Stephanie Lea BA, BSc, RTR, MAHSR. Canadian Public Health Association Centenary Conference Toronto, Ontario June 14, 2010

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1 Describing Service Provision of the Nova Scotia Breast Screening Program (NSBSP) to Nova Scotia Women Aged 50 to 69 Years from : 2006: Final Results Stephanie Lea BA, BSc, RTR, MAHSR Canadian Public Health Association Centenary Conference Toronto, Ontario June 14, 2010

2 Outline Background Project Rationale Project Objectives Methods Results Conclusions Relevance

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 28 are expected to die from it. In 2010(est): approx. 22,200 new cases with 5,300 deaths in Canada of these: 740 new cases and 180 deaths would be in Nova Scotia (Canadian Cancer Statistics Toronto: Canadian Cancer Society, 2010.)

4 Breast Cancer Evidence shows that screening mammography can reduce mortality from breast cancer by approximately 30% in women aged (Fletcher et al, 1993) The goal of a screening program: earlier diagnosis date (lesser stage) so earlier intervention and improved survival rates. The 5-year survival rate is now 87% with treatment

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+ As of December 31, 2009 in NSBSP Database: 169,872 women and 645,577 screens 2,825 cancers found

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7 Project Rationale As of Oct. 1, 2008 the last screening site joined the NSBSP All breast screening in NS captured under one program NS is the 1 st province to achieve this The province-wide rollout of Full Field Digital Mammography Screening capacity increase of approx. 60% Natural experiment pre- versus post- FFDM Further explore Geographic Information Systems (GIS) as a useful tool

8 Project Objectives A retrospective study describing service provision by the Nova Scotia Breast Screening Program to NS women aged from Objectives: To describe the need for breast cancer screening in NS and by DHA To describe use of breast screening services by women aged in NS and by DHA To describe how screening services were delivered by fixed and mobile sites in NS and by DHA

9 Methods - Data 2006 Census data for population counts and boundary files Study population: all Nova Scotia women aged that are in or not in the NSBSP Geographical data provided in collaboration with the GIS Centre at Dalhousie NSBSP database

10 Methods - Data Final data set for project (50-69 years): 131,581 screens 38,629 women Data fields: Client info (id#, DOB, PC and DHA of residence) Screening visit info (date, site, PC and DHA of site)

11 Results - Need Women aged years in NS = 118,727 women (2006 Census)

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13 Results - Use National 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 Retention Rate: Estimated percentage of women who are re-screened within 30 months of their previous screen Target: 75% re-screened within 30 months

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15 BRAND MARKETING INTERNAL LAUNCH PREVIEW INTEGRATED March 2004

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20 Left DHA = 6% Stayed in DHA = 94%

21 Results Access to Screening Services

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25 Project Conclusions was a period of growth and change for the NSBSP Participation did not meet national target, by province or DHA Retention was close to national target by province and varied by DHA There was only capacity to meet the needs of half the target population

26 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. Project results will inform further use of GIS as a tool for research, evaluation and surveillance

27 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 Dr. Sarah Kirk - Thesis Examination Chair Dr. Tom Rathwell Thesis Committee Member Ms. Jennifer Strang Dalhousie GIS Centre Canadian Breast Cancer Foundation Atlantic Chapter Nova Scotia Breast Screening Program GIS Centre Dalhousie University Atlantic Regional Training Centre

28 Questions?