||As of this Report
|Age-adjusted percentage of Ontario screen-eligible women, aged 50 to 69, who were up-to-date with all tests for the 3 cancer screening programs (mammogram, Pap test and at least 1 of the colorectal tests)
| See Methodology and Approach to find out how the ratings are calculated.
In 2014, approximately 492,000 eligible Ontario women aged 50 to 69 who were eligible for all 3 cancer screening programs were up-to-date with all tests for the 3 cancer screening programs (mammogram, Pap test and at least 1 of the colorectal tests: fecal occult blood test, flexible sigmoidoscopy or colonoscopy). Among the 1,435,506 women who were eligible for breast, cervical and colorectal cancer screening in 2014, 34% were up-to-date with all tests, compared to 36% in 2011. In 2014, approximately 1,137,700 Ontario women ages 50 to 69 (or 79% of eligible women) were up-to-date with at least 1 test for the 3 cancer screening programs. The proportion of Ontario women who were up-to-date with at least 1 test has remained stable since 2011.
What is cancer screening?
- A screening test identifies people in a healthy, asymptomatic population who may be at risk for disease. It is not a diagnostic test. The purpose of screening is to prevent cancer by identifying pre-cancerous changes or to find cancer at an early stage, when it is easier to treat. Ontario operates organized, population-based screening programs for 3 types of cancer: breast, cervical and colorectal.
Breast cancer screening (mammogram)
- A mammogram uses low-dose X-rays to produce images of the breast1. A breast magnetic resonance imaging (MRI) scan uses magnetic waves and an intravenous contrast agent to create cross-sectional images of the breast2. Both tests may show changes in the breasts that may indicate early signs of breast cancer, even when the changes are too small for a woman or her doctor to feel or see.
- Breast cancer screening with mammography is recommended every 2 years for average risk women aged 50 to 741.
- Breast cancer screening with mammography and breast MRI or ultrasound is recommended every year for women aged 30 to 69 who are identified as being at high risk for breast cancer3.
- Most women with an abnormal mammogram result will not have breast cancer4. More tests are required after an abnormal mammogram result to determine whether a cancer is present.
- Diagnostic assessment includes additional radiological or surgical procedures, such as diagnostic mammography, ultrasonography, and core and/or open surgical biopsy.
- In Ontario, breast cancer screening occurs both through the Ontario Breast Screening Program (OBSP)—an organized, provincewide screening program—and through non-OBSP centres.
Cervical cancer screening (Pap test)
- The purpose of cervical cancer screening is to prevent cancer by identifying pre-cancerous changes to the cells of the cervix.
- Changes in the cervix usually develop very slowly over many years, so there is a long period of time when abnormal cell changes can be detected before cervical cancer appears. These changes, called precursor lesions, can be found with a Pap test.
- Cancer Care Ontario updated its cervical cancer screening guidelines in 2012 to recommend cervical cancer screening every 3 years for women aged 21 to 69 who are, or who have ever been, sexually active. Screening can stop at age 70 in women who have had 3 or more normal tests in the previous 10 years4.
Colorectal cancer screening
- The purpose of colorectal cancer screening is to prevent cancer by identifying polyps (pre-cancerous lesions) or to find colorectal cancer at an early stage.
- There are different types of colorectal cancer screening tests, ranging from at-home tests (such as the fecal occult blood test, or FOBT) to visual inspection of the colon (such as colonoscopy or flexible sigmoidoscopy).
- Based on a 2001 guideline from the Canadian Task Force on Preventive Health Care5, ColonCancerCheck recommends that people aged 50 to 74 without a family history of colorectal cancer (i.e. those at average risk) be screened every 2 years with an FOBT6.
- For people at increased risk of colorectal cancer due to a family history (i.e. they have a parent, sibling or child diagnosed with the disease), ColonCancerCheck recommends screening with colonoscopy starting at age 50, or 10 years before their relative was diagnosed, whichever occurs first6.
- Ontarians are considered up-to-date with colorectal tests if they have had an FOBT in the past 2 years, a flexible sigmoidoscopy in the past 5 years or a colonoscopy in the last 10 years.
- It is important to note that this indicator may include colonoscopies done for indications other than screening, because a large proportion of colonoscopies are done for non-screening purposes.
What do the results show?
Of the Ontario women who are eligible for all tests in the 3 cancer screening programs, the majority are up-to-date with at least 1 test (Figures 1 and 2).
- In Ontario, women aged 50 to 69 may be eligible for all 3 cancer screening programs depending on their screening and past medical history. Women with previous cervical, colorectal or breast cancers—or those with previous complete hysterectomies, mastectomies or colectomies—may not be eligible for screening.
- The percentage of women up-to-date with at least 1 test has remained steady at 79% since 2011 (Figure 2). The percentage of women up-to-date with all tests for the 3 cancer screening programs decreased by 1 percentage point, from 35% in 2013 to 34% in 2014 (Figure 1).
- In 2014, approximately 492,000 Ontario women aged 50 to 69 who were eligible for all 3 cancer screening programs were up-to-date with all tests for the 3 cancer screening programs, and 1,137,700 Ontario women aged 50 to 69 were up-to-date with at least 1 test.
- In 2014, the Local Health Integration Network (LHIN) with the highest percentage of women up-to-date with at least 1 test was North Simcoe Muskoka (82%). Toronto Central LHIN had the lowest percentage of women up-to-date with at least 1 test (76%).
- The LHIN with the highest percentage of women up-to-date with all tests in 2014 was North East (28%). The Central LHIN had the highest percentage of women up-to-date with all tests for the 3 cancer screening programs (39%).
- For more information on the participation of each screening program, please visit the breast cancer screening participation, cervical cancer screening participation and colorectal cancer screening participation sections.
Participation in cancer screening varies by socio-demographic factor‡.
- Overall cancer screening participation varied by age group (Figures 3 and 4). In 2014, the percentage of women who were up-to-date with at least 1 test was highest in the middle (aged 55 to 59) and oldest age groups (aged 60 to 64 and 65 to 69) (80%).
- The percentage of women who were up-to-date with all tests in the 3 cancer screening programs was highest (37%) among those in the middle and older age groups (aged 55 to 59 and 60 to 64).
- The percentage of women who were up-to-date with at least 1 test was highest in rural (81%) and rural-remote areas (80%) in 2014. It was lowest in rural-very remote areas (78%).
- The percentage of women who were up-to-date with all tests for the 3 cancer screening programs declined with the distance from urban centres (i.e. it was 35% for women in urban areas vs. 29% for women in rural-very remote areas).
- Overall participation increased steadily as urban neighbourhood income quintiles rose. In 2014, the percentage of women living in the highest income urban areas who were up-to-date with at least 1 test was 84%, 12 percentage points higher than the percentage of women in the lowest income urban areas who were up-to-date with at least 1 test (72%).
- A similar pattern was observed for women who were up-to-date with all 3 tests: the percentage of women in the highest income areas who were up-to-date with all 3 tests was 13 percentage points higher than women living in the lowest income urban areas (40% vs. 27%).
- In 2014, the percentage of women who were up-to-date with at least 1 test was highest in neighbourhoods with lower percentages of self-reported immigrant residents (81% compared to 76% in neighbourhoods with more self-reported immigrant residents). A similar pattern was seen for the percentage of women who were up-to-date with all 3 tests in 2014.
‡ Some data are not shown. Percentages by socio-demographic factor are available in the data tables (select the desired file type and click “Download”) and presented in the figures by age group.
Why is this important to Ontarians?
Cancer burden weighs heavily on Ontario.
- Breast cancer and colorectal cancer are 2 of the leading causes of cancer deaths in Ontario8. Breast cancer is the most common cancer diagnosed among Ontario women, and it is the second-most common cause of cancer deaths. Colorectal cancer is the third-most common cancer diagnosed among Ontario women, and it was the third leading cause of cancer deaths in 20158. For more information on incidence and mortality of breast and colorectal cancer, visit the Cancer in Ontario section.
- Cervical cancer is not as common in Ontario. An estimated 640 Ontario women were diagnosed with cervical cancer in 2015, and roughly 150 women died of the disease in the same year9. See the Special Focus story on Cervical Cancer for more information.
Regular screening leads to better outcomes.
- Cancer screening can detect cancer at an early stage and can sometimes detect cell changes that may turn into cancer (pre-cancers). Treatment of early-stage cancers or pre-cancers can increase the chance of survival.
- In the years since they began, Ontario’s breast, colorectal and cervical screening programs have contributed to the early detection of cancer and pre-cancers and have led to improved patient outcomes10–12.
- For breast cancer screening:
- A recent summary of evidence reported that using mammography to screen for breast cancer resulted in a 21% reduction in breast cancer mortality in average risk women aged 50 to 6913.
- Finding breast cancer early increases the treatment options available, and it can lead to better treatment outcomes and survival rates14.
- For cervical cancer screening:
- Organized cervical cancer screening consistently reduces cervical cancer incidence (i.e. new cancer cases) and mortality (i.e. deaths)15–17.
- For colorectal cancer screening:
- A meta-analysis showed that regular screening (annual or biennial) using an FOBT for people aged 50 and older—followed by a colonoscopy for those with an abnormal FOBT—can reduce deaths from colorectal cancer by 13%18.
- Evidence indicates that screening for colorectal cancer using flexible sigmoidoscopy can reduce colorectal cancer incidence and mortality18. Screening with FOBT can lead to the detection of colorectal cancer at an earlier stage19. Someone with colorectal cancer has a 90% chance of being cured if the cancer is caught early. The likelihood of curing someone with colorectal cancer decreases to 12% if the disease is detected at a later stage20.
- An integrated Primary Care Screening Activity Report for all 3 screening programs (cervical, breast and colorectal) was recently developed. This tool allows physicians in a patient enrolment model (PEM) practice to see the complete screening status for each patient, including those who are due for screening and follow-up. Next steps include encouraging increased use of the Primary Care Screening Activity Report. Screening data are refreshed on a monthly basis.
- Cancer Care Ontario has been expanding its correspondence program across the 3 screening programs. Invitation letters are now sent to all screen-eligible Ontarians, inviting them to participate in breast, cervical and colorectal cancer screening, and recall letters are sent to remind people when they are due for their next screen. In addition, Cancer Care Ontario is introducing physician-linked invitation and recall letters for patients with a primary care provider who participates in a PEM practice.
- Annual public awareness campaigns and educational activities are conducted in each region.
- Building on research of under-/never-screened populations and evidence-based framework and approaches intended to improve screening participation.
- These approaches include the use of geographic information and tools to support local efforts.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Mammograms; 2015 Jan 16 [2015 Dec 18]. Available from: https://cancercare.on.ca/pcs/screening/breastscreening/mammograms.
- The Canadian Cancer Society [Internet]. Toronto: Canadian Cancer Society; c2016. Magnetic resonance imaging (MRI); [cited 2016 Jan 29]. Available from: http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/magnetic-resonance-imaging-mri/?region=on.
- Chiarelli AM, Prummel MV, Muradali D, Majpruz V, Horgan M, Carroll JC, et al. Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screening from Ontario high risk breast screening. J Clin Oncol. 2014 Jul 20; 32(21):2224–30.
- Cancer Care Ontario. Ontario Breast Screening Program 2011 report. Toronto: Cancer Care Ontario; 2013.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Ontario cervical screening cytology guidelines summary; 2012 May [cited 2015 Dec 18]. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=13104.
- McLeod RS, Canadian Task Force on Preventive Health Care. Screening strategies for colorectal cancer: a systematic review of the evidence. Can J Gastroenterol. 2001 Oct; 15(10):647–60.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. About ColonCancerCheck. 2015 April 10 [cited 2015 Dec 18]. Available from: https://cancercare.on.ca/pcs/screening/coloscreening/cccworks/.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Registered nurse flexible sigmoidoscopy; 2016 Feb 26 [cited 2015 Dec 18]. Available from: https://cancercare.on.ca/pcs/screening/coloscreening/rnfs/.
- Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian cancer statistics 2015. Toronto: Canadian Cancer Society; 2015. Available from: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2015-EN.pdf?la=en.
- Cancer Care Ontario. Ontario cervical screening program 2012 report. Toronto: Cancer Care Ontario; 2014.
- Cancer Care Ontario. ColonCancerCheck 2010 program report. Toronto: Cancer Care Ontario; 2012.
- Cancer Care Ontario. Ontario Breast Screening Program 2011 report. Toronto: Cancer Care Ontario; 2013.
- Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force Recommendations. Ann Intern Med. 2016 Feb 16; 164(4):1–20.
- The Canadian Task Force on Preventive Health Care. Recommendations on screening for breast cancer in average-risk women ages 40–74 years. CMAJ. 2011 Nov 22; 183(17):1991–2001.
- Pettersson F, Björkholm E, Näslund I. Evaluation of screening for cervical cancer in Sweden: trends in incidence and mortality 1958–1980. Int J Epidemiol. 1985 Dec; 14(4):521–7.
- Lynge E, Madsen M, Engholm G. Effect of organized screening on incidence and mortality of cervical cancer in Denmark. Cancer Res. 1989 Apr 15; 49(8):2157–60.
- Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of the cervix in England: evaluation based on routinely collected statics. BMJ. 1999 Apr 3; 318(7188):904–8.
- Tinmouth J, Vella E, Baxter NN, Dubé C, Gould M, Hey A, et al. Colorectal cancer screening in average risk populations: evidence summary. Toronto: Cancer Care Ontario; 2015.
- Steele RJ, Kostourou I, McClements P, Watling C, Libby G, Weller D, et al. Effect of repeated invitations on uptake of colorectal cancer screening using faecal occult blood testing: analysis of prevalence and incidence screening. British Medical Journal. 2010; 341:5531–5525.
- National Cancer Institute [Internet]. Bethesda (MD): National Cancer Institute. SEER cancer statistics review 1975–2009, Table 6.12: cancer of the colon and rectum; [cited 2015 Dec 18]. Available from: http://seer.cancer.gov/csr/1975_2009_pops09/results_single/sect_06_table.12.pdf.