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Less than half of eligible Ontarians get all recommended screening tests for cancer, diabetes and heart disease

October 28, 2015 Toronto

A new study from the Institute for Clinical Evaluative Sciences (ICES) has found that only one third of women and less than half of men in Ontario get all the cancer, diabetes and heart disease screening tests for which they are eligible.

Infographic showing less than half of eligible Ontarians get all the recommended screening for cancer, diabetes and heart diseaseClick for full size image

Ontario and Canadian health guidelines recommend that all people be tested at determined ages for cervical, breast, and colon cancers, as well as for elevations of cholesterol and glucose. However, despite a range of province-wide strategies to encourage screening uptake, rates for the completion of all these tests for which a person is eligible continue to be low across the province.

Published today in the journal CMAJ Open, this new study reviews the health care records of over 6.6 million Ontarians (approximately 3.8 million women and 2.8 million men) who were age-eligible for these five screening tests in 2011, excluding those for whom the tests don’t apply due to previous diagnoses or treatment. The researchers used postal codes to break this population down into 18,950 “small areas” based on census dissemination areas (the smallest geographical census unit at less than 1,000 people). The researchers then used census data and physician billing claims to look at demographic factors for each small area including income, high school completion, language spoken at home, and physician characteristics.

Overall, the study found that among all small areas or neighbourhoods in Ontario, on average less than one third of women had completed all five screening tests for which they were eligible. Men fared slightly better, at roughly 40 per cent, but this may be explained by the fact that men require only three of these tests.

Additionally, screening rates (whether for individual tests or for all five tests combined) were progressively lower in areas showing lower rates of high school completion, lower income, and less individual attachment to a primary care physician. These trends applied regardless of sex or region.

“Because we examined the health data at the ‘small area’ or community level, our findings demonstrate that screening disparities could be identified and addressed at the neighbourhood level in order to improve widespread screening participation,” says study senior author Dr. Lawrence Paszat, a senior core scientist at ICES and principal investigator of the Ontario Cancer Screening Research Network. “For example, in addition to strengthening access to primary care at the community level, trained health advisors could canvass neighbourhoods, along with community-level interventions such as locally-focused promotional advertising or mobile health vans.”

The researchers note that this study, by the investigators of the Ontario Cancer Screening Research Network, is the first to examine community screening rates throughout Ontario. “We suggest setting a sequence of targets for improving the rates over the next 10 years to at least 65 per cent participation for all eligible men and women,” says Paszat. “This study will assist health policy planners, primary care teams  and local service agencies to better target neighbourhood interventions in order to reach  populations that are less likely to get screened, thereby improving early diagnosis and patient outcomes.”

“Since their implementation, Ontario’s organized breast, colorectal and cervical screening programs have contributed to the early detection of cancers and pre-cancers and have improved patient outcomes,” comments Dr. Jill Tinmouth, scientific lead, ColonCancerCheck, Cancer Care Ontario. “This research provides us with new insights to help explain why many eligible Ontarians are still not getting screened for these cancers and will enhance our efforts to increase screening participation across the province. Effective screening and earlier diagnosis are critical in reducing the incidence and impact of cancer and we are committed to ensuring that more Ontarians are getting screened regularly.”

“Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study,” was published today in the journal CMAJ Open.

Author block: Kimberly A. Fernandes, Rinku Sutradhar, Cornelia M. Borkhoff, Nancy Baxter, Aisha Lofters, Linda Rabeneck, Jill Tinmouth, Lawrence Paszat.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

Cancer Care Ontario – a division of CCO and the Ontario government’s principal cancer advisor – plays an important role in equipping health professionals, organizations and policy-makers with the most up-to-date cancer knowledge and tools to prevent cancer and deliver high quality patient care. It does this by collecting and analyzing data about cancer services and combining it with evidence and research that is shared with the healthcare community in the form of guidelines and standards. It also monitors and measures the performance of the cancer system, and oversees a funding and governance model that ties funding to performance, making healthcare providers more accountable and ensuring value for investments in the system. Cancer Care Ontario actively engages people with cancer and their families in the design, delivery and evaluation of Ontario’s cancer system, and shares CCO’s mission of working together to improve the performance of Ontario’s cancer system by driving quality, accountability, innovation and value.

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