Cervical cancer screening among women from Muslim-majority countries in Ontario, Canada

Background — Immigrant women are less likely to be screened for cervical cancer in Ontario. Religion may play a role for some women. In this population-based retrospective cohort study, we used country of birth as a proxy for religious affiliation and examined screening uptake among foreign-born women from Muslim-majority versus other countries, stratified by region of origin.

Methods — We linked several provincial databases and identified all women eligible for cervical cancer screening between April 1, 2012 and March 31, 2015. Women were classified into region of origin based on country of birth. Countries were classified as Muslim-majority (50% or more of the country’s estimated 2010 population identifying as Muslim) or not.

Results — Being born in a Muslim-majority country was significantly associated with lower likelihood of being up-to-date on Pap testing, after adjustment for region of origin, neighbourhood income, and primary care-related factors (adjusted relative risk 0.93 [95% CI 0.92-0.93]). Sub-Saharan African women from Muslim-majority countries had the highest prevalence of being overdue (59.6%), and the lowest adjusted relative risk for screening when compared to women from non-Muslim-majority Sub-Saharan African countries (ARR 0.77 [95% CI 0.76-0.79]). Adjusted relative risks were lowest for women with no primary care versus those in a capitation-based model (ARR 0.28 [95% CI 0.27-0.29] overall).

Conclusion — We have shown that being born in a Muslim-majority country is associated with a decreased likelihood of being up-to-date on cervical cancer screening in Ontario. Future research should explore this relationship in a culturally safe manner. We have also shown that access to primary care has a sizeable impact on screening uptake.

Impact — Screening efforts need to focus on identified subgroups as well as on increasing access to primary care for all.