Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Rd., Mail Code 5475, Stanford, CA, 94305, USA.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Can J Public Health. 2020 Oct;111(5):794-803. doi: 10.17269/s41997-019-00282-5. Epub 2020 Feb 4.
Breast cancer screening aims to identify cancers in early stages when prognosis is better and treatments less invasive. We describe inter- and intra-provincial variation in the percentage of screen-detected cases under publicly funded healthcare systems and factors related to having screen- vs non-screen-detected breast cancer across five Canadian provinces.
Women aged 40+ diagnosed with incident breast cancer from 2007 to 2012 in five Canadian provinces were identified from their respective provincial cancer registries. Standardized provincial datasets were created linking screening, health administrative, and claims data. Province-specific logistic regression models were used to evaluate the association of demographic and healthcare utilization factors in each province with the odds of screen-detected cancer.
There was significant inter- and intra-provincial variation by age. Screen detection ranged from 42% to 52% in ages 50-69 but women aged 50-59 had approximately 4-8% lower screen detection than those aged 60-69 in all provinces. Screening associations with income quintile and rurality varied across provinces. Those least likely to be screen-detected within a province were consistently in the lowest income quintile; OR ranged from 0.62-0.89 relative to highest income quintile/urban patients aged 50-69. Lack of visits to primary care 30 months prior to diagnosis was also consistently associated with lower odds of screen detection (OR range, 0.37-0.76).
Breast cancer screen detection rates in the Canadian provinces examined are relatively high. Associations with income-rurality indicate a need for greater attention and/or targeted outreach to specific communities and/or provincial regions to improve access to breast cancer screening services intra-provincially.
乳腺癌筛查旨在发现早期癌症，此时预后较好，治疗方法也不那么具有侵入性。我们描述了在公共资助的医疗保健系统下，各省筛查检出病例的百分比的省内和省际差异，以及与在加拿大五个省份中筛查与非筛查乳腺癌相关的因素。
从五个加拿大省份各自的癌症登记处确定了 2007 年至 2012 年间诊断为乳腺癌的 40 岁以上的女性。创建了标准化的省级数据集，将筛查、卫生行政和索赔数据联系起来。在每个省份，使用特定于省份的逻辑回归模型评估了人口统计学和医疗保健利用因素与筛查检出癌症的几率之间的关联。
在年龄方面存在显著的省内和省际差异。在 50-69 岁的年龄组中，筛查检出率在 42%-52%之间，但在所有省份中，50-59 岁的女性筛查检出率比 60-69 岁的女性低 4-8%左右。与收入五分位数和农村性别的筛查关联在各省之间有所不同。在一个省内最不可能被筛查检出的是那些收入最低的五分位数的人；50-69 岁的人，与收入最高的五分位数/城市患者相比，OR 范围为 0.62-0.89。在诊断前 30 个月缺乏对初级保健的就诊也与较低的筛查检出几率始终相关（OR 范围为 0.37-0.76）。
在所检查的加拿大省份中，乳腺癌筛查检出率相对较高。与收入-农村性别的关联表明，需要更加关注和/或有针对性地向特定社区和/或省级地区提供服务，以改善省内乳腺癌筛查服务的获取。
