BMC Cancer
Volume 19, Issue 1, 2019

Disparities in breast cancer diagnosis for immigrant women in Ontario and BC: Results from the CanIMPACT study (Article) (Open Access)

Lofters A.K.* , McBride M.L. , Li D. , Whitehead M. , Moineddin R. , Jiang L. , Grunfeld E. , Groome P.A. , Biswanger N. , Decker K. , Kendell C. , Krzyzanowska M. , Mittmann Matthias S.N. , Porter G. , Powell D. , Turner D. , Vick B. , Winget M. , Yuan Y.
  • a Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond St, Toronto, M5B 1W8, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, ICES, Toronto, Canada
  • b BC Cancer, Vancouver, Canada, School of Population and Public Health, University of British Columbia, Vancouver, Canada
  • c BC Cancer, Vancouver, Canada
  • d ICES, Queen's University, Kingston, Canada
  • e Department of Family and Community Medicine, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, ICES, Toronto, Canada
  • f ICES, Queen's University, Kingston, Canada, Critical Care Services Ontario, Toronto, ON, Canada
  • g Department of Family and Community Medicine, University of Toronto, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, ICES, Toronto, Canada, Ontario Institute for Cancer Research, Toronto, ON, Canada
  • h ICES, Queen's University, Kingston, Canada, Department of Public Health Sciences, Queen's University, Kingston, Canada, Cancer Research Institute, Queen's University, Kingston, Canada
  • i [Affiliation not available]
  • j [Affiliation not available]
  • k [Affiliation not available]
  • l [Affiliation not available]
  • m [Affiliation not available]
  • n [Affiliation not available]
  • o [Affiliation not available]
  • p [Affiliation not available]
  • q [Affiliation not available]
  • r [Affiliation not available]
  • s [Affiliation not available]

Abstract

Background: In Canada, clinical practice guidelines recommend breast cancer screening, but there are gaps in adherence to recommendations for screening, particularly among certain hard-to-reach populations, that may differ by province. We compared stage of diagnosis, proportion of screen-detected breast cancers, and length of diagnostic interval for immigrant women versus long-term residents of BC and Ontario. Methods: We conducted a retrospective cohort study using linked administrative databases in BC and Ontario. We identified all women residing in either province who were diagnosed with incident invasive breast cancer between 2007 and 2011, and determined who was foreign-born using the Immigration Refugee and Citizenship Canada database. We used descriptive statistics and bivariate analyses to describe the sample and study outcomes. We conducted multivariate analyses (modified Poisson regression and quantile regression) to control for potential confounders. Results: There were 14,198 BC women and 46,952 Ontario women included in the study population, of which 11.8 and 11.7% were foreign-born respectively. In both provinces, immigrants and long-term residents had similar primary care access. In both provinces, immigrant women were significantly less likely to have a screen-detected breast cancer (adjusted relative risk 0.88 [0.79-0.96] in BC, 0.88 [0.84-0.93] in Ontario) and had a significantly longer median diagnostic interval (2 [0.2-3.8] days in BC, 5.5 [4.4-6.6] days in Ontario) than long-term residents. Women from East Asia and the Pacific were less likely to have a screen-detected cancer and had a longer diagnostic interval, but were diagnosed at an earlier stage than long-term residents. In Ontario, women from Latin America and the Caribbean and from South Asia were less likely to have a screen-detected cancer, had a longer median diagnostic interval, and were diagnosed at a later stage than long-term residents. These findings were not explained by access to primary care. Conclusions: There are inequalities in breast cancer diagnosis for Canadian immigrant women. We have identified particular immigrant groups (women from Latin America and the Caribbean and from South Asia) that appear to be subject to disparities in the diagnostic process that need to be addressed in order to effectively reduce gaps in care. © 2019 The Author(s).

Author Keywords

Breast cancer Immigrant health Diagnosis interval Stage of diagnosis Cancer screening health equity

Index Keywords

immigrant South and Central America breast cancer primary medical care demography Neoplasm Staging human epidemiology middle aged birthplace foreign born Ethnic Groups Cohort Studies ethnic group comparative study East Asian cancer staging Aged Databases, Factual factual database ethnology South Asia Breast Neoplasms migrant invasive carcinoma Humans Canada incidental finding female Emigrants and Immigrants Pacific Islander breast tumor Incidence Caribbean Article Retrospective Studies Ontario major clinical study health care access cohort analysis cancer diagnosis retrospective study health care disparity British Columbia British Colombia long term resident
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059795132&doi=10.1186%2fs12885-018-5201-0&partnerID=40&md5=5deb5f0477db78c9030e3b1e910dfd68
DOI: 10.1186/s12885-018-5201-0
ISSN: 14712407
Cited by: 1
Original Language: English