MedicalResearch.com Interview with:
Sheila F. Dunn, MD, MSc
Scientist, Women’s College Research Institute
Director, Family Practice Health Centre
Staff Physician, Department of Family and Community Medicine
Women’s College Hospital
Associate Professor, Department of Family and Community Medicine
University of Toronto
MedicalResearch.com: What is the background for this study?
Response: Despite organized cervical and breast cancer screening programs, inequities in screening remain. In Ontario, women who are newcomers, especially those of South Asian and East Asian origin, have much lower screening rates than Canadian-born women.
In order to address these inequities the CARES program used a multi-faceted community-based intervention to increase knowledge and promote cervical and breast cancer screening among newcomer and otherwise marginalized women in Toronto, Ontario, Canada. We reached out to women in the target groups through a network of community agencies. Women attended group educational sessions co-led by peers who spoke their language. Access to screening was facilitated through group screening visits, a visit health bus and on-site Pap smears. Administrative data were used to compare screening after the education date for CARES participants with a control group matched for age, screening status and area of residence.
MedicalResearch.com: What are the main findings?
Response: Over 18 months, almost 2000 women attended 145 educational sessions provided in 20 languages. Administrative data were available for 372 women. By the end of follow-up, 26% and 36% of under or never-screened (UNS) CARES participants had Pap or mammography screening respectively. Compared with their matched controls the CARES group were 4 to 5 times more likely to have a Pap smear or mammogram in the 8 months following education.
MedicalResearch.com: What should readers take away from your report?
Response: Multifaceted interventions can improve uptake of cancer screening among marginalized groups. Previous research on educational interventions alone has shown mixed or minimal impact on cancer screening uptake. Important elements of the CARES program included outreach to provide interventions where communities meet, linguistically tailoring educational sessions to non-English speaking groups, integrating a peer leader into the intervention and facilitating access to screening. Nevertheless, although CARES improved screening uptake, the majority of UNS women did NOT go on to be screened within the follow-up period. Whether such individuals need additional support to get to screening, or their lack of engagement reflects an informed decision not to be screened is not known.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Although multi-faceted interventions have been shown to be effective, they can be costly and are not always sustainable. Some components may be more important than others in promoting screening. Further research on effective and economically feasible ways of facilitating access to screening is needed. In addition, long term follow up of individuals involved in such programmatic interventions is essential to learn about retention in screening as well as any delayed impact of this programming on individuals cancer screening behaviour.
MedicalResearch.com: Is there anything else you would like to add?
Response: In delivering this intervention we were able to witness the power of the group interaction in supporting knowledge and uptake of preventive health recommendations among newcomer women.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Cervical and Breast Cancer Screening After CARES: A Community Program for Immigrant and Marginalized Women
Dunn, Sheila F. et al.
American Journal of Preventive Medicine , Volume 0 , Issue 0
Jan 14 2017
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