title: Cervical and Breast Cancer Screening After CARES: A Community Program for Immigrant and Marginalized Women.
abstract: BACKGROUND
  Marginalized populations such as immigrants and refugees are less likely to receive cancer screening. Cancer Awareness: Ready for Education and Screening (CARES), a multifaceted community-based program in Toronto, Canada, aimed to improve breast and cervical screening among marginalized women. This matched cohort study assessed the impact of CARES on cervical and mammography screening among under-screened/never screened (UNS) attendees.
  
  
  METHODS
  Provincial administrative data collected from 1998 to 2014 and provided in 2015 were used to match CARES participants who were age eligible for screening to three controls matched for age, geography, and pre-education screening status. Dates of post-education Pap and mammography screening up to June 30, 2014 were determined. Analysis in 2016 compared screening uptake and time to screening for UNS participants and controls.
  
  
  RESULTS
  From May 15, 2012 to October 31, 2013, a total of 1,993 women attended 145 educational sessions provided in 20 languages. Thirty-five percent (118/331) and 48% (99/206) of CARES participants who were age eligible for Pap and mammography, respectively, were UNS on the education date. Subsequently, 26% and 36% had Pap and mammography, respectively, versus 9% and 14% of UNS controls. ORs for screening within 8 months of follow-up among UNS CARES participants versus their matched controls were 5.1 (95% CI=2.4, 10.9) for Pap and 4.2 (95%=CI 2.3, 7.8) for mammography. Hazard ratios for Pap and mammography were 3.6 (95% CI=2.1, 6.1) and 3.2 (95% CI=2.0, 5.3), respectively.
  
  
  CONCLUSIONS
  CARES' multifaceted intervention was successful in increasing Pap and mammography screening in this multiethnic under-screened population.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: sheila.dunn@wchospital.ca.
authors.forename: Sheila F
authors.initials: SF
authors.lastname: Dunn
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Aisha K
authors.initials: AK
authors.lastname: Lofters
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ophira M
authors.initials: OM
authors.lastname: Ginsburg
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Meaney
authors.affiliation: School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada.
authors.forename: Farah
authors.initials: F
authors.lastname: Ahmad
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M Catherine
authors.initials: MC
authors.lastname: Moravac
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cam Tu Janet
authors.initials: CTJ
authors.lastname: Nguyen
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Arisz
mesh_terms: D000328:Adult; D001364:Awareness; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D002170:Canada; D016022:Case-Control Studies; D003153:Community Health Services / Q000458:organization & administration; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D055815:Young Adult