Ontario Cancer Screening Performance Report, 2023

Effective cancer screening through organized population-based screening programs is essential to reducing the burden of cancer in Ontario. Publicly reporting on Ontario’s cancer screening program performance helps us promote transparency and accountability.

The 2023 Ontario Cancer Screening Performance Report builds on the 2016 and 2020 reports with:

• Screening program performance data from 2017 to 2021 for most indicators, including an assessment of performance during the COVID-19 pandemic
• A focus on equity in cancer screening, including a Spotlight on Cancer Screening in First Nations, Inuit, Métis and Urban Indigenous Peoples, and an analysis of how cancer screening participation and follow-up of abnormal screening results differs according to levels of neighborhood marginalization
• A description of completed and planned enhancements to the cancer screening programs since the release of the 2020 report

Report Highlights

• Strong performance is observed for many cancer screening indicators, but there is still room for improvement
• It is important to continue to measure disparities in cancer screening for underserved populations and to make efforts to reduce these inequities

Equity in Cancer Screening

• People living in neighbourhoods with higher levels of material deprivation (the inability of individuals and communities to access and attain basic material needs) and ethnic concentration had lower rates of breast and cervical screening participation, lower rates of retention in the High Risk Ontario Breast Screening Program, lower rates of follow-up after an abnormal cervical and colorectal cancer screening test, higher rates of being overdue for colorectal screening, and lower rates of completing lung cancer screening after being determined eligible
• Indigenous people in Ontario experience disparities in cancer screening. Ontario Health’s Indigenous Cancer Care Unit continues to work with First Nations, Inuit, Métis and urban Indigenous communities throughout Ontario to understand and address barriers to cancer screening
• Three research projects that are being conducted in partnership with Indigenous partners across Ontario are highlighted in this report

Ontario Breast Screening Program

• Participation and retention decreased during the COVID-19 pandemic, but began to recover in 2021
• Almost all participants with an abnormal screening mammogram result received a definitive diagnosis within six months. Targets for timely follow-up were not met in the most recent years likely due to delays related to the COVID-19 pandemic and human resource challenges
• Cancer detection rates increased in 2021, likely related to the prioritization of screening for those with higher breast cancer risk during the pandemic
• Sensitivity and specificity (measures of screening quality) remained consistently high

Ontario Cervical Screening Program

• Cervical screening participation has continued to decrease over time. A large decrease occurred in the 21 to 24 age group, related to new evidence-based guidance which encouraged health care providers to delay initiation of cytology-based screening for immunocompetent people until age 25
• Retention decreased during the pandemic, but began to recover in 2021
• Most participants with a high-grade cervical cytology test result received follow-up within six months
• Cervical pre-cancer and cancer detection rates increased in the most recent year, likely related to the prioritization of people at higher risk for cervical cancer during the pandemic

ColonCancerCheck Program

• The percentage of people overdue for colorectal cancer screening was stable before the COVID-19 pandemic, after which it increased
• Participation in fecal-based colorectal cancer screening has remained stable. The COVID-19 pandemic minimally impacted fecal test participation likely because the test can be done at home
• Following the implementation of the fecal immunochemical test in 2019, improved rates of follow-up after an abnormal fecal test, increased positive predictive value and improved cancer detection rate have been observed
• Colonoscopy quality remained consistently high

Ontario Lung Screening Program

• Ontario’s Lung Cancer Screening Pilot for People at High Risk transitioned to an organized cancer screening program in 2021
• The percentage of low-dose computed tomography (LDCT) scans that had abnormal findings (Lung-RADS^® 3, 4A, 4B, 4X) and rates of cancer detection have decreased over time because the percentage of people having their first LDCT screen has decreased as the program matures
• Most lung cancers detected through the Ontario Lung Screening Program were early stage (78%), compared with only 35% of all lung cancers diagnosed in Ontario among people ages 55 to 74