Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population-based study

Abstract

Breast cancer screening programs operate across Canada providing mammography to women in target age groups with the goal of reducing breast cancer mortality through early detection of tumors. Disparities in breast screening participation among socio-demographic groups, including immigrants, have been reported in Canada. Our objectives were to: (1) assess breast screening participation and retention among immigrant and nonimmigrant women in British Columbia (BC), Canada; and (2) to characterize factors associated with screening among screening-age recent immigrant women in BC. We examined 2 population-based cohorts of women eligible for breast screening participation (537 783 women) and retention (281 052 women) using linked health and immigration data. Breast screening rates were presented according to socio-demographic and health-related variables stratified by birth country. Factors associated with screening among recent immigrant women were explored using Poisson regression. We observed marked variation in screening participation across birth country cohorts. Eastern European/Central Asian women showed low participation (37.9%) with rates from individual countries ranging from 35.0% to 49.0%. Participation rates for immigrant women from the most common birth countries, such as China/Macau/Hong Kong/Taiwan (45.7%), India (44.5%), the Philippines (45.9%), and South Korea (39.0%), were lower than the nonimmigrant rates (51.2%). Retention rates showed less variation by birth country; however, some disparities between immigrant and nonimmigrant groups persisted. Associations between screening indicators and study factors varied considerably across immigrant groups. Primary care physician visits were consistently positively associated with screening participation; this variable was also the only predictor associated with screening within each of the groups of recent immigrants. Our study provides unique data on both screening participation and retention among Canadian immigrant women compiled by individual country of birth. Our results are further demonstration that screening disparities exist among immigrant populations as well as in comparison with nonimmigrant women.

Keywords: breast cancer; cancer screening; equity; immigrants; mammography; primary care.

Figure 1

Age‐standardized screening participation rates by country of birth for countries with 100 or more women in the participation cohort. Vertical dashed line represents the nonimmigrant participation rate. CMHT, China, Macau, Hong Kong, and Taiwan

Figure 2

Age‐standardized 30‐month screening retention rates by country of birth for countries with 100 or more women in the retention cohort. Vertical dashed line represents the non‐immigrant retention rate. CMHT, China, Macau, Hong Kong, and Taiwan