Voruganti Teja, Moineddin Rahim, Jembere Nathaniel, Elit Laurie, Grunfeld Eva, Lofters Aisha K
Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont.
CMAJ Open. 2016 Aug 12;4(3):E424-E430. doi: 10.9778/cmajo.20160029. eCollection 2016 Jul-Sep.
Globally, cervical cancer is the fourth most common cancer in women and 7th most common cancer overall. Cervical cancer is highly preventable with screening. Previous work has shown that immigrants are less likely to undergo screening than nonimmigrants in Ontario, Canada. We examined whether immigrant women are more likely to present with later stage cervical cancer than long-term residents of the province.
We conducted a retrospective matched cohort study of women with cervical cancer diagnosed between 2010 and 2014 using provincial administrative health data. We compared the odds of late-stage diagnosis between immigrants and long-term residents, adjusting for socioeconomic measures, comorbidities and health care use. The outcome of interest was stage of cervical cancer diagnosis, defined as early (stage I) or late (stages II-IV). We confirmed results with a cohort of women with cancer diagnosed between 2007 and 2012.
Complete staging data were available for 218 immigrants and 1348 matched long-term residents. We found no association between immigrant status and stage at diagnosis (adjusted odds ratio [OR] 0.94, 95% confidence interval [CI] 0.63-1.39). Factors that did show significant association with late-stage diagnosis were physician characteristics, whether a woman had previously undergone screening and had visited a gynecologist in the past 3 years. These results were echoed in the 2007-2012 cohort (immigrants v. long-term residents, OR 0.94, 95% CI 0.71-1.20).
Our results show that being an immigrant is not associated with late-stage diagnosis of cervical cancer in Ontario. Programs broadly aimed at immigrants may require a targeted approach to address higher-risk subgroups.
在全球范围内，宫颈癌是女性第四大常见癌症，在所有癌症中位列第七。宫颈癌通过筛查可得到高度预防。此前的研究表明，在加拿大安大略省，移民接受筛查的可能性低于非移民。我们研究了移民女性相较于该省长期居民，是否更有可能在宫颈癌晚期就诊。
我们利用省级行政卫生数据，对2010年至2014年间诊断为宫颈癌的女性进行了一项回顾性匹配队列研究。我们比较了移民和长期居民晚期诊断的几率，并对社会经济指标、合并症和医疗保健使用情况进行了调整。感兴趣的结果是宫颈癌诊断阶段，定义为早期（I期）或晚期（II - IV期）。我们用2007年至2012年间诊断为癌症的女性队列证实了结果。
有218名移民和1348名匹配的长期居民可获得完整的分期数据。我们发现移民身份与诊断阶段之间没有关联（调整后的优势比[OR]为0.94，95%置信区间[CI]为0.63 - 1.39）。与晚期诊断有显著关联的因素包括医生特征、女性此前是否接受过筛查以及过去3年是否看过妇科医生。这些结果在2007 - 2012年队列中得到了印证（移民与长期居民相比，OR为0.94，95% CI为0.71 - 1.20）。
我们的结果表明，在安大略省，移民身份与宫颈癌晚期诊断无关。广泛针对移民的项目可能需要采取有针对性的方法来解决高风险亚组的问题。
