Assessing Breast Cancer Screening and Outcomes Among First Nations Women in Alberta.

BACKGROUND: Breast cancer (BC) incidence rates for First Nations (FN) women in Canada have been steadily increasing and are often diagnosed at a later stage. Despite efforts to expand the reach of BC screening programs for FN populations in Alberta (AB), gaps in screening and outcomes exist. METHODS: Existing population-based administrative databases including the AB BC Screening Program, the AB Cancer Registry, and an AB-specific FN registry data were linked to evaluate BC screening participation, detection, and timeliness of outcomes in this retrospective study. Tests of proportions and trends compared the findings between FN and non-FN women, aged 50-74 years, beginning in 2008. Incorporation of FN principles of ownership, control, access, and possession (OCAP®) managed respectful sharing and utilization of FN data and findings. RESULTS: The average age-standardized participation (2013-8) and retention rates (2015-6) for FN women compared to non-FN women in AB were 23.8% (P < .0001) and 10.3% (P = .059) lower per year, respectively. FN women were diagnosed with an invasive cancer more often in Stage II (P-value = .02). Following 90% completion of diagnostic assessments, it took 2-4 weeks longer for FN women to receive their first diagnosis as well as definitive diagnoses than non-FN women. CONCLUSION: Collectively, these findings suggest that access to and provision of screening services for FN women may not be equitable and may contribute to higher BC incidence and mortality rates. Collaborations between FN groups and screening programs are needed to eliminate these inequities to prevent more cancers in FN women.

Creation of a Métis-Specific Instrument for Cancer Screening: A Scoping Review of Cancer-Screening Programs and Instruments.

Understanding the barriers to and facilitators of cancer screening programs among Indigenous populations remains limited. In the spirit of mutual respect, this co-led, collaborative project was carried out between the Métis Nation of Alberta and Screening Programs from Alberta Health Services (AHS). This scoping review assessed the cancer screening literature for available questionnaires and then identified themes and suitable questions for a Métis-specific cancer screening questionnaire. Literature searches on cervical, breast, and colorectal cancer screening programs and related concepts were conducted in electronic databases, including the Native Health Database, MEDLINE (Ovid), PsycINFO, PubMed, PubMed Central, CINAHL, MEDLINE (Ebsco), Psychology & Behavioral Sciences Collection, and Web of Science. Grey literature was collected from AHS Insite, Open Archives Initiative repository, American Society of Clinical Oncology, European Society of Medical Oncology, Google, and Google Scholar. 135 articles were screened based on the eligibility criteria with 114 articles selected, including 14 Indigenous-specific ones. Knowledge, attitude, belief, behaviour, barrier, and facilitator themes emerged from the review, but no Métis-specific cancer screening instruments were found. Thus, one was developed using existing cancer screening instruments, with additional questions created by the project team. A survey of the Métis population in Alberta will use this questionnaire and provide data to address the burden of cancer among Métis people.

Impact of switching from digital mammography to tomosynthesis plus digital mammography on breast cancer screening in Alberta, Canada.

OBJECTIVES: To compare abnormal call rates (ACR), cancer detection rates (CDR), positive predictive values (PPVs), and annual return to screen recommendations after switching from digital mammography (DM) to digital breast tomosynthesis plus DM (DBT + DM) for breast cancer screening. SETTING: The Alberta Breast Cancer Screening Program collects screening data from clinics throughout the province of Alberta, Canada. METHODS: This study retrospectively collected data, between 2015 and 2018, on women aged 40+ who underwent breast cancer screening at two large volume multisite radiology groups to compare metrics one year prior and one year after DBT + DM implementation. Comparisons between modalities were carried out within age groups, within breast density categories, and for initial vs. subsequent screens. RESULTS: A total of 125,432 DM and 128,912 DBT + DM screening exams were performed. For women aged 50-74, the DBT + DM group had a higher ACR (p < 0.01) but lower annual return to screens (p < 0.01). CDR was higher post-DBT + DM implementation for women with scattered (6.0 per 1000 vs. 4.4 per 1000; p = 0.001) or heterogeneously dense breasts (6.5 per 1000 vs. 4.2 per 1000; p < 0.001). PPV was higher with DBT + DM for all age groups, with women 50-74 having a PPV of 8.3% using DBT + DM vs. 7.1% with DM (p = 0.009). CONCLUSION: All metrics improved or stayed the same after switching to DBT + DM except for ACR. However, the increase in ACR could be attributed to a trend already occurring prior to the switch. Longer term monitoring is needed to confirm these findings.

Cancer Screening Interventions in Indigenous Populations: A Rapid Review.

Cancer screening is an important component of a cancer control strategy. Indigenous people in Canada have higher incidence rates for many types of cancer, including those that can be detected early or prevented through organized screening programs. Increased participation and retention in cancer screening is critical to improved population health outcomes amongst Indigenous people. This rapid review evaluates cancer screening interventions published in the last six years. Included studies demonstrated increased participation in breast, colorectal, or cervical cancer screening programs in Indigenous populations or showed promise of increased participation based on the factors that influence people's screening practices, such as knowledge, attitude, or intent to screen. The Preferred Reporting Items for Systematic Reviews guided the search strategy. The review identified 85 articles with 12 meeting the specified criteria: seven studies reported an increase in cancer screening participation and five studies reported improved knowledge, attitude, or intent to screen. The use of multiple culturally appropriate strategies in co-designed studies were the most effective. This review will be used to inform First Nations (FN) populations and Screening Programs in Alberta of potential strategies to address disparities identified through a recent data analysis comparing cancer screening and outcomes between FN and non-FN people.