title: Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada.
abstract: BACKGROUND
  Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening.
  
  
  METHODS
  We conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two-year period of 2010-2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables.
  
  
  RESULTS
  64% of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95% CI 0.85-0.88 for new immigrants and 0.90, 95% CI 0.89-0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low-income neighborhoods, having a male physician, having internationally-trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22% less likely to be screened compared to those who were (ARR 0.78, 95% CI 0.77-0.79).
  
  
  CONCLUSIONS
  To enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.
authors.affiliation: Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada. mvahabi@ryerson.ca.|Immigration and Settlement Studies, Ryerson University, Toronto, Canada. mvahabi@ryerson.ca.|Ryerson Centre for Global Health and Health Equity, Toronto, Canada. mvahabi@ryerson.ca.
authors.forename: Mandana
authors.initials: M
authors.lastname: Vahabi
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. aisha.lofters@utoronto.ca.|Department of Family and Community Medicine, University of Toronto, Toronto, Canada. aisha.lofters@utoronto.ca.|Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada. aisha.lofters@utoronto.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. aisha.lofters@utoronto.ca.
authors.forename: Aisha
authors.initials: A
authors.lastname: Lofters
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada. matthew.kumar@ices.on.ca.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. rick.glazier@ices.on.ca.|Department of Family and Community Medicine, University of Toronto, Toronto, Canada. rick.glazier@ices.on.ca.|Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada. rick.glazier@ices.on.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. rick.glazier@ices.on.ca.|Dalla, Lana School of Public Health, University of Toronto, Toronto, Canada. rick.glazier@ices.on.ca.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000069:Acculturation; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data