UBC Theses and Dissertations
Investigations into breast cancer screening participation and retention in British Columbia, Canada Woods, Ryan Reginald
Breast cancer screening programs operate across Canada and aim to reduce breast cancer mortality through early detection of breast tumours. In British Columbia (BC), a significant fraction of eligible women are not receiving regular mammograms. Research from other jurisdictions suggests that some immigrant populations participate less in screening than non-immigrants. Other research suggests that the primary care system may influence screening participation among women. Measures of primary care access, coordination and continuity in BC show recent declines, and only a small percentage of physicians are accepting responsibility for patients’ ongoing primary care needs. This thesis includes a series of population-based studies, using administrative health and other databases, to assess differences between immigrant and non-immigrant women, and among immigrant groups for: 1) breast cancer screening participation and retention; 2) breast cancer risk; and 3) differences in breast cancer stage at diagnosis. An additional study examines whether primary care factors, such as physician characteristics, or measures of physician and patient relationships, associate with screening utilization. Breast screening participation varied markedly according to country of birth, with some immigrant groups demonstrating very low participation. Among recent immigrants, the number of primary care physician visits was consistently identified as an important predictor of participation. Both stage-specific and age-specific incidence rates, showed substantial variation by country of birth. Eastern European/Central Asian and Indian immigrants demonstrated a worse stage at diagnosis compared to non-immigrants. Several primary care factors, such as low continuity of care, few physician visits, having a male physician and short duration of affiliation with a provider were associated with lower participation. The effects of these factors were stronger within some subgroups, such as low-income and some immigrant groups. Although physician factors did not show a strong relationship with retention overall, among first-time screeners, low continuity and few physician visits were associated with lower retention. These results suggest a number of areas for potential screening promotions, interventions and future research.
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