee, Alberta; Nicole Mittmann, Cancer Care Ontario, Toronto, Ontario; Geoff Porter, Dalhousie University, Halifax, Nova Scotia; Dawn Powell, CanIMPACT Patient Advisory Committee, Ontario; Donna Turner, CancerCare Manitoba, Winnipeg, Manitoba; Robin Urquhart, Dalhousie University, Halifax, Nova Scotia; Bonnie Vick, CanIMPACT Patient Advisory Committee, Saskatchewan; Marcy Winget, Stanford University School of Medicine, Stanford, California, USA; Yan Yuan, University of Alberta, Edmonton, Alberta.
Funding Information:
This study was funded by the Canadian Institutes of Health Research (CIHR) (grant 128272). Additional funding received by The Canadian Centre for Applied Research in Cancer Control (ARCC), funded by the Canadian Cancer Society grant #2015-703549. The funding body played no role in the design of the study, the collection, analysis and interpretation of data, or in writing the manuscript.
Publisher Copyright:
© 2019 The Author(s).
ASJC Scopus Subject Areas
- Oncology
- Genetics
- Cancer Research
ODS de las Naciones Unidas
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