1. Access to Breast Cancer Screening in Nova Scotia: Describing Service Provision of the Nova Scotia Breast Screening Program (NSBSP) from 2002-2006 Stephanie Lea BA, BSc, RT(R) Master of Applied Health Services Research Candidate June 3, 2008

2. 2 Outline Burden of breast cancer NSBSP Project Rationale Project Objectives Methods Project Relevance

3. 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. 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. 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. 6 NSBSP Clinical Pathway

7. 7 NSBSP History Timeline There are currently 13 screening sites: 3 mobile vans and 10 fixed

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9. 9 Growth of Screening Volume 1991-2006

10. 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 population  The 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 months  The retention rate for NS in 2005 – 2006 timeframe was 64.7%

11. 11 Target Population as % of Whole and Participation by DHA DHA % NS Target Pop.Part. % 2005/06 DHA 17.3%48.0% DHA 26.8%59.9 % DHA 39.1%45.5 % DHA 47.3%56.3 % DHA 53.9%52.0 % DHA 65.3%12.0 % DHA 75.2%35.0 % DHA 815.1%46.0 % DHA 940%53.0 % Source: Nova Scotia Community Counts web page – data modeled from Statistics Canada and NSBSP

12. 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. 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. 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. 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. 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. 17 GIS Software - ArcGIS

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20. 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. 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. 22 Thank you! Questions and comments welcome and appreciated.