Go to content

Only 37% of recent immigrant women in Toronto receiving cervical cancer screening


A new Institute of Clinical Evaluative Sciences (ICES) study shows that just 37% of recent immigrant women to Toronto are receiving Papanicolau (Pap) smears to screen for cervical cancer, despite recommendations that all women 18 to 69 years of age receive them.

“Although national surveys have demonstrated that women with lower income, lower education, those who speak a foreign language, and those who are not Canadian-born are less likely to report Pap smear screening, self-reporting of Pap smears may be subject to biases and no previous study of actual screening has examined immigrant or minority women,” said Dr. Rick Glazier, ICES senior scientist and report co-author.

To examine this issue further, investigators identified all women 18-66 years of age in Toronto who had a Pap smear between 2000 and 2002. Among this group, they examined any differences in Pap smear rates by socioeconomic status and recency of immigration. (The Toronto area receives almost half of all new immigrants to Canada and is now one of the most diverse urban areas in the world). To identify new immigrants, the investigators used people registering for healthcare in Ontario for the first time after 1993, 81% of whom are expected to be immigrants.

Of the over 724,000 women included in the study, 55% had Pap smears within the study period. Recent immigrant women comprised 22% of the study population and had screening rates of just 37%, compared to 61% for non-recent immigrants. Women who spoke a foreign language and visible minorities also had significantly lower rates of Pap smears. Low income and low education were also associated with lower Pap smear rates.

“Many patients do not understand why Pap screening is necessary for them. Cultural factors need to be considered and education is needed for both patients and doctors, as primary care physicians play a central role in explaining and recommending screening,” said Dr. Aisha Lofters, the study’s lead author.

“In addition, an organized screening program that tracks and attends to socially disadvantaged women, such as that under development by the Ontario Cervical Screening Program (OCSP), may prove to be essential in reducing socioeconomic differences in cervical cancer screening.”

The study, “Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada”, is in the June 2007 issue of the journal Preventive Medicine.

Author affiliations: ICES (Drs. Glazier and Moineddin); Department of Family and Community Medicine (Drs. Lofters, Glazier, and Moineddin), and Department of Public Health Sciences (Dr. Glazier, Agha, and Moineddin), University of Toronto; Department of Family and Community Medicine, Mount Sinai Hospital (Dr. Lofters); Department of Family and Community Medicine (Dr. Glazier, Dr. Lofters), and Centre for Research on Inner City Health (Drs. Glazier and Agha, Ms. Creatore), St. Michael’s Hospital.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare 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.


  • Julie Dowdie
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143

Read the Journal Article