Access to Breast Cancer Access to Breast Cancer Screening in Nova Scotia: Screening in Nova Scotia:

Describing Service Provision of the Nova Describing Service Provision of the Nova Scotia Breast Screening Program (NSBSP) Scotia Breast Screening Program (NSBSP)

from 2002-2006from 2002-2006

Stephanie Lea BA, BSc, RT(R)Stephanie Lea BA, BSc, RT(R)Master of Applied Health Master of Applied Health

Services Research CandidateServices Research Candidate

June 3, 2008June 3, 2008

2

Outline

Burden of breast cancer

NSBSP

Project Rationale

Project Objectives

Methods

Project Relevance

3

Breast Cancer

The most frequently diagnosed cancer in Canadian

women - it accounts for 30% of diagnosed cancers each

year.

1in 9 women are expected to develop breast cancer in

their lifetime and 1 in 27 are expected to die from it.

In 2007(est): approx. 22,300 new cases with 5,300

deaths in Canada – of these: 680 new cases and 200

deaths would be in Nova Scotia

4

Breast Cancer

Evidence shows that screening mammography can

reduce mortality from breast cancer by approximately

30% in women aged 50-69. (Fletcher et al, 1993)

The goal of a screening program: earlier diagnosis date

so earlier intervention and improved survival rates.

The 5-year survival rate: 86% with treatment

5

Nova Scotia Breast Screening Program (NSBSP)

The NSBSP began as a provincial program in 1991

Target population: women aged 50-69, but the program

accepts women 40+

Screening guidelines call for biennial screening for target

group

Women self refer for appointments

The 2006 target population = 118,755 women (2006 Census)

As of December 2006 in NSBSP Database: 133,900

women and 433,833 screens

6

NSBSP Clinical Pathway

7

June '04 - Cumberland Regional, Amherst - fixed

site

June '03 - Mobile 3 - Northern

Jan '03 - Dartmouth

General -fixed site

June '02 - Colchester Regional, Truro - fixed site

April '01 - Yarmouth Regional - fixed site

May '00 - Cape Breton

Regional, Sydney - fixed site

July '97 - Mobile 2 - Western

Sept. '94 - Mobile 1- Cape

BretonJune '91- Halifax Shopping

Centre - fixed Site

NSBSP began as a

provincial program

July '05 - South Shore Regional, Bridgewater -

fixed site

Jan '07 - Aberdeen, New

Glasgow - fixed site

Jan '06 - Valley Regional, Kentville - fixed site

July '07 - Cobequid, Lower Sackville -fixed site (FFDM)

March '07 - Mobile 4 (FFDM) - Cape Breton

1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

NSBSP History Timeline

There are currently 13 screening sites: 3 mobile vans and 10 fixed

8

9

Growth of Screening Volume 1991-2006

10

Project Rationale

National Indicators

Indicators of interest:

Participation Rate: Percentage of women who have a screening mammogram (calculated biennially) as a proportion of the eligible population Target: ≥ 70% of the target populationThe participation rate for NS was 51.77% for the biennial

timeframe of 2005 and 2006

Retention Rate: Estimated percentage of women who are re-screened within 30 months of their previous screen

Target: ≥75% re-screened within 30 monthsThe retention rate for NS in 2005 – 2006 timeframe was

64.7%

11

Target Population as % of Whole and Participation by DHA DHA % NS Target Pop. Part. % 2005/06

DHA 1 7.3% 48.0%

DHA 2 6.8% 59.9 %

DHA 3 9.1% 45.5 %

DHA 4 7.3% 56.3 %

DHA 5 3.9% 52.0 %

DHA 6 5.3% 12.0 %

DHA 7 5.2% 35.0 %

DHA 8 15.1% 46.0 %

DHA 9 40% 53.0 %

Source: Nova Scotia Community Counts web page – data modeled from Statistics Canada and NSBSP

12

Project Rationale

By the end of 2008 the last screening site will join the NSBSP

All breast screening in NS will be captured under one program

The province-wide rollout of Full Field Digital Mammography

Screening capacity increase of at least 60%

Natural experiment – pre- versus post- FFDM

Province-wide rollout of Diagnostic Reporting System (DRS)

All mammography exams in province captured in database (via MIS

and DRS)

No manual entry = workload reduction

Data quality and accuracy

13

Project Rationale

Geographic Information Systems (GIS) opportunities

Public Health Agency of Canada – GIS Infrastructure

Centre of Geographic Sciences (COGS) student Faye Welsh

“GIS is a tool that allows users to create interactive queries

(user created searches), analyse the spatial information, edit

data, and present the results of all these operations (GIS, 2007)

in the form of maps that visually represent many different

layers of information and how these different types of

information may work together (Payne, 2006)”.

14

Project Objectives

A retrospective study describing service provision by the

Nova Scotia Breast Screening Program to NS women

aged 50-69 from 2002-2006.

Objectives:

To describe patterns of need by age group, region

(DHA) and over time

To describe patterns of use by age group, region

(DHA) and over time

To describe patterns of service delivery, by both fixed

and mobile sites over time

15

Methods - Data

2006 Census data for population counts and boundary

files

Geographical data provided in collaboration with the GIS

Centre at Dalhousie: DHA boundary files, road networks,

postal codes as geographic points etc.

NSBSP database - Data extraction resulted in 241,000

screening visit files (this includes all ages – 40+)

16

Methods

Study population: Very unique situation as there

is NO p-value or sample size calculations! All

Nova Scotia women aged 50-69 that are in or

not in the NSBSP are included.

Analysis software: SAS and GIS

Results: descriptive statistics and maps

17

GIS Software - ArcGIS

18

19

20

Project Relevance

“Given that all screening mammography will be

overseen by the NSBSP, it is now timely to evaluate the

role of the mobile units in relation to the fixed sites in

providing equitable screening services to women

throughout Nova Scotia” (NSBSP Annual Report, 2006)

Project results will inform the deployment of the mobile

vans and provide context for further studies - the impact

of FFDM for example.

21

Acknowledgements

Dr. Jennifer Payne – Thesis Supervisor and Principal Investigator

Dr. Judy Caines – Thesis Committee Member and Co-Investigator

Dr. Gerry Schaller and Dr. Sian Iles – Co-Investigators

Canadian Breast Cancer Foundation – Atlantic Chapter

Nova Scotia Breast Screening Program

GIS Infrastructure Public Health Agency of Canada

Centre of Geographic Sciences (COGS)

GIS Centre Dalhousie University

22

Thank you!

Questions and comments welcome and appreciated.