This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Breast and Cervical Cancer Screening in Ontario and the United States

Steven J. Katz, MD, MPH; Timothy P. Hofer, MD, MSc

JAMA. 1994;272(7):530-534.

Abstract
Objective.
—To compare the association of income and education with breast and cervical cancer screening in Ontario, Canada, and the United States.

Design.
—Survey using data from the Ontario Health Survey and the US National Health Interview Survey.

Participants.
—A multistage random sample of women aged 18 years and older living in households in Ontario (N=23 521) and the United States (N=23 932) in 1990.

Main Outcome Measure.
—Persons were considered screened if they reported a Papanicolaou test within the previous 2 years, a clinical breast examination within the previous year, or a mammogram within the previous year.

Results.
—Papanicolaou test and clinical breast examination rates were similar between countries, but mammography rates were two to three times higher in the United States across all age groups. Compared with women with less than a high school degree, college graduates were more likely to receive screening (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2 to 1.7) and there was no difference between countries. Across all procedures, women with higher incomes were more likely to receive screening. For Papanicolaou test and clinical breast examination, there was no difference between countries. Compared with the lowest income, the OR was 1.7 (95% CI, 1.3 to 2.1) in Ontario and 1.9 (95% CI, 1.6 to 2.2) in the United States for Papanicolaou test and 2.1 (95% CI, 1.6 to 2.8) in Ontario and 2.1 (95% CI, 1.8 to 2.6) in the United States for the clinical breast examination for women with income greater than $45 600 (US dollars). For mammography screening, the association of income with use was greater in the United States: the OR was 1.8 (95% CI, 1.3 to 2.6) in Ontario and 2.7 (95% CI, 2.3 to 3.2) in the United States for women with income greater than $45 600 (US dollars).

Conclusions.
—Despite the long-time presence of universal insurance coverage in Ontario, the disparities in the use of cancer screening procedures by the poor were similar to the United States. Universal coverage is not sufficient to overcome the large disparities in screenings across socioeconomic status demonstrated in both countries.

(JAMA. 1994;272:530-534)

Author Affiliations
From the Division of General Medicine (Dr Katz and Dr Hofer) and the Department of Health Services Management and Policy (Dr Katz), University of Michigan, and the Department of Veterans Affairs Medical Center (Dr Hofer), Ann Arbor, Mich.

Footnotes
The opinions represented in this article are those of the authors and do not reflect those of the Robert Wood Johnson Foundation, the National Center for Health Statistics, or the Ontario Ministry of Health.

Reprint requests to Division of General Internal Medicine, University of Michigan Medical Center, 3116 Taubman Center, Ann Arbor, Ml 48 109-0376 (Dr Katz).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Determining use of preventive health care in Ontario: Comparison of rates of 3 maneuvers in administrative and survey data
Wang et al.
cfp 2009;55:178-179.e5.
ABSTRACT | FULL TEXT  

Factors influencing the uptake of screening services for breast and cervical cancer in Taiwan
Lin
The Journal of the Royal Society for the Promotion of Health 2008;128:327-334.
ABSTRACT  

Recommendation for and Receipt of Cancer Screenings Among Medicaid Recipients 50 Years and Older
DuBard et al.
Arch Intern Med 2008;168:2014-2021.
ABSTRACT | FULL TEXT  

Screening Mammography in Older Women: Effect of Wealth and Prognosis
Williams et al.
Arch Intern Med 2008;168:514-520.
ABSTRACT | FULL TEXT  

Transcending the Known in Public Health Practice: The Inequality Paradox: The Population Approach and Vulnerable Populations
Frohlich and Potvin
Am. J. Public Health 2008;98:216-221.
ABSTRACT | FULL TEXT  

Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women
Ogilvie et al.
CMAJ 2007;177:480-483.
ABSTRACT | FULL TEXT  

Cancer incidence among semiconductor and electronic storage device workers
Bender et al.
Occup. Environ. Med. 2007;64:30-36.
ABSTRACT | FULL TEXT  

Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system
Munoz et al.
Eur J Public Health 2006;16:361-367.
ABSTRACT | FULL TEXT  

Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey
Lasser et al.
Am. J. Public Health 2006;96:1300-1307.
ABSTRACT | FULL TEXT  

Cervical cancer incidence and mortality in the best and worst of worlds
Rydstrom and Tornberg
Scand J Public Health 2006;34:295-303.
ABSTRACT  

Inequity in Mental Health Care Under Canadian Universal Health Coverage
Steele et al.
Psychiatr. Serv. 2006;57:317-324.
ABSTRACT | FULL TEXT  

Explaining Black-White Differences in Receipt of Recommended Colon Cancer Treatment
Baldwin et al.
JNCI J Natl Cancer Inst 2005;97:1211-1220.
ABSTRACT | FULL TEXT  

Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared to clinician collected human papillomavirus specimens: a meta-analysis
Ogilvie et al.
Sex. Transm. Infect. 2005;81:207-212.
ABSTRACT | FULL TEXT  

Association of socioeconomic status and receipt of colorectal cancer investigations: a population-based retrospective cohort study
Singh et al.
CMAJ 2004;171:461-465.
ABSTRACT | FULL TEXT  

Effect of patient socioeconomic status on perceptions of first- and second-year medical students
Woo et al.
CMAJ 2004;170:1915-1919.
ABSTRACT | FULL TEXT  

Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996
Ng et al.
CMAJ 2004;170:1545-1549.
ABSTRACT | FULL TEXT  

A Large Population-Based Randomized Controlled Trial to Increase Attendance at Screening for Cervical Cancer
Eaker et al.
Cancer Epidemiol. Biomarkers Prev. 2004;13:346-354.
ABSTRACT | FULL TEXT  

Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says "no"
Roos et al.
CMAJ 2004;170:209-214.
ABSTRACT | FULL TEXT  

Delivering Equitable Care: Comparing Preventive Services in Manitoba
Gupta et al.
Am. J. Public Health 2003;93:2086-2092.
ABSTRACT | FULL TEXT  

Effectiveness of Interventions to Increase Papanicolaou Smear Use
Yabroff et al.
J Am Board Fam Med 2003;16:188-203.
ABSTRACT | FULL TEXT  

Relationship Between Avoidable Hospitalizations for Diabetes Mellitus and Income Level
Booth and Hux
Arch Intern Med 2003;163:101-106.
ABSTRACT | FULL TEXT  

Cancer Screening Practices From National Health Interview Surveys: Past, Present, and Future
Hiatt et al.
JNCI J Natl Cancer Inst 2002;94:1837-1846.
ABSTRACT | FULL TEXT  

Utilisation of coronary angiography after acute myocardial infarction in Ontario over time: have referral patterns changed?
Khaykin et al.
Heart 2002;88:460-466.
ABSTRACT | FULL TEXT  

Equity in prevention and health care
Lorant et al.
J. Epidemiol. Community Health 2002;56:510-516.
ABSTRACT | FULL TEXT  

Gender differences in clinical status at time of coronary revascularisation in Spain
Aguilar et al.
J. Epidemiol. Community Health 2002;56:555-559.
ABSTRACT | FULL TEXT  

Improving Adherence to Regular Pap Smear Screening among Asian Women: A Population-Based Study in Singapore
Lee et al.
Health Educ Behav 2002;29:207-218.
ABSTRACT  

Impact of Sociodemographic Factors, Hormone Receptor Status, and Tumor Grade on Ethnic Differences in Tumor Stage and Size for Breast Cancer in US Women
Miller et al.
Am J Epidemiol 2002;155:534-545.
ABSTRACT | FULL TEXT  

Effect of Socioeconomic Status on Treatment and Mortality After Stroke * Editorial Comment
Kapral et al.
Stroke 2002;33:268-275.
ABSTRACT | FULL TEXT  

Commentary: Social inequalities in health, social epidemiology and social value
Birch
Int J Epidemiol 2001;30:294-296.
FULL TEXT  

Predictors of mammography use among Canadian women aged 50-69: findings from the 1996/97 National Population Health Survey
Maxwell et al.
CMAJ 2001;164:329-334.
ABSTRACT | FULL TEXT  

Quality of Care for Patients With Rheumatoid Arthritis
MacLean et al.
JAMA 2000;284:984-992.
ABSTRACT | FULL TEXT  

What Is the Right Cancer Screening Rate?
Harris
ANN INTERN MED 2000;132:732-734.
FULL TEXT  

Effects of Socioeconomic Status on Access to Invasive Cardiac Procedures and on Mortality after Acute Myocardial Infarction
Alter et al.
NEJM 1999;341:1359-1367.
ABSTRACT | FULL TEXT  

Interventions Targeted toward Patients to Increase Mammography Use
Yabroff and Mandelblatt
Cancer Epidemiol. Biomarkers Prev. 1999;8:749-757.
ABSTRACT | FULL TEXT  

Influence of Socioeconomic and Cultural Factors on Racial Differences in Late-Stage Presentation of Breast Cancer
Lannin et al.
JAMA 1998;279:1801-1807.
ABSTRACT | FULL TEXT  

Improving Preventive Health Care in a Medical Resident Practice
Cardozo et al.
Arch Intern Med 1998;158:261-264.
ABSTRACT | FULL TEXT  

The Health of Navajo Women: Findings from the Navajo Health and Nutrition Survey, 1991-1992
Strauss et al.
J. Nutr. 1997;127:2128-2128.
ABSTRACT | FULL TEXT  

A Detailed Comparison of Physician Services for the Elderly in the United States and Canada
Welch et al.
JAMA 1996;275:1410-1416.
ABSTRACT  

Health Care for Older People: A Look Across a Frontier
Evans
JAMA 1996;275:1449-1450.
ABSTRACT  

Immunization Coverage Among Infants Enrolled in the Tennessee Medicaid Program
Griffin et al.
Arch Pediatr Adolesc Med 1995;149:559-564.
ABSTRACT  

Differences in the Frequency of Cholesterol Screening in Patients With Medicaid Compared With Private Insurance
Hueston et al.
Arch Fam Med 1995;4:331-334.
ABSTRACT  

Socioeconomic Status and Attitudes of 51 Patients With Giant Basal and Squamous Cell Carcinoma and Paired Controls
Robinson et al.
Arch Dermatol 1995;131:428-431.
ABSTRACT