Breast, cervical and Colorectal cancer screening rates among Canadian with and without self-reported visual impairment
Authors: Milena Cioana, James Im, Yvonne Buys, Hatem Krema, Sophia Liu, Peng Yan, Ya-Ping Jin.
Author Disclosure Block: M. Cioana: None. J. Im: None. Y. Buys: Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Ontario’s Ministry of Health for the COVID-19 Challenge Questions Initiative; Glaucoma Research Society of Canada. Funded grants or clinical trials; Description of relationship(s); Grant/Research support. H. Krema: None. S. Liu: None. P. Yan: None. Y. Jin: Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Ontario’s Ministry of Health for the COVID-19 Challenge Questions Initiative, Glaucoma Research Society of Canada. Funded grants or clinical trials; Description of relationship(s); Grant/Research support.
Purpose: Adherence to cancer screening guidelines can lead to early detection and reduced mortality. Due to barriers in reading, driving, and ambulating, individuals with visual impairment (VI) may participate in cancer screening less often than those without VI. This study compared participation rates in government-funded screening for breast, cervical and colorectal cancer in Canadians with and without VI, and examined associated sociodemographic factors.
Study Design: Cross-sectional survey.
Methods: Self-reported data on vision status and participation in mammography, pap smear, and fecal occult blood test was analyzed from respondents to the Canadian Community Health Survey 2013/2014 and 2017/2018. Participation in screening at the recommended age and time interval was compared between individuals with and without VI. Sample size ranged from 43-240 (VI group) to 2,527-22,361 (non-VI group) in 2013/2014, and from 398-2,265 (VI group) to 1,573-11,217 (non-VI group) in 2017/2018. Screening rates by sociodemographic characteristics, including having a family doctor, household income, education, and sex (for colorectal cancer screening only) were also compared.
Results: Canadians with VI had lower participation rates in breast (53.0% [95%CI 36.3%-69.7%] vs. 67.0% [95%CI 64.5%-69.4%]) and cervical (53.8% [95%CI 29.3%-78.3%] vs. 76.2% [95%CI 74.0%-78.3%]) cancer
screening at recommended time intervals compared to those without VI in 2013/2014. Colorectal cancer screening rates at the recommended interval were 30.0% (95%CI 14.4%-45.6%) for males with VI vs.
24.8% (95%CI 23.3%-26.2%) for males without VI, 23.2% (95%CI 14.1%-32.2%) for females with VI vs. 24.6% (95%CI 23.2%-25.9%) for females without VI, and were similar for males and females combined together (25.7% [95%CI 17.3%-34.1%] vs. 24.7% [95%CI 23.7%-25.6%]). Differences between the VI and non-VI groups across the three cancer screening categories persisted despite having a family physician. Lower household income and education level were associated with lower screening rates in the VI group for all cancer screenings examined. The 2017/2018 data similarly revealed a lower mammography screening rate (61.9% vs. 69.4%) and a comparable colorectal cancer screening rate (40.7% vs. 38.0%) in Canadians with and without VI. Information for cervical cancer screening was unavailable in 2017/2018.
Conclusions: Canadians with self-reported VI seem to have lower participation rates in breast and cervical cancer screening than those without VI. Smaller sample sizes in individuals with VI are likely responsible for non-significant differences. Having a family physician did not impact this difference.
Policy-makers, organizations and clinicians should understand the unique barriers faced by individuals with VI, and facilitate their adherence to appropriate screening practices.