Study finds that people with low incomes and precarious housing less likely to get screened for cancer
Adults living with low incomes are less likely to be screened for colorectal, cervical and breast cancer, says researchers from the Department of Family and Community Medicine (DFCM) in a study. It used social determinants of health to examine cancer screening disparities among patients of the St. Michael’s Hospital Academic Family Health Team.
Lead investigators Drs. Aisha Lofters and Tara Kiran, Assistant Professors at DFCM and family physicians at St. Michael’s Hospital, also found that housing status – whether the patient owns, rents or lives in a special housing arrangement– is linked with a patient’s likelihood to get screened for cancer.
“Our goal was to figure out if there are particular groups of patients where we could do a better job ensuring they are receiving regular screenings for cancer,” says Dr. Lofters, a researcher and physician at St. Michael’s Hospital.
“The point of screening is to catch cancer at an early stage or, even better, catch an abnormality before it turns into cancer so doctors can focus on treatment and prevention before it spreads.”
To conduct the study, researchers used a survey given to patients who are eligible for cancer screening that asks for socio-economic data like race, income, country of birth and other social determinants of health. Researchers then used patient’s electronic medical records to compare the sociodemographic information of patients who were overdue for cancer screening versus those who were up-to-date.
“The most striking differences in screening rates are between low and high-income patients and those who own their home or have other living arrangements,” says Dr. Lofters.
Patients in the low-income bracket – as defined by Statistics Canada – were at the highest risk of falling behind with cancer screening for all three types of cancers versus those with higher incomes, says Dr. Lofters.
Patients who owned their homes had the best screening rates, followed by patients who rent. Those who lived in more precarious housing situations, such as subsidized housing, shelters, hostels, or undetermined, were far less likely to receive cancer screening than those with more permanent housing situations.. Those who lived in more precarious housing situations, such as subsidized housing, shelters, hostels, or undetermined, were far less likely to receive cancer screening than those with more permanent housing situations.
“We aren’t sure why housing status plays such a large role in cancer screening rates,” says Dr. Lofters. “We think that it might be a reflection of wealth - similar to income – or it could be how stable your life is. If you’re going from home-to-home, getting a cancer screening may not be a high priority for you at that time. You also don’t have a long-term address to receive reminders and notifications that you may be due for a screening test.”
Dr. Lofters points out that the patients included in this study are part of St. Michael’s Hospital Academic Family Health Team and have family doctors, so it’s likely that the rates for screening are much lower for those without a family doctor.
One option to improve screening rates is home screening tests, such as cervical self-sampling tests, that patients mail to labs independently. While Dr. Lofters admits that it will not address all the barriers to pap tests and the research is far from complete on these options, she hopes it’s an alternative that one day may be made available.
“As a province, we’re not meeting the targets that Cancer Care Ontario set out for screening,” says Dr. Lofters. “So there’s definitely room for improvement and we’re always looking for innovations.”