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Measuring Ontario’s Small Area Inequalities in Cancer (MOSAIC) Study

Cancer affects many Ontarians and cancer rates vary widely across the province. By identifying health disparities in cancer incidence and survival across Ontario, we can help knowledge-users move towards more equitable cancer outcomes in their communities.

We expect to release the findings of this ongoing study in 2022. You can sign up now and we’ll send you an email when the study findings are available.

Sign Up for Study Findings

About the MOSAIC Study

A multidisciplinary research team at Ontario Health leads the MOSAIC study. The team aims to better understand inequalities in cancer burden at the small-area level in Ontario and how they have changed over time. The study has 3 objectives:

  1. Identify inequalities by small area as well as over time (i.e., spatio-temporal differences) in cancer incidence and relative survival among the cancers of interest
  2. Explore underlying factors that may be driving spatio-temporal inequalities in cancer incidence and survival
  3. Engage knowledge users in the research process to enhance utility and reach of the study findings
MOSAIC Study Placemat thumnail

Questions and Answers

Who is involved in the MOSAIC study?

The MOSAIC study is led by a multidisciplinary team based at Ontario Health. The team includes epidemiologists, biostatisticians, practicing clinicians, health system administrators and a knowledge translation specialist. An important objective of the study is to involve anticipated knowledge-users in the research process to make the findings more useful and accessible. To do this, we invited stakeholders to participate in an advisory committee, and other interested knowledge-users to review and test knowledge products.

Research team

Principal Investigators

Dr. Prithwish De, Director, Surveillance and Cancer Registry
Todd Norwood, Staff Scientist, Surveillance and Cancer Registry


Zeinab El-Masri, Senior Specialist, Knowledge Dissemination & Evaluation, Surveillance and Cancer Registry
Dr. Linda Rabeneck, Vice-President, Clinical Institutes and Quality Programs
Dr. Simron Singh, Medical Oncologist, Sunnybrook Health Sciences Centre
Dr. Jill Tinmouth, Physician and Scientist, Sunnybrook Health Sciences Centre


Dr. Shabnam Balamchi, Decision Scientist, Data and Decision Science (formerly Senior Research Associate, Surveillance and Cancer Registry)
Dr. Eric Holowaty, Consultant, University of Toronto
Jay Kim, Senior Research Associate, Surveillance and Cancer Registry
Amidu Raifu, Senior Research Associate, Surveillance and Cancer Registry
Dr. Laura Seliske, Senior Analyst, Ontario Renal Network (formerly Research Associate, Surveillance and Cancer Registry)

Research Coordinator

Inthuja Selvaratnam, Research Coordinator, Surveillance and Cancer Registry

What is already known about geographic variation in cancer incidence and cancer survival in Ontario?

We know there is considerable geographic variation across Ontario’s larger regions. For example, Ontario Cancer Profiles shows a 2-fold difference in the range of incidence rates of lung cancer across Ontario’s public health units (47.5 to 101.1 per 100,000 people). The statistics also show a nearly 2-fold difference in the range of relative survival rates (16.6% to 31.4%). However, we know much less about the variation in cancer incidence and survival at the neighbourhood level within these large areas in Ontario.

What are the advantages of examining incidence and survival at the small-area level?

The main advantage is that smaller areas tend to have more homogeneous populations than larger areas. For example, a neighbourhood is more likely than a municipality to be made up of people who are similar to each other. Also, larger areas like municipalities typically have more variation within them than between them. For example, statistics from Ontario Cancer Profiles show that, for 2016, Toronto and Mississauga have similar age-standardized rates for all cancers. However, within each of these cities, we would expect variation across the neighbourhoods.

What factors are accounted for in the incidence and survival analyses?

The MOSAIC study aims to examine the association of socio-economic, demographic and urban/rural/remoteness factors with cancer incidence and survival. The study will also examine how cancer screening and modifiable risk factors are associated with cancer incidence. Factors such as ethnicity, access to care and comorbidities were not included but should be considered for future research.

What policies or practices might change as a result of the MOSAIC study?

The disparities identified in the study can help inform more targeted interventions and policies for communities where there’s evidence of the greatest inequalities. Knowledge users can use the study findings to:

  • further investigate, understand and address the underlying causes of the disparities
  • create community risk profiles that can help inform how chronic disease prevention resources should be distributed
  • ensure that appropriate health and social resources are geographically allocated to support the most vulnerable cancer patients during their treatment and recovery

This study was conducted with the support of the Ontario Institute for Cancer Research through funding provided by the Government of Ontario.