3.7.1 Definition The percentage of Ontario men and women of screen-eligible age (ages 50-74), who have completed at least one FOBT in the prior two years. Calculation Number of people completing at least one FOBT in the prior 2 years/Target population (populations averaged over a period of time) x 100 = Population FOBT Participation rate (%) Analysis For calendar years 2002 to 2009 (02-03, 04-05, 06-07, 08-09) Considerations Include only FOBT as a primary screening test. The target population at increased risk (1st degree relative with previous colorectal cancer) cannot be accurately identified, and the provincial number of primary screening colonoscopies cannot be captured. Indicator currently published in Cancer System Quality Index (CSQI). International comparisons are most reliable without complex exclusion criteria (i.e., previous colorectal cancer or those who have had a colonoscopy). Technical Specifications Individuals with an FOBT are identified by: GOO4 Lab.med.in office – occult blood L179 ColonCancerCheck Fetal Occult Blood Testing (new in 2008) L181 Lab Med – Biochem – Occult Blood Multiple claims with unique Health Insurance Number (HIN), Service Date and Fee Code assumed to be a single claim Registered Persons Data Base (RPDB) is used as the definitive source for date of birth, sex, and postal code Local Health Integrated Network (LHIN) assignment is based on Postal Code Conversion file (PCCF+), version 5e Exclusions: Individuals not residing in Ontario or with an unknown place of residence. Individuals aged 49 and under or 75 and over or of indeterminate age. Individuals with missing date of birth, gender, or postal code in both OHIP and RPDB. Numerator Total number of age-eligible individuals who used and returned a program FOBT kit irrespective of result. Note that each individual is counted once regardless of the number of tests performed. Denominator Total number of age-eligible individuals residing in Ontario within a given period adjusted to the 1991 Canadian population using the direct method. Calculated as the average of the two years included in the period.

3.7.2 Definition The percentage of Ontario men and women of screen-eligible age (ages 50-74), who have completed at least one FOBT in the prior two years. Calculation Number of people completing at least one FOBT in the prior 2 years/Target population (populations averaged over a period of time) x 100 = Population FOBT Participation rate (%) Analysis Age standardized % of women, men, total aged 50-74 with ≥1 FOBT by LHIN Considerations Include only FOBT as a primary screening test. The target population at increased risk (1st degree relative with previous colorectal cancer) cannot be accurately identified, and the provincial number of primary screening colonoscopies cannot be captured. Indicator currently published in Cancer System Quality Index (CSQI). International comparisons are most reliable without complex exclusion criteria (i.e., previous colorectal cancer or those who have had a colonoscopy). Technical Specifications Individuals with an FOBT are identified by: GOO4 Lab.med.in office – occult blood L179 ColonCancerCheck Fetal Occult Blood Testing (new in 2008) L181 Lab Med – Biochem – Occult Blood Multiple claims with unique Health Insurance Number (HIN), Service Date and Fee Code assumed to be a single claim Registered Persons Data Base (RPDB) is used as the definitive source for date of birth, sex, and postal code Local Health Integrated Network (LHIN) assignment is based on Postal Code Conversion file (PCCF+), version 5e Exclusions: Individuals not residing in Ontario or with an unknown place of residence. Individuals aged 49 and under or 75 and over or of indeterminate age. Individuals with missing date of birth, gender, or postal code in both OHIP and RPDB. Numerator Total number of age-eligible individuals who used and returned a program FOBT kit irrespective of result. Note that each individual is counted once regardless of the number of tests performed. Denominator Total number of age-eligible individuals residing in Ontario within a given period adjusted to the 1991 Canadian population using the direct method. Calculated as the average of the two years included in the period.

3.8.1 Definition Percentage of screen-eligible women (ages 50–69) receiving a mammogram within a two-year time interval, by program (OBSP and non-OBSP), in Ontario Calculation Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval/Number of screen-eligible women (ages 50-69) x 100 = Breast screening participation rate (%) Analysis By program, (OBSP and non-OBSP) and year, 2002-2003, 2004-2005, 2006-2007, 2008-2009 Considerations "Screen-eligible women" excludes women with a previous diagnosis of breast cancer. Technical Specifications A two-year time interval refers to the time period between January 1, and December 31 of the subsequent year for example 2009-10 refers to the time period between January 1, 2009, and December 31, 2010. Mammograms (breast cancer screening) were identified through ICMS and OHIP claims: ICMS record for Mammogram X185   Mammogram – dedicated equipment - bilateral Women receiving a mammogram are counted only once; re-screens are excluded. Numerator Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval Denominator Number of screen-eligible Women (ages 50-69)

3.8.2 Definition Percentage of screen-eligible women (ages 50–69) receiving a mammogram within a two-year time interval, by program (OBSP and non-OBSP), in Ontario Calculation Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval/Number of screen-eligible women (ages 50-69) x 100 = Breast screening participation rate (%) Analysis By LHIN and year, 2002-2003, 2004-2005, 2006-2007, 2008-2009, Considerations "Screen-eligible women" excludes women with a previous diagnosis of breast cancer. Technical Specifications A two-year time interval refers to the time period between January 1, and December 31 of the subsequent year for example 2009-10 refers to the time period between January 1, 2009, and December 31, 2010. Mammograms (breast cancer screening) were identified through ICMS and OHIP claims: ICMS record for Mammogram X185   Mammogram – dedicated equipment - bilateral Women receiving a mammogram are counted only once; re-screens are excluded. Numerator Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval Denominator Number of screen-eligible Women (ages 50-69)

3.8.3 Definition Percentage of screen-eligible women (ages 50–69) receiving a mammogram within a two-year time interval, by program (OBSP and non-OBSP), in Ontario Calculation Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval/Number of screen-eligible women (ages 50-69) x 100 = Breast screening participation rate (%) Analysis By program, (OBSP and non-OBSP) and LHIN, 2008-2009 Considerations "Screen-eligible women" excludes women with a previous diagnosis of breast cancer. Technical Specifications A two-year time interval refers to the time period between January 1, and December 31 of the subsequent year for example 2009-10 refers to the time period between January 1, 2009, and December 31, 2010. Mammograms (breast cancer screening) were identified through ICMS and OHIP claims: ICMS record for Mammogram X185   Mammogram – dedicated equipment - bilateral Women receiving a mammogram are counted only once; re-screens are excluded. Numerator Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval Denominator Number of screen-eligible Women (ages 50-69)

3.8.4 Definition Percentage of screen-eligible women (ages 50–69) receiving a mammogram within a two-year time interval, by program (OBSP and non-OBSP), in Ontario Calculation Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval/Number of screen-eligible women (ages 50-69) x 100 = Breast screening participation rate (%) Analysis By income quintile, 2008-2009 Considerations "Screen-eligible women" excludes women with a previous diagnosis of breast cancer. Technical Specifications A two-year time interval refers to the time period between January 1, and December 31 of the subsequent year for example 2009-10 refers to the time period between January 1, 2009, and December 31, 2010. Mammograms (breast cancer screening) were identified through ICMS and OHIP claims: ICMS record for Mammogram X185   Mammogram – dedicated equipment - bilateral Women receiving a mammogram are counted only once; re-screens are excluded. Numerator Number of screen-eligible women (ages 50-69) receiving a mammogram within a two-year time interval Denominator Number of screen-eligible Women (ages 50-69)

3.9.1 Definition The percentage of Ontario women, 20-69 years old, who have completed at least one Pap test in a three-year period. Calculations Number of eligible women who have completed at least one Pap test in a three-year period/Number of eligible women x 100 = Cervical screening participation (%) Analysis For the calendar years 2001-2003, 2004-2006, 2007-2009, by LHIN Considerations Only women who were Ontario residents (valid HINs) and 20-69 years old on the day of their Pap test were included in these analyses. Women with a prior hysterectomy were excluded. Technical Specifications PAP tests were identified through CytoBase and OHIP claims: CytoBase record for Pap test E430 D/T proc-Pap smear performed outside of hosp-add G365 D/T proc-Gynaecology-Papanicolaou smear G394 Add. Pap smear for follow-up of abnormal or inadequate smears L713 Gynaecological specimen L733 Cervicovaginal specimen L812 Cervical Vaginal specimen All CytoBase Pap tests were counted, including those with inadequate specimen. Multiple OHIP claims for the same patient and day were assumed to be a single claim. If a lab code (L codes) occurred within 4 weeks of a E/G code this was considered as a duplicate and such record was removed. Duplicate records across the two data sources (Cytobase and OHIP) were excluded; all records pertaining to the same person (HIN) that occurred within 14 days were considered to be the same test and the earliest date was recorded. Patients’ dates of birth and postal codes were obtained from RPDB. Patients’ age was determined at the time of their first Pap test. LHIN and SES assignment was based on the Postal Code Conversion file (PCCF+), version 5e. SES information was based on income quintiles (IQ) developed by Statistics Canada that provide a 1-to-5, low-to-high measure of affluence related to the place of residence based on 2006 Census summary data. Exclusions: Women with missing HIN, date of birth or postal code. Women with a prior hysterectomy identified through CIHI DAD and NACRS: CCP (1988-2001) procedure: 80.3, 80.4, 80.5, 80.6, 80.7, 86.42 CCI (2002-2009) procedure: 1RM89 or 1RM91 A proportion of women who had a hysterectomy prior to 1988 was estimated from the published age-adjusted rates and removed from the cohort. Snider JA, Beauvais JE. Pap Smear Utilization in Canada: Estimates after Adjusting the Eligible Population for Hysterectomy Status. Public Health Agency of Canada. Chronic Disease in Canada. 1998; 19(1):19-24. Numerator Total number of women, 20-69 years old, who have completed at least one Pap test in a three-year period. Each women was counted regardless of the number of Pap tests performed. If a women had multiple Pap tests, the first was selected. Denominator Total number of women, 20-69 years old, Ontario residents, averaged over a three-year period and adjusted to the 1991 Canadian population using the direct method.

3.9.2 Definition The percentage of Ontario women, 20-69 years old, who have completed at least one Pap test in a three-year period. Calculations Number of eligible women who have completed at least one Pap test in a three-year period/Number of eligible women x 100 = Cervical screening participation (%) Analysis For the calendar years 2001-2003, 2004-2006, 2007-2009. Crude and age-standardized percentage presented by 10-year age groups (20-29, 30-39, 40-49, 50-59, and 60-69). Considerations Only women who were Ontario residents (valid HINs) and 20-69 years old on the day of their Pap test were included in these analyses. Women with a prior hysterectomy were excluded. Technical Specifications PAP tests were identified through CytoBase and OHIP claims: CytoBase record for Pap test E430 D/T proc-Pap smear performed outside of hosp-add G365 D/T proc-Gynaecology-Papanicolaou smear G394 Add. Pap smear for follow-up of abnormal or inadequate smears L713 Gynaecological specimen L733 Cervicovaginal specimen L812 Cervical Vaginal specimen All CytoBase Pap tests were counted, including those with inadequate specimen. Multiple OHIP claims for the same patient and day were assumed to be a single claim. If a lab code (L codes) occurred within 4 weeks of a E/G code this was considered as a duplicate and such record was removed. Duplicate records across the two data sources (Cytobase and OHIP) were excluded; all records pertaining to the same person (HIN) that occurred within 14 days were considered to be the same test and the earliest date was recorded. Patients’ dates of birth and postal codes were obtained from RPDB. Patients’ age was determined at the time of their first Pap test. LHIN and SES assignment was based on the Postal Code Conversion file (PCCF+), version 5e. SES information was based on income quintiles (IQ) developed by Statistics Canada that provide a 1-to-5, low-to-high measure of affluence related to the place of residence based on 2006 Census summary data. Exclusions: Women with missing HIN, date of birth or postal code. Women with a prior hysterectomy identified through CIHI DAD and NACRS: CCP (1988-2001) procedure: 80.3, 80.4, 80.5, 80.6, 80.7, 86.42 CCI (2002-2009) procedure: 1RM89 or 1RM91 A proportion of women who had a hysterectomy prior to 1988 was estimated from the published age-adjusted rates and removed from the cohort. Snider JA, Beauvais JE. Pap Smear Utilization in Canada: Estimates after Adjusting the Eligible Population for Hysterectomy Status. Public Health Agency of Canada. Chronic Disease in Canada. 1998; 19(1):19-24. Numerator Total number of women, 20-69 years old, who have completed at least one Pap test in a three-year period. Each women was counted regardless of the number of Pap tests performed. If a women had multiple Pap tests, the first was selected. Denominator Total number of women, 20-69 years old, Ontario residents, averaged over a three-year period and adjusted to the 1991 Canadian population using the direct method.

3.9.3 Definition The percentage of Ontario women, 20-69 years old, who have completed at least one Pap test in a three-year period. Calculations Number of eligible women who have completed at least one Pap test in a three-year period/Number of eligible women x 100 = Cervical screening participation (%) Analysis Crude and age-standardized percentage presented by 10-year age groups (20-29, 30-39, 40-49, 50-59, and 60-69), by income quintile Considerations Only women who were Ontario residents (valid HINs) and 20-69 years old on the day of their Pap test were included in these analyses. Women with a prior hysterectomy were excluded. Technical Specifications PAP tests were identified through CytoBase and OHIP claims: CytoBase record for Pap test E430 D/T proc-Pap smear performed outside of hosp-add G365 D/T proc-Gynaecology-Papanicolaou smear G394 Add. Pap smear for follow-up of abnormal or inadequate smears L713 Gynaecological specimen L733 Cervicovaginal specimen L812 Cervical Vaginal specimen All CytoBase Pap tests were counted, including those with inadequate specimen. Multiple OHIP claims for the same patient and day were assumed to be a single claim. If a lab code (L codes) occurred within 4 weeks of a E/G code this was considered as a duplicate and such record was removed. Duplicate records across the two data sources (Cytobase and OHIP) were excluded; all records pertaining to the same person (HIN) that occurred within 14 days were considered to be the same test and the earliest date was recorded. Patients’ dates of birth and postal codes were obtained from RPDB. Patients’ age was determined at the time of their first Pap test. LHIN and SES assignment was based on the Postal Code Conversion file (PCCF+), version 5e. SES information was based on income quintiles (IQ) developed by Statistics Canada that provide a 1-to-5, low-to-high measure of affluence related to the place of residence based on 2006 Census summary data. Exclusions: Women with missing HIN, date of birth or postal code. Women with a prior hysterectomy identified through CIHI DAD and NACRS: CCP (1988-2001) procedure: 80.3, 80.4, 80.5, 80.6, 80.7, 86.42 CCI (2002-2009) procedure: 1RM89 or 1RM91 A proportion of women who had a hysterectomy prior to 1988 was estimated from the published age-adjusted rates and removed from the cohort. Snider JA, Beauvais JE. Pap Smear Utilization in Canada: Estimates after Adjusting the Eligible Population for Hysterectomy Status. Public Health Agency of Canada. Chronic Disease in Canada. 1998; 19(1):19-24. Numerator Total number of women, 20-69 years old, who have completed at least one Pap test in a three-year period. Each women was counted regardless of the number of Pap tests performed. If a women had multiple Pap tests, the first was selected. Denominator Total number of women, 20-69 years old, Ontario residents, averaged over a three-year period and adjusted to the 1991 Canadian population using the direct method.

3.10.1 Definition The percentage of Ontario women, 50-69 years old, who are up-to-date on three cancer screening tests (Mammogram, FOBT and Pap test) they are eligible for. Calculation Number of eligible women who are up-to-date on three cancer screening tests/Number of eligible women x 100 = Cancer screening completeness (%) Analysis Crude and age-standardized percentage presented by LHIN, 2007-2009 Considerations Only women who were Ontario residents (valid HINs) and 50-69 years old on the day of their screening test were included in these analyses. Cancer Screening participation was based on the time period appropriate to each type of screening (2008-2009) for breast and colorectal screening and 2007-2009 for cervical screening. Technical Specifications A woman was assigned an ‘up-to-date’ status if she received all three screening tests in the corresponding time period. Mammograms (breast cancer screening) were identified through ICMS and OHIP claims: ICMS record for Mammogram X185 Mammogram – dedicated equipment - bilateral FOBTs (colorectal cancer screening) were identified through OHIP claims: G004 Laboratory Medicine in private office - Occult Blood L179 ColonCancerCheck FOBT kit L181 Lab Med-Biochem – Occult Blood Q133 Tracking code for CRC screening Q152 FOBT Completion fee PAP tests (cervical cancer screening) were identified through CytoBase and OHIP claims: CytoBase record for Pap test E430 D/T proc-Pap smear performed outside of hosp-add G365 D/T proc-Gynaecology-Papanicolaou smear G394 Add. Pap smear for follow-up of abnormal or inadequate smears L713 Gynaecological specimen L733 Cervicovaginal specimen L812 Cervical Vaginal specimen Multiple OHIP claims for the same patient, test and day were assumed to be a single claim. Each screening test was counted once only. Patients’ dates of birth, gender and postal codes were obtained from RPDB. Patients’ age was determined as of July 1, 2008. Women were divided into two groups: those with an active affiliation to a signatory physician within a PEM as of January 1, 2007 (the first possible test) and those without. LHIN and SES assignment was based on the Postal Code Conversion file (PCCF+), version 5e. SES information was based on income quintiles (IQ) developed by Statistics Canada that provide a 1-to-5, low-to-high measure of affluence related to the place of residence based on 2006 Census summary data.   Exclusions: Women with missing HIN, date of birth or postal code. Women with a prior diagnosis of breast cancer [prior to January 1, 2008 (the first possible Mammogram test) or a the actual Mammogram] identified through OCR: ICD-9=174 Women with a prior hysterectomy [prior to January 1, 2007 (the first possible Pap test) or the actual Pap test] identified through CIHI DAD and NACRS: CCP (1988-2001) procedure: 80.3, 80.4, 80.5, 80.6, 80.7, 86.42 CCI (2002-2009) procedure: 1RM89 or 1RM91 A proportion of women who had a hysterectomy prior to 1988 was estimated from the published age-adjusted rates and removed from the cohort. Snider JA, Beauvais JE. Pap Smear Utilization in Canada: Estimates after Adjusting the Eligible Population for Hysterectomy Status. Public Health Agency of Canada. Chronic Disease in Canada. 1998;19(1):19-24. Numerator Total number of women, 50-69 years old, who are up-to-date on three cancer screening tests (Mammogram, FOBT and Pap test). Each woman was counted once regardless of the number of screening tests performed. Denominator Total number of women, 50-69 years old, Ontario residents, adjusted to the 1991 Canadian population using the direct method.

3.10.3 Definition The percentage of Ontario women, 50-69 years old, who are up-to-date on three cancer screening tests (Mammogram, FOBT and Pap test) they are eligible for. Calculation Number of eligible women who are up-to-date on three cancer screening tests/Number of eligible women x 100 = Cancer screening completeness (%) Analysis For the calendar years 2007-2009, by income quintile. Considerations Only women who were Ontario residents (valid HINs) and 50-69 years old on the day of their screening test were included in these analyses. Cancer Screening participation was based on the time period appropriate to each type of screening (2008-2009) for breast and colorectal screening and 2007-2009 for cervical screening. Technical Specifications A woman was assigned an ‘up-to-date’ status if she received all three screening tests in the corresponding time period. Mammograms (breast cancer screening) were identified through ICMS and OHIP claims: ICMS record for Mammogram X185 Mammogram – dedicated equipment - bilateral FOBTs (colorectal cancer screening) were identified through OHIP claims: G004 Laboratory Medicine in private office - Occult Blood L179 ColonCancerCheck FOBT kit L181 Lab Med-Biochem – Occult Blood Q133 Tracking code for CRC screening Q152 FOBT Completion fee PAP tests (cervical cancer screening) were identified through CytoBase and OHIP claims: CytoBase record for Pap test E430 D/T proc-Pap smear performed outside of hosp-add G365 D/T proc-Gynaecology-Papanicolaou smear G394 Add. Pap smear for follow-up of abnormal or inadequate smears L713 Gynaecological specimen L733 Cervicovaginal specimen L812 Cervical Vaginal specimen Multiple OHIP claims for the same patient, test and day were assumed to be a single claim. Each screening test was counted once only. Patients’ dates of birth, gender and postal codes were obtained from RPDB. Patients’ age was determined as of July 1, 2008. Women were divided into two groups: those with an active affiliation to a signatory physician within a PEM as of January 1, 2007 (the first possible test) and those without. LHIN and SES assignment was based on the Postal Code Conversion file (PCCF+), version 5e. SES information was based on income quintiles (IQ) developed by Statistics Canada that provide a 1-to-5, low-to-high measure of affluence related to the place of residence based on 2006 Census summary data.   Exclusions: Women with missing HIN, date of birth or postal code. Women with a prior diagnosis of breast cancer [prior to January 1, 2008 (the first possible Mammogram test) or a the actual Mammogram] identified through OCR: ICD-9=174 Women with a prior hysterectomy [prior to January 1, 2007 (the first possible Pap test) or the actual Pap test] identified through CIHI DAD and NACRS: CCP (1988-2001) procedure: 80.3, 80.4, 80.5, 80.6, 80.7, 86.42 CCI (2002-2009) procedure: 1RM89 or 1RM91 A proportion of women who had a hysterectomy prior to 1988 was estimated from the published age-adjusted rates and removed from the cohort. Snider JA, Beauvais JE. Pap Smear Utilization in Canada: Estimates after Adjusting the Eligible Population for Hysterectomy Status. Public Health Agency of Canada. Chronic Disease in Canada. 1998;19(1):19-24. Numerator Total number of women, 50-69 years old, who are up-to-date on three cancer screening tests (Mammogram, FOBT and Pap test). Each woman was counted once regardless of the number of screening tests performed. Denominator Total number of women, 50-69 years old, Ontario residents, adjusted to the 1991 Canadian population using the direct method.