Introduction: Marginalized populations such as immigrants and refugees are less likely to receive cancer screening. Cancer Awareness: Ready for Education and Screening (CARES), a multifaceted community-based program in Toronto, Canada, aimed to improve breast and cervical screening among marginalized women. This matched cohort study assessed the impact of CARES on cervical and mammography screening among under-screened/never screened (UNS) attendees.
Methods: Provincial administrative data collected from 1998 to 2014 and provided in 2015 were used to match CARES participants who were age eligible for screening to three controls matched for age, geography, and pre-education screening status. Dates of post-education Pap and mammography screening up to June 30, 2014 were determined. Analysis in 2016 compared screening uptake and time to screening for UNS participants and controls.
Results: From May 15, 2012 to October 31, 2013, a total of 1,993 women attended 145 educational sessions provided in 20 languages. Thirty-five percent (118/331) and 48% (99/206) of CARES participants who were age eligible for Pap and mammography, respectively, were UNS on the education date. Subsequently, 26% and 36% had Pap and mammography, respectively, versus 9% and 14% of UNS controls. ORs for screening within 8 months of follow-up among UNS CARES participants versus their matched controls were 5.1 (95% CI¼2.4, 10.9) for Pap and 4.2 (95%¼CI 2.3, 7.8) for mammography. Hazard ratios for Pap and mammography were 3.6 (95% CI¼2.1, 6.1) and 3.2 (95% CI¼2.0, 5.3), respectively.
Conclusions: CARES’ multifaceted intervention was successful in increasing Pap and mammography screening in this multiethnic under-screened population.
Population screening for cervical and breast cancers reduces related morbidity and mortality. Ontario, Canada’s most populous province, has organized cervical and breast cancer screening programs and universal health insurance covers the cost of screening for residents. Nevertheless, inequities in screening participation persist; screening rates are lower in newcomer women, especially those of South Asian origin, and women who are older, of low SES, in poorer health, or otherwise marginalized.1–7 In 2006–2008, almost half of female immigrants living in Canada’s largest city, Toronto, were under-screened or never screened (UNS) for cervical cancer.2 A population-based study of Ontario women found that 57% of women immigrating since 1985 were up to date with mammography versus 66% of long-term residents, both well below the Canadian target of 70%.8