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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. Outline. Burden of breast cancer NSBSP - PowerPoint PPT Presentation
Citation preview
Access to Breast Cancer Access to Breast Cancer Screening in Nova Scotia: Screening in Nova Scotia:
Describing Service Provision of the Nova Describing Service Provision of the Nova Scotia Breast Screening Program (NSBSP) Scotia Breast Screening Program (NSBSP)
from 2002-2006from 2002-2006
Stephanie Lea BA, BSc, RT(R)Stephanie Lea BA, BSc, RT(R)Master of Applied Health Master of Applied Health
Services Research CandidateServices Research Candidate
June 3, 2008June 3, 2008
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Outline
Burden of breast cancer
NSBSP
Project Rationale
Project Objectives
Methods
Project Relevance
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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
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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
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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
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NSBSP Clinical Pathway
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June '04 - Cumberland Regional, Amherst - fixed
site
June '03 - Mobile 3 - Northern
Jan '03 - Dartmouth
General -fixed site
June '02 - Colchester Regional, Truro - fixed site
April '01 - Yarmouth Regional - fixed site
May '00 - Cape Breton
Regional, Sydney - fixed site
July '97 - Mobile 2 - Western
Sept. '94 - Mobile 1- Cape
BretonJune '91- Halifax Shopping
Centre - fixed Site
NSBSP began as a
provincial program
July '05 - South Shore Regional, Bridgewater -
fixed site
Jan '07 - Aberdeen, New
Glasgow - fixed site
Jan '06 - Valley Regional, Kentville - fixed site
July '07 - Cobequid, Lower Sackville -fixed site (FFDM)
March '07 - Mobile 4 (FFDM) - Cape Breton
1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
NSBSP History Timeline
There are currently 13 screening sites: 3 mobile vans and 10 fixed
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Growth of Screening Volume 1991-2006
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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 populationThe 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 monthsThe retention rate for NS in 2005 – 2006 timeframe was
64.7%
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Target Population as % of Whole and Participation by DHA DHA % NS Target Pop. Part. % 2005/06
DHA 1 7.3% 48.0%
DHA 2 6.8% 59.9 %
DHA 3 9.1% 45.5 %
DHA 4 7.3% 56.3 %
DHA 5 3.9% 52.0 %
DHA 6 5.3% 12.0 %
DHA 7 5.2% 35.0 %
DHA 8 15.1% 46.0 %
DHA 9 40% 53.0 %
Source: Nova Scotia Community Counts web page – data modeled from Statistics Canada and NSBSP
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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
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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)”.
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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
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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+)
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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
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GIS Software - ArcGIS
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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.
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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
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Thank you!
Questions and comments welcome and appreciated.