Effective cancer screening through organized population-based programs is critical to reducing the burden of cancer in Ontario. Publicly reporting on cancer screening program performance helps us to promote transparency and accountability on the performance of Ontario’s cancer screening programs.
The 2020 Ontario Cancer Screening Performance Report builds on the 2016 report with:
- performance data from 2014 to 2018 for most indicators
- enhancements made to cancer screening in Ontario since the release of the 2016 report
Highlights of the Report
Breast cancer screening
- Participation in the Ontario Breast Screening Program (OBSP) remained stable between 61% and 66% between 2000 and 2018 despite a decline in retention over the last 6 years. In 2018, 77% of participants returned for a subsequent mammogram within 30 months, down from 83% in 2012.
- From 2000 to 2018, more than 90% of women with an abnormal mammogram received follow-up within 6 months.
- In 2018, 77% of women with an abnormal mammogram who needed tissue biopsy were diagnosed within 7 weeks of their abnormal screen date. The 7-week diagnostic interval has remained a challenge, and is short of the Canadian performance target of 90% or greater. However, Ontario ranks within the top 3 provinces in Canada on this indicator.
- From 2014 to 2018, 92% to 94% of women with an abnormal mammogram who did not need a tissue biopsy were diagnosed within 5 weeks of their abnormal screen date. This exceeds the Canadian target of 90% or greater. Mammography sensitivity[*] increased from 83% in 2013 to 86% in 2016, then jumped to 92% in 2017. The High Risk OBSP is the first and only population-based organized breast screening program for women at high risk of breast cancer in Canada. Retention in the High Risk OBSP increased from 70% in 2015 to 77% in 2017.
- The percentage of women screened within 90 days of being confirmed as high risk declined from 55% in 2014 to 44% in 2016, and then increased after 2016 to a high of 59% in 2018.
- Within the High Risk OBSP, the combined positive predictive value[*] for initial screens and re-screens increased from 6% in 2013 to 7% in 2017.
- From 2012 to 2016, the proportion of breast cancers detected at an early stage improved, increasing from 61% to 65%.
- When screening through the Ontario Cervical Screening Program launched in 2000, 59% of eligible women in Ontario were getting screened for cervical cancer. Participation in cervical screening peaked at 67% in the 3-year period from 2007 to 2009. It remained stable at 60% during the 2013 to 2015 and 2016 to 2018 periods.
- Retention in the screening program decreased from 2011 (71%) to 2014 (60%). Decreases in retention happened at the same time Ontario’s cervical screening guidelines extended the recommended interval for Pap tests to once every 3 years.
- Follow-up of abnormal results increased from the start of the Ontario Cervical Screening Program in 2000 (49%) to 2018 (86%).
- From 2013 to 2017, the positive predictive value[*] for pre-cancerous lesions increased from 5% to 7%, while the positive predictive value for cervical cancer remained stable at 0.3%.
- Like other jurisdictions around the world, Ontario is planning to transition from the Pap test to human papillomavirus (HPV) testing.
Colorectal cancer screening
- On June 24, 2019, the ColonCancerCheck program transitioned to the fecal immunochemical test (FIT) as the recommended screening test for people at average risk for colorectal cancer.
- The proportion of people overdue for colorectal cancer screening declined (improved) from 50% in 2008 to 38% in 2018. This exceeds the European performance target of no more than 55%.
- The proportion of people who did not receive follow-up within 6 months of an abnormal fecal test result also declined (improved) from 2008 to 2018, from 37% to 20%.
- The number of colonoscopy-related adverse events in Ontario decreased from 2014 to 2018. The perforation rate was consistently below the national and European minimum performance targets of less than 1 per 1,000 colonoscopies during this period.
- The percentage of screen-detected colorectal cancers diagnosed at an early stage increased from 28% in 2013 to 32% in 2017.