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Study shows where mammographies underused in large urban cities


A new study from the Institute for Clinical Evaluative Sciences (ICES) shows that low income, high immigration areas of Toronto have significantly lower mammography rates than high-income low immigration areas, offering insight into how Toronto and similar urban areas could improve their screening rates.

Researchers compared mammography rates among four different areas of Toronto (low income-high immigration, low income-low immigration, high income-high immigration, and high income-low immigration) to examine mammography use by area for women aged 45 to 64 years old in 2000.

Of the over 113,000 women in the study group, 24% received a mammogram in 2000. However, only 21% of women in the low income-high immigration group had a mammogram compared with 27% in the high income-low immigration group.

“There’s a combination of patient, physician and system factors that can cause the underuse of mammography in large, multicultural urban cities like Toronto,” said lead author Dr. Richard Glazier, ICES adjunct scientist and scientist at St. Michael’s Hospital Inner City Health Research Unit.

“At the patient level there are barriers related to language, cultural norms, competing time demands, and lack of knowledge which need to be addressed. Strategies for improving physician interventions could include items such as better educational materials, flow sheets, and reminders.”

“Improving the system means removing indirect financial barriers for patients, such as transportation costs and time off work, having educational materials translated into a greater number of languages, creating more evening and weekend mammography clinics for those without work flexibility, and increasing the number of physicians willing to accept new patients in Toronto’s inner city.”

The study, “Geographic methods for understanding and responding to disparities in mammography use in Toronto, Canada”, is in the September 2004 issue of the Journal of General Internal Medicine.

Author affiliations: ICES (Dr. Glazier); Inner City Health Research Unit (Drs. Glazier, Matheson, Steele, and Ms. Creatore, Mr. Gozdyra, and Ms. Boyle), and Department of Family and Community Medicine (Drs. Glazier, Steele, and Moineddin), St. Michael’s Hospital; Departments of Family and Community Medicine (Drs. Glazier, Steele and Moineddin), and Public Health Sciences (Drs. Glazier and Moineddin), University of Toronto.

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

Read the Journal Article