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Ontario Cancer Facts

Cervical Cancer Screening Rates below Provincial Target, Vary with Neighbourhood Income

Feb 2014

  • The overall cervical cancer screening rate among Ontario women ages 20 to 69 is well below the provincial target of 85%.
  • Women living in low-income neighbourhoods have the lowest cervical cancer screening rate and the highest burden of cervical cancer.
  • Regular screening, follow-up of abnormal results and HPV vaccination can help prevent cervical cancer.

The rates for cervical cancer screening with the Pap test in Ontario are well below the provincial target of 85%, with overall 65% of women ages 20 to 69 having been screened in 2009–2011. Cervical screening rates are lowest for women living in the lowest income neighbourhoods and rise steadily as income increases. In 2009–2011, only 58% of women ages 20 to 69 living in the lowest income neighbourhoods were screened for cervical cancer, compared to 70% of women living in the highest income neighbourhoods.

 

Under-screening in women with lower incomes is a concern because cervical cancer is more common among women living in low-income neighbourhoods.[1]Reference 1 Close reference Lofters AK, Moineddin R, Hwang SW, Glazier RH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC Women’s Health 2011; May 27;11:20. doi: 10.1186/1472–6874–11–20. [2]Reference 2 Close reference Brookfield KF, Cheung MC, Lucci J, Fleming LE, Koniaris LG. Disparities in Survival Among Women With Invasive Cervical Cancer. A Problem of Access to Care. Cancer 2009;115:166–78. [3]Reference 3 Close reference Ng E, Wilkins R, Fung MFK, Berthelot J. Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996. CMAJ 2004;170(10):1545–9. Women with low income and education, who are older, who speak a foreign language or who are not Canadian-born are less likely to be screened for cervical cancer. Possible explanations for this screening shortcoming include lack of knowledge of cervical cancer screening, lack of time, language barriers and cultural factors.[4]Reference 4Close reference Lofters A, Glazier RH, Agha MM, Creatore MI, Moineddin R. Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada. Prev Med 2007;44:536–42.[5]Reference 5Close reference Lofters A, Moineddin R, Hwang SW, Glazier RH. Low Rates of Cervical Cancer Screening Among Urban Immigrants: A population-based study in Ontario, Canada. Med Care. 2010;48:611–8.[6]Reference 6 Close reference Woltman KJ, Newbold KB. Immigrant Women and Cervical Cancer Screening Uptake: A Multilevel Analysis. Can J Pub Health 2007;98(6):470–5.

Report Date: January 2013            
Data Sources: CytoBase, OHIP's Claim History Database, Ontario Cancer Registry, Pathology Information Management System and Registered Persons Database            
Prepared by: Screening Evaluation and Reporting, Cancer Care Ontario            
Notes:            
*Standardized to the age distribution of the 2006 Canadian population.            
†By definition, quintiles divide the population into five equally sized groups.            
‡Significantly different from the reference group at 95% Confidence Intervals
Ontario Cancer Plan Target: ≥85%

Percentage of screen-eligible women aged 20 to 69 who completed at least one Pap test in a three year period, 2009–2011
Neighbourhood Income Quintile† Percentage (%)*
Ontario 64.9
Q1 (lowest) 57.6
Q2 62.3‡
Q3 65.4‡
Q4 68.3‡
Q5 (highest) 70.0‡

An estimated 610 Ontario women were diagnosed with cervical cancer and 150 women died from this disease in 2013.Improving the cervical screening rate is essential because cervical cancer is almost entirely preventable with regular screening, appropriate and timely follow-up of abnormal results, and human papillomavirus (HPV) vaccination. Between 1981 and 2009, incidence of cervical cancer in Ontario dropped by 38% and mortality by 59%.These large reductions in incidence and mortality are due to widespread cervical cancer screening.