Screening for cervical cancer low for immigrant women

February 2, 2011, St. Michael's Hospital

Immigrant women in Ontario are not screened for cervical cancer as often as native-born Canadians, with the lowest rates being among older, poorer South Asians, new research shows.

Only one in five – 21.9 per cent – of South Asian immigrants over the age of 50 living in low-income neighbourhoods had had a recent Pap test, according to a study led by doctors at St. Michael's Hospital.

In contrast, 79 per cent of Canadian-born women living in the highest-income neighbourhoods and who had a primary care doctor were up-to-date with their screening. In Canada, federal and provincial guidelines call for a Pap test at least once every three years.

The study compared cervical cancer for immigrant and Canadian-born women living in urban areas of Ontario between 2006 and 2008. Overall, of the 2.9 million women ages 18 to 69 whose medical billing records were compared, 61.3 per cent were up-to-date.

The study, led by family physician Dr. Aisha Lofters, appeared in a recent edition of the journal Preventative Medicine.

"We need to reach out to the South Asian immigrant community and let them know the importance of the test," said Dr. Lofters, who is with the hospital's Center for Research on Inner City Health.

Dr. Lofters said the low screening rates for poorer, older South Asians may have a lot to do with culture and their experience in their homelands. Cervical cancer screening rates in many South Asian countries are quite low – only 1 per cent in Bangladesh, even for those in the highest income strata.

"These women may not be coming from a culture where this is normal or practiced protocol," she said. "Some women were not even aware that they needed the test."

The length of time spent in Canada had little effect on a woman's screening rates. Even those who had been living in Canada for 10 or more years had rates similar to those who had recently immigrated, suggesting low patterns continue after immigration. Many of the women may be reluctant to see male doctors, Dr. Lofters said.

Cervical cancer is the second most common cancer among women worldwide. Rates are almost twice as high in the less developed world than the more developed world, where more people have Pap tests. The World Health Organization estimates that 95 per cent of in less developed countries have never been screened and that screening every 5 to 10 years could significantly reduce deaths worldwide from cervical cancer.

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