What we’re doing: We’re working with the St. Michael’s Hospital Academic Family Health Team (SMHAFHT) to identify barriers to cancer screening related to social factors, and develop interventions to reduce these barriers.

Why we’re doing it: Screening for breast, cervical, and colorectal cancer has been shown to reduce sickness and death, yet research has found that a range of factors can negatively impact screening rates. For example, evidence demonstrates that people living on a low income are less likely to be screened than those living on a high income.

How we’re doing it: Our program of research consists of 5 phases:

Phase 1: We are currently using electronic medical record data and socio-demographic surveys to understand the characteristics of patients who are not being screened, with a focus on those living on low incomes.

Phase 2: Simultaneously, we are conducting an exploratory trial at the SMHAFHT to compare the effectiveness of a reminder letter versus a reminder phone call in improving screening rates for our overall practice and specific subgroups.

Phase 3: We will interview patients to understand their perspectives on cancer screening. We will work with our patients to co-develop an innovative, customized approach at SMHAFHT to recall patients living on a low income who are overdue for breast, cervical, and colorectal cancer screening.

Phase 4: We will pilot our co-designed solution with patients living on a low income at the SMHAFHT using quality improvement methodology to assess the feasibility of implementation, acceptability to patients and providers, and effectiveness in improving screening rates.

What we’ve found so far: In an early study, we used information from socio-demographic surveys given to patients at the SMHAFHT to explore the relationship between income and cancer screening. Findings also revealed issues related to the collection and use of self-reported socio-demographic data. We found that:

  • Patients who reported a lower income or not owning a home were less likely to undergo routine cancer screening.
  • Many people choose not to respond to some socio-demographic questions asked in a primary care setting, particularly information related to their income.
  • Neighbourhood income may not always be a good proxy for household income. Research often uses the average household income of a patient’s neighbourhood to approximate the patient’s own household income. We found, however, that looking at someone’s neighbourhood is not always the same as looking at their income. People living on high incomes and people living on low incomes may live within one neighbourhood, and looking at them as a group may erase important differences in health and health care access and experiences.

Full text of study available here.

Our partners: Cancer Care Ontario, Applied Health Research Centre

Action point: We anticipate that our results will influence care delivery at Family Health Teams across Ontario as many are interested in finding ways to improve screening rates. Our findings will highlight the unique importance of focusing efforts on people facing barriers to screening and investigating which strategies may be successful for these groups.


Lofters A, Glazier RH, Agha MM, Creatore MI, Moineddin R. Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada. Prev Med. 2007 Jun; 44(6):536-42. Abstract available here.

Honein-AbouHaidar GN, Baxter NN, Moineddin R, Urbach DR, Rabeneck L, Bierman AS. Trends and inequities in colorectal cancer screening participation in Ontario, Canada, 2005-2011. Cancer Epidemiol. 2013;37(6):946-56. Abstract available here.

Lofters AK, Moineddin R, Hwang SW, Glazier RH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC Womens Health. 2011;11:20. Full text available here.

Vahabi M, Lofters A, Kumar M, Glazier RH. Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada. BMC Public Health. 2015;15:679. Full text available here.

Borkhoff CM, Saskin R, Rabeneck L, Baxter NN, Liu Y, Tinmouth J, et al. Disparities in receipt of screening tests for cancer, diabetes and high cholesterol in Ontario, Canada: a population-based study using area-based methods. Can J Public Health. 2013;104(4):e284-90. Abstract available here.

For more information: Please contact Principal Investigators Dr. Tara Kiran at KiranT@smh.ca or Dr. Aisha Lofters at aisha.lofters@utoronto.ca.