Primary care physician involvement increases likelihood of cancer screening in people with cystic fibrosis: a population-based study from Ontario, Canada

Background — People with cystic fibrosis (pwCF) are living longer and with an increased risk of malignancies, preventative cancer screening is crucial. The objectives of this study were to determine cancer screening rates for pwCF compared to the general population, and assess the impact of primary care provider (PCP) involvement on screening rates among those with CF.

Methods — This population-based cohort study linked Canadian CF Registry data with health administrative databases. Four screening cohorts were identified: breast, cervical, colorectal pre-transplant, colorectal post-transplant. PCP involvement was defined using billing codes. Screening rates were calculated as the number screened divided by the number of person-years individuals were eligible for screening. Poisson regression was used to describe rates.

Results — In the CF cohort, 74/110 (67.3 %) were screened for breast cancer, and 321/541 (59.3 %) for cervical cancer. 186/402 (46.3 %) in the pre-transplant cohort were screened with colonoscopy and 75/148 (50.7 %) in the post-transplant cohort. Those with CF were significantly more likely to be screened for breast cancer (RR 3.39, 95 % CI 2.70–4.26) and colorectal cancer pre-transplant (RR 1.58, 95 % CI 1.37–1.82) compared to the non-CF cohort. Having a PCP increased the likelihood that pwCF received screening for breast cancer (RR 3.6, 95 % CI 1.13–11.44), cervical cancer (RR 1.71, 95 % CI 1.13–2.57), and colorectal cancer (pre-transplant population only) (RR 1.57, 95 % CI 1.06–2.32).

Conclusions — Screening rates for cancers in CF remain suboptimal. These results highlight opportunities to improve screening uptake through better integration of PCP in CF care models and to increase awareness of cancer risk.