Background: In spite of supporting evidence and widespread promotional campaigns, screening rates for breast, cervical and colorectal cancers in Ontario are lower than expected. These low screening rates may be partially due to lack of knowledge on the part of patients. Given the importance of early detection to reduce cancer mortality and morbidity, it is prudent to investigate where knowledge deficits may exist. The purpose of this study was to assess patient knowledge of the Ontario screening guidelines for breast, cervical and colorectal cancers. Methods: Patients of a family health team in Toronto, Ontario were surveyed regarding their knowledge of cancer screening guidelines. Questions included knowledge regarding the test, screening interval and age for cancer screening for breast, cervical and colorectal cancers as well as sociodemographic characteristics. Responses were summarized using descriptive statistics. Results: A total of 117 patients were surveyed. Knowledge of the appropriate screening test was high for breast and cervical cancer (85.5% and 70.1% respectively) though much lower for colorectal cancer (17.1%). Knowledge regarding the age that screening should occur and the screening intervals were much lower across all cancer types. For breast cancer, 16.2% knew the age screening should occur and 30.8% knew the screening interval. For cervical cancer, 6.8% knew the age screening should occur and only 4.3% knew the screening interval. For colorectal cancer, 32.5% knew the age to start screening and 26% knew the screening interval. Conclusions: Knowledge of the cancer screening guidelines appeared to be low across all cancer types, particularly for the ages at when screening should occur and the appropriate screening intervals. These results suggest that public health practitioners and cancer prevention organizations may need to increase efforts for patient education on cancer screening.
The Canadian Cancer Society estimates that over 187,000 people will have been diagnosed with and over 75,500 people will have died of cancer by the end of 2013 [
The reasons for the lower-than-desired screening rates are not entirely clear; however, evidence supports so- cioeconomic status as a contributing factor. For example, women who are immigrants, older and of lower so- cioeconomic status report lower rates of cervical cancer screening [
Therefore, it is important to gain a sense of what baseline knowledge exists, especially among populations where low socioeconomic status may be prevalent. Thus, the purpose of this study was to assess the overall knowledge of the Ontario screening guidelines for breast, cervical and colorectal cancers among a diverse group of patients of a large, urban family health team.
We surveyed patients of a large, academic, urban family practice located in Toronto, Ontario. The patient popu- lation this practice serves is diverse, with varying socioeconomic, cultural, language, religious and ethnic back- grounds. Particular focus is also placed on inner city health issues associated with homeless, disadvantaged and vulnerable individuals. Patients were approached in the waiting room using convenience sampling. The survey was provided to any patient who appeared to be screen-eligible (based on age) for any or all of the three evi- dence-supported forms of cancer screening. The survey was comprised of: 1) nine questions regarding knowl- edge of the three evidence-supported guidelines of cancer screening in Ontario (one question each on method, frequency and ages of screening) in a multiple choice format; and 2) nine sociodemographic questions. The sur- vey was anonymous; no personal identifiers were collected. Upon completion of the survey, an information sheet was given out to all participants outlining the current screening guidelines in Ontario.
Data were summarized using descriptive statistics. Analysis of correct responses was determined by comparing the participant survey answers to current screening guidelines. We also analyzed correct responses within at risk populations as follows: 1) breast cancer—females, aged 50 - 69; 2) cervical cancer—all females surveyed; 3) colorectal cancer—all males and females, aged 50 and over. These categories were used as liberal estimates of respondents who would be eligible for each screening type.
This study received ethics approval from the Research Ethics Board (REB) at St. Michael’s Hospital.
A total of 117 patients completed surveys. The majority of respondents were women (76.1%) and 58% of res- pondents were over 50 years of age (
. Respondent demographics (n = 117)
Demographic | N (%) |
---|---|
Age | |
<50 | 47 (42.0) |
50 - 54 | 11 (9.8) |
55 - 59 | 11 (9.8) |
60 - 64 | 14 (12.5) |
65 - 69 | 16 (14.3) |
70 - 74 | 6 (5.4) |
>75 | 7 (6.3) |
Gender | |
Female | 86 (76.1) |
Male | 27 (23.9) |
Marital status | |
Married/partnered | 57 (50.0) |
Separated/divorced | 14 (12.3) |
Widowed | 12 (10.5) |
Single, never married | 31 (27.2) |
Length of time in Canada | |
<5 years | 2 (1.8) |
5 - 10 years | 8 (7.0) |
>10 years | 33 (28.9) |
All my life | 71 (62.3) |
Language | |
English | 95 (84.1) |
French | 2 (1.8) |
Other | 16 (14.1) |
Race | |
Caucasian | 73 (64.6) |
Non-Caucasian | 40 (35.4) |
Highest level of education completed | |
Less than high school | 9 (8.0) |
High school | 16 (14.2) |
College/university | 88 (77.8) |
Perceived financial status | |
More than enough | 28 (25.2) |
Just enough | 66 (59.5) |
Struggle to get by | 17 (15.3) |
Self-rated health | |
Excellent | 8 (7.1) |
Very good | 41 (36.3) |
Good | 43 (38.1) |
Fair | 17 (15.0) |
Poor | 4 (3.5) |
Most respondents (85.5%) knew that a mammogram was the recommended screening test for breast cancer (
Among women assumed to be eligible for breast cancer screening (ages 50 - 69), 88.9% knew the correct screening test, 16.7% knew the correct ages, and 47.2% knew the correct screening interval (
Overall, knowledge of cancer screening guidelines in this study was low, especially for cervical and colorectal cancers where the incorrect responses were greater in number and proportion to correct responses. In addition, knowledge of when to start screening and how often screening should occur also appeared low across all cancer types. The one exception where knowledge appeared to be high was for breast cancer, where the majority of in- dividuals correctly answered that mammograms were the recommended screening test. We also stratified res- ponses according to screening eligibility for each cancer type and despite small numbers, the findings yielded similar results: overall knowledge of cancer screening guidelines appeared to be low.
Our results are similar to other Canadian studies found in the literature, where overall cancer screening knowledge was low [
These findings of patient knowledge deficit, including among those who are screen-eligible, are intriguing as they suggest that there is room for improvement in terms of how health care organizations, health professionals and health ministries educate the public and promote screening programs. One study notes that colorectal cancer screening was low among older Canadians due to reasons such as physician screening recommendations, sur- prising colorectal cancer information and difficulties understanding cancer information [
While study findings suggest that knowledge of the cancer screening guidelines are low, one must keep in mind the limitations of this study. First, our survey was not validated. However, we strove to keep the survey brief and to use language that was as simple and clear as possible. Second, since convenience sampling was used, the
. Knowledge of current Ontario cancer screening guidelines (n = 117)
N (%) | |
---|---|
Breast cancer | |
Screening test | |
Ultrasound | 1 (0.9) |
MRI | 2 (1.7) |
Mammogram | 100 (85.5) |
Breast exam by doctor or nurse | 10 (8.6) |
Unsure/don’t know | 4 (3.4) |
Ages for testing | |
20 - 74 | 31 (26.5) |
30 - 74 | 31 (26.5) |
40 - 74 | 31 (26.5) |
50 - 69 | 19 (16.2) |
Unsure/don’t know | 5 (4.3) |
Frequency of testing | |
Every 6 months | 10 (8.6) |
Every 1 year | 58 (49.6) |
Every 2 years | 36 (30.8) |
Every 3 years | 2 (1.7) |
Unsure/don’t know | 11 (9.4) |
Cervical cancer | |
Screening test | |
Fecal occult blood test | 0 (0.0) |
Pap test | 82 (70.1) |
Pelvic ultrasounds | 10 (8.6) |
Pelvic exam | 5 (4.3) |
Unsure/don’t know | 20 (17.1) |
Ages for starting testing | |
At least 18 years old and ever been sexually active | 52 (44.4) |
At least 21 years old and ever been sexually active | 8 (6.8) |
21 years old, regardless of sexual activity | 17 (14.5) |
At least 25 years old, regardless of sexual activity | 17 (14.5) |
Unsure/don’t know | 22 (18.8) |
Frequency of testing | |
Every 6 months | 4 (3.4) |
Every 1 year | 67 (57.3) |
Every 2 years | 19 (16.2) |
Every 3 years | 5 (4.3) |
Unsure/don’t know | 22 (18.8) |
Colorectal cancer | |
Screening test | |
Fecal occult blood test | 20 (17.1) |
Rectal exam | 10 (8.6) |
Abdominal ultrasound | 2 (1.7) |
Colonoscopy | 64 (54.7) |
Unsure/don’t know | 21 (18.0) |
Age to start testing | |
40 years | 48 (41.0) |
45 years | 11 (9.4) |
50 years | 38 (32.5) |
55 years | 5 (4.3) |
Unsure/don’t know | 15 (12.8) |
Frequency of testing | |
Every 1 year | 36 (30.8) |
Every 2 years | 31 (26.5) |
Every 3 years | 19 (16.2) |
Every 10 years | 5 (4.3) |
Unsure/don’t know | 25 (21.4) |
Proportion of correct responses
study population may not be entirely representative and in turn, may lead to bias in study findings. Third, pa- tients were approached based on visual estimation of age. Therefore, some eligible patients in the waiting room might have been missed based on appearance. However, considering the broad age range, the number of patients missed is likely to be low. Lastly, the sample size (N = 117) may not be large enough to draw conclusions gene- ralizable to the broader population.
Possible next steps would be to further study the degree of knowledge among patients who are screen-eligible
Response distribution for breast, cervical and colorectal screening for par- ticipants assumed to be eligible for screening
and if this is directly related to screening rates. In addition, exploring factors that are associated with decreased level of knowledge among screen eligible patients (e.g. socioeconomic status) would also be an important future direction. In turn, these results could further yield how to make screening materials more appropriate for pa- tients and whether such changes would ultimately yield higher screening rates.
The findings from this study suggest overall knowledge, based on age, screening test type and frequency of screening, of Ontario’s screening guidelines for breast, cervical and colorectal cancers appear to be low. Further study is needed to discern underlying reasons for this low knowledge level and in turn, what strategies can be used for improvement.