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International Comparisons Screening

How does Ontario compare?

“Working together to create the best cancer system in the world” is Cancer Care Ontario’s vision. Is Ontario succeeding? To find out, national and international screening data were compared against Ontario’s results. The selected findings presented below identify how Ontario is doing in relation to other jurisdictions.

A note on jurisdictional comparisons

  • This is the 9th year that the Cancer System Quality Index (CSQI) has showcased international comparators for Ontario’s performance.
  • In this section, Ontario is compared with selected jurisdictions, in most cases because they have healthcare, data and participation measurement systems that are similar to those in Ontario.
  • Ensuring that the data and measures from other jurisdictions are comparable to those used in Ontario is a challenge. Caution should be used when comparing Ontario’s indicator results to those from other jurisdictions due to potential differences in data definitions, methodologies and time periods. Cross-jurisdictional comparison is still useful, however, for providing a rough indication of how Ontario is doing compared to other jurisdictions.

Cancer screening: breast, cervical and colorectal

This section covers jurisdictional comparisons of screening participation for 3 types of cancer: breast, cervical and colorectal.

Strong evidence suggests that organized screening for breast, cervical and colorectal cancer can reduce mortality (i.e., deaths) from these cancers.

  • A cancer screening test identifies people in a healthy, asymptomatic population who may be at risk of getting cancer. Cancer screening tests are not diagnostic. Instead they can find cancer early when it may be smaller and easier to treat. Screening for some forms of cancer can also help prevent disease by finding abnormal cells that could turn into cancer.
  • Ontario operates organized population-based screening programs for 3 types of cancer: breast, cervical and colorectal. Cancer Care Ontario collects breast, cervical and colorectal screening data provincially. For more information, please see:

    Screening participation for breast, cervical and colorectal cancers

    • To compare Ontario with other jurisdictions, administrative data (data collected for the administration of health and social service programs) were used, as were self-reported responses from the Canadian Community Health Survey (where available). Self-reported participation is typically higher than participation calculated with administrative data due to potential bias and the methods used to collect survey data.
    • Caution needs to be exercised when comparing participation across jurisdictions because screening programs and definitions can differ in important ways, as can the methodology for calculating screening participation, eligible age groups, screening periods and reporting periods. Data also may be missing or not publicly available.
    • Given these limitations, exact comparisons are difficult. However, the administrative and self-reported data shown here are useful for comparing screening participation in Ontario to other jurisdictions in Canada and around the world.

    Jurisdictional comparisons are focused on mammography, Pap tests and the proportion of people overdue for colorectal cancer screening, with additional information provided on fecal occult blood test (FOBT) participation. FOBT screening contributes to the calculation of the overdue for screening indicator. In jurisdictions such as Ontario where opportunistic screening with colonoscopy exists in addition to a fecal-based screening test, FOBT participation is not a recommended measure of program performance [1].

    • Ontario FOBT participation represents an underestimation of true colorectal cancer screening participation. However, data have been included on FOBT participation from other jurisdictions because it is what most report.
    • To make comparisons more appropriate, the percentage of people overdue for screening can be derived from FOBT participation in jurisdictions where the fecal-based test is the only type of screening method.

Figure 1. Percentage of screen-eligible Ontarians participating in breast and cervical screening compared to best comparable jurisdiction

Notes:

  • *Best jurisdiction refers to the jurisdiction with participation methodology that best approximates Ontario’s.
  • Breast cancer and cervical screening participation data for Ontario are age-adjusted.
  • For breast cancer screening, Ontario and Australia data are from the period of 2015-16. Australia data are preliminary.
  • For cervical screening, Ontario and Australia data are from 2014-16.

Figure 2. Percentage of screen-eligible Ontarians overdue for colorectal cancer screening compared to best comparable jurisdiction

Notes:

  • *Best jurisdiction refers to the jurisdiction with participation methodology that best approximates Ontario’s.
  • Ontario data are age-adjusted.
  • For colorectal cancer screening, Ontario data are from 2016. Manitoba data are from 2011-12.
  • In Ontario, individuals are considered "overdue" for colorectal cancer screening if they have not had an FOBT in 2 years, colonoscopy in 10 years, or flexible sigmoidoscopy in 10 years. In Manitoba, individuals are considered overdue for colorectal cancer screening if they have not had an FOBT in 2 years and/or a colonoscopy/flexible sigmoidoscopy in 5 years.

Data Table 1. Percentage of screen-eligible Ontarians participating in breast and cervical screening compared to best comparable jurisdiction

Cancer Screening Breast cancer screening in 2015-2016 Cervical cancer screening in 2014-2016
Ontario 64.8 62.0
Best reported jurisdiction 54.4 69.5
  1. *Best jurisdiction refere to the jurisdiction with participation methodology that best approximate Ontario's.
  2. Breast cancer and cervical screening participation data for Ontario age-adjusted.
  3. For breast cancer screening, Ontario and Australia data are from the period of 2015–2016. Australia data are preliminary.
  4. For cervical screening, Ontario and Australia data are from 2014–2016.

Data Table 2. Percentage of screen-eligible Ontarians overdue for colorectal cancer screening compared to best comparable jurisdiction

Colorectal cancer screening 2016
Ontario 38.1
Best reported jurisdiction (Manitoba) 50.0
  1. *Best jurisdiction refers to the jurisdiction with participation methodology that best approximates Ontario's.
  2. Ontario data are age-adjusted.
  3. For colorectal cancer screening, Ontario data are from 2016. Manitoba data are from 2011–2012.
  4. In Ontario, individuals are considered "overdue" for colorectal cancer screening if they have not had an FOBT in 2 years, colonoscopy in 10 years, or flexible sigmoidscopy in 10 years. In Manitoba, individuals are considered overdue for colorectal cancer screening if they habe not had an FOBT in 2 years/ or a colonoscopy/ flexible sigmoidoscopy in 5 years.

Table 1. Jurisdictional comparisons for breast cancer screening (mammography): administrative and self-reported data

Breast screening participation administrative data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2015–2016

Age-adjusted percentage of Ontario women, age 50 to 74, who completed at least 1 mammogram within a 30-month period

Administrative

64.8%

Breast Cancer Screening Participation and Retention

Best Local Health Integration Network (LHIN) in Ontario

 

North Simcoe Muskoka

 

 

2015–2016

Age-adjusted percentage of Ontario women, age 50 to 74, who completed at least 1 mammogram within a 30-month period

Administrative

68.8%

Breast Cancer Screening Participation and Retention

Australia*

2015–2016

(preliminary data only)

Age-adjusted percentage of women, age 50 to 74, who had a program screening mammogram in a 2-year period

Administrative

54.4%

Supplementary data tables

England

2017

Percentage of screen-eligible women, age 53 to 70, who have had a mammogram with a recorded result in the last 3 years

Administrative

75.4%

Breast Screening Program England Statistics for 2016–2017

France

2016

Age-standardized percentage of women, age 50 to 74, who had a program mammogram within a 2-year period

Administrative

50.7%

French Institute for Public Health Surveillance

Ireland

2015

Percentage of target population (all women age 50 to 65 known to the program), who had a mammogram in a 1-year period

Administrative

 74.7%

BreastCheck Programme Report 2015–2016

Netherlands

2012

Percentage of screen-eligible women, age 50 to 75, who had a mammogram in a 2-year period

Administrative

80%

Health Council of the Netherlands Population Screening for Breast Cancer: Expectations and Developments

* Best jurisdiction: the jurisdiction with participation methodology that best approximates Ontario’s

Self-reported breast screening participation data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2012

Percentage of women, age 50 to 69, who reported being up to date with breast cancer screening (defined as having had a mammogram for any reason in the previous 2 years)

Self-reported (Canadian Community Health Survey)

73%

Canadian Partnership Against Cancer’s 2017 Cancer System Performance Report

Quebec (province reporting highest participation)

2012

Percentage of women, age 50 to 69, who reported being up to date with breast cancer screening (defined as having had a mammogram for any reason in the previous 2 years)

Self-reported (Canadian Community Health Survey)

74%

Canadian Partnership Against Cancer’s 2017 Cancer System Performance Report

Table 2. Jurisdictional comparisons for cervical cancer screening (Pap test): administrative and self-reported data

Cervical screening participation administrative data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2014–2016

Age-standardized percentage of women, age 20 to 69, who had a Pap test in a 42-month (3.5-year) period (rate corrected for hysterectomy)

Administrative

62.0%

Cervical Screening Participation and Retention

Best Local Health Integration Network (LHIN) in Ontario

 

North Simcoe Muskoka

 

2014–2016

Age-standardized percentage of women, age 20 to 69, who had a Pap test in a 42-month (3.5-year) period (rate corrected for hysterectomy)

Administrative

65.7%

Cervical Screening Participation and Retention

Australia*

2014–2016

Age-standardized percentage of women, age 20 to 69, who had a Pap test in a 3-year period (corrected for hysterectomy)

Administrative

69.5%

Supplementary data tables

England

2016–2017

Percentage of screen-eligible women, age 25 to 64, who had an adequate screening test within the 3.5-year period ending on March 31, 2017 (for women age 25 to 49) and within the 5.5-year period ending on March 31, 2017 for women age 50 to 64.*

 

Women are invited to participate in cervical screening at different frequencies depending on age. Women age 25 to 49 are invited to participate every 3.5 years, while women age 50 to 64 are invited to participate every 5.5 years. The age-appropriate coverage measure takes the frequency of invitation by age.

 

All coverage calculations corrected for hysterectomy.

Administrative

72.0%

National Health Service Cervical Screening Programme, England: Statistics for 2016–2017

Ireland

2011–2016 (5-year period ending August 31, 2016)

Percentage of women, age 25 to 60, who had a Pap test in the 5-year reporting period ending August 31, 2016, adjusted for hysterectomy

Administrative

79.7%

CervicalCheck Programme Report 2015–2016

* Best jurisdiction: the jurisdiction with participation methodology that best approximates Ontario’s

Self-reported cervical screening participation data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2012

Age-adjusted percentage of women, age 25 to 69, who reported being up to date with cervical cancer screening, defined as having had at least 1 Pap test in the previous 3 years

Self-reported (Canadian Community Health Survey)

82%

Canadian Partnership Against Cancer’s 2017 Cancer System Performance Report

Prince Edward Island (province reporting highest participation)

2012

Age-adjusted percentage of women, age 25 to 69, who reported being up to date with cervical cancer screening, defined as having had at least 1 Pap test in the previous 3 years

Self-reported (Canadian Community Health Survey)

89%

Canadian Partnership Against Cancer’s 2017 Cancer System Performance Report

Table 3. Jurisdictional comparisons for colorectal cancer screening (overdue for screening): administrative and self-reported data

Overdue for colorectal cancer screening administrative data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2016

Age-adjusted percentage of men and women, age 50 to 74, who were overdue for colorectal screening in a calendar year, where overdue is defined as not having had a fecal occult blood test (FOBT) in the past 2 years, a flexible sigmoidoscopy in the last 10 years or a colonoscopy in the last 10 years

Administrative data

38.1%

Colorectal Cancer Screening Participation

Best Local Health Integration Network (LHIN) in Ontario

 

North Simcoe Muskoka
 

2016

Age-adjusted percentage of men and women, age 50 to 74, who were overdue for colorectal cancer screening in a calendar year, where overdue is defined as not having had a fecal occult blood test (FOBT) in the past 2 years, a flexible sigmoidoscopy in the last 10 years or a colonoscopy in the last 10 years

Administrative data

34.3%

Colorectal Cancer Screening Participation

Manitoba*

 

 

 

 

 

 

 

 

 

 

2011–2012

Overdue for screening (1 – percentage of men and women who are up to date):

percentage of men and women, age 50 to 74, who were overdue for colorectal cancer screening, where overdue is defined as not having had a screening fecal occult blood test (FOBT) in the past 2 years and/or a colonoscopy/ flexible sigmoidoscopy in the last 5 years

Administrative data

50%

Colorectal Cancer Screening Report, January 2011–December 2012

* Best jurisdiction: the jurisdiction with participation methodology that best approximates Ontario’s

Self-reported up to date with screening data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2012

Up to date with colorectal cancer screening: percentage of population, age 50 to 74, reporting a fecal test in the last 2 years and/or flexible sigmoidoscopy or colonoscopy in the last 5 years for any reason

Self-reported (Canadian Community Health Survey)

60%

Canadian Partnership Against Cancer’s 2016 Cancer System Performance Report

Manitoba (province reporting highest participation)

2014

Up to date with colorectal cancer screening: percentage of population, age 50 to 74, reporting a fecal test in the last 2 years and/or flexible sigmoidoscopy or colonoscopy in the last 10 years for any reason

Self-reported (Canadian Community Health Survey)

68%

Canadian Partnership Against Cancer’s Colorectal CancerScreening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2013–December 2014

Table 4. Jurisdictional comparisons for colorectal cancer screening (fecal test): administrative and self-reported data

Fecal test (fecal occult blood test or fecal immunochemical test) participation administrative data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Alberta

2013–2014

Percentage of screen-eligible men and women, age 50 to 74, who successfully completed at least 1 fecal test in the screening program within a 30-month period

Administrative

42%

Canadian Partnership Against Cancer’s Colorectal Cancer Screening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2013–December 2014

Australia

2013–2014

Percentage of men and women, age 50 to 69, invited to participate in screening and who returned a completed bowel cancer screening fecal occult blood test (FOBT) kit for analysis in a 2-year period

Administrative

37%

National Bowel Cancer Screening Program: Monitoring Report, 2016

Manitoba

2013–2014

Percentage of screen-eligible men and women, age 50 to 74, who successfully completed at least 1 fecal test in the screening program within a 30-month period

Administrative

17%

Canadian Partnership Against Cancer’s Colorectal Cancer Screening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2013–December 2014

Nova Scotia

2013–2014

Percentage of screen-eligible men and women, age 50 to 74, who successfully completed at least 1 fecal test in the screening program within a 30-month period

Administrative

26%

Canadian Partnership Against Cancer’s Colorectal Cancer Screening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2013–December 2014

Prince Edward Island

2013–2014

Percentage of screen-eligible men and women, age 50 to 74, who successfully completed at least 1 fecal test in the screening program within a 30-month period

Administrative

20%

Canadian Partnership Against Cancer’s Colorectal Cancer Screening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2013–December 2014

Self-reported fecal screening test (fecal occult blood test or fecal immunochemical test) participation data

Country/region

Reporting period

Definition

Type of data

Rate

Source

Ontario

2012

Percentage of population, age 50 to 74, that reported having had a fecal test in the past 2 years for any reason

Self-reported (Canadian Community Health Survey)

38%

Canadian Partnership Against Cancer’s 2016 Cancer System Performance Report

Manitoba (province reporting highest participation)

2014

Percentage of population, age 50 to 74, that reported having had a fecal test in the past 2 years for screening purposes

Self-reported (Canadian Community Health Survey)

49%

Canadian Partnership Against Cancer’s Colorectal Cancer Screening in Canada: Monitoring & Evaluation of Quality Indicators—Results Report, January 2013–December 2014

Canadian provincial administrative data are available for comparison within Canada (i.e., among provinces).

Other data are sourced from surveys and are self-reported, so a degree of self-reporting bias is to be expected.

Breast cancer screening in Ontario (Figure 1)

  • It is difficult to compare breast cancer screening participation across jurisdictions due to differences in administrative and self-reported data, screening periods (2-year or 3-year), target age groups, reporting periods and how participation is calculated (e.g., participation based on invitation compared to participation based on eligible population).
  • Finding breast cancer early increases the number of treatment options available, which can lead to better outcomes and survival rates.
  • A Canadian study on mammography effectiveness in screening studies found that mammograms are associated with a 21% reduction in breast cancer mortality in average risk women age 50 to 69 (compared to no screening) [2].
  • About 1 woman in 10 will need more tests because her mammogram was not clearly normal. While an abnormal mammogram does not necessarily mean that a woman has cancer, it lets a healthcare provider know that further follow-up is needed [2].
  • In the 2015–2016 reporting period, Ontario’s 30-month (2.5-year) participation rate was about 65%. During the same reporting period, Australia had a participation rate of about 54%. However, Australia uses a 2-year period to measure participation. Also, Australian rates are based on preliminary data released early in 2016. 

For more information on breast cancer screening participation in Ontario, see the CSQI’s “Breast cancer screening participation and retention” section.

Cervical screening in Ontario (Figure 1)

  • It is difficult to compare cervical screening participation across jurisdictions due to differences in administrative and self-reported data, screening periods, target age groups, reporting periods, and variations in whether or not rates are corrected for hysterectomy.
  • Self-reported participation is typically higher than participation calculated with administrative data due to potential bias and the methods used to collect survey data.
  • In the 2014–2016 reporting period, Ontario’s 42-month (3.5-year) participation rate was 62%. During the same reporting period, Australia had a participation rate of 70%. However, Australia uses a 3-year period to measure participation.

For more information on cervical screening participation in Ontario, see this year’s “Cervical screening participation and retention” section.

Colorectal cancer screening in Ontario (Figure 2)

  • Jurisdictional comparisons for the proportion of people overdue for colorectal cancer screening are reported in this section, with additional information provided on FOBT participation.
  • FOBT screening contributes to the calculation of the overdue for screening indicator, and in jurisdictions such as Ontario where there is opportunistic screening with colonoscopy in addition to a fecal-based screening test, FOBT participation is not a recommended measure of program performance [1].
  • The percentage of those overdue for colorectal cancer screening identifies the percentage of screen-eligible Ontarians who have not been screened by the end of a calendar year. This measure takes into account all colorectal tests (including FOBT, flexible sigmoidoscopy and colonoscopy) because people who have had a recent flexible sigmoidoscopy or colonoscopy (for screening or other reasons) do not need to get screened for colorectal cancer using an FOBT.
  • In 2016, the percentage of Ontarians overdue for colorectal cancer screening was 38%. Manitoba’s most recent report of colorectal cancer screening participation was in 2011–2012, when the participation rate was 50% [3]. Caution needs to be exercised when comparing participation across these jurisdictions because of the differences in reporting periods (2016 in Ontario vs. 2011–2012 in Manitoba).
    • Manitoba has seen improvement in participation since 2010, when the participation rate was 45%. It is expected that Manitoba has improved further since the 2011–2012 report.
    • Also, while Manitoba’s "overdue for colorectal cancer screening measure includes colonoscopy and flexible sigmoidoscopy in the last 5 years (and FOBT in the last 2 years), Ontario’s overdue for screening rate includes colonoscopy and flexible sigmoidoscopy in the last 10 years [3].

For more information on colorectal cancer screening participation in Ontario, see the “Colorectal cancer screening participation” section in this year’s CSQI.

Notes

  1. Moss S, Ancelle-Park R, Brenner H. Evaluation and interpretation of screening outcomes. In: Segnan N, Patnick J, von Karsa L, editors. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First ed. Luxembourg: Publications Office of the European Union; 2010. p. 72–102.
  2. Canadian Task Force on Preventive Health Care; Tonelli M, Gorber CS, Joffres M, Dickinson J, Singh H, et al. Recommendations on screening for breast cancer in average-risk women aged 40–74 years. CMAJ. 2011 Nov 22;183(17):1991–2001.
  3. Canadian Partnership Against Cancer. The 2015 cancer system performance report. Toronto: Canadian Partnership Against Cancer; 2015.