Description  | Specific Indicators |  Corresponding Outcomes from the Ontario Public Health Standards |  Corresponding Indicators from Other Sources |  Data Sources  |   Method of Calculation |  Basic Categories |  Indicator Comments |  Cross-References to Other Indicators |  Cited References |  Changes Made

Description

• Proportion of Ontario women aged 50-69 screened at least once in a two-year period in the Ontario Breast Screening Program (OBSP)

Specific Indicator

• OBSP screening rate: screened in past two years
  

Corresponding Outcome(s) from the Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.

Link to OPHS
http://www.ontario.ca/publichealthstandards

Outcomes Related to this Indicator

• Board of Health Outcome (Chronic Disease Prevention): The public is aware of the benefits of screening for early detection of cancers and other chronic diseases of public health importance.

Health Promotion and Policy Development Requirements Related to this Indicator

• The board of health shall collaborate with community partners to promote provincially approved screening programs related to the early detection of cancers (Chronic Disease Prevention). 
• The board of health shall increase public awareness in the following areas...benefits of screening for early detection of cancers and other chronic diseases of public health importance...These efforts shall include:
      a. Adapting and/or supplementing national and provincial health communications strategies; and/or
      b. Developing and implementing regional/local communications strategies (Chronic Disease Prevention).
• The board of health shall provide advice and information to link people to community programs and services on the following topics....Screening for chronic diseases and early detection of cancers (Chronic Disease Prevention).

Ontario's Cancer System Quality Index

http://www.cancercare.on.ca/english/home/

Search for "Cancer System Quality Index", then "Access" and then "Breast cancer screening".¹

• Percentage of screen-eligible women (ages 50-69) receiving a mammogram within the past two years, by type of screening (whether through the OBSP or outside the program), in Ontario.

Report from the Evaluation Indicators Working Group: Guidelines for Monitoring Breast Screening Program Performance

http://www.phac-aspc.gc.ca/publicat/eiwg-gtie/index.html

• Percentage of women who have a screening mammogram (calculated biennially) as a proportion of the eligible population.
  

Data Sources

Ontario Breast Screening Program analyst, Cancer Care Ontario, will calculate with numerator from the Ontario Breast Screening Program's Integrated Client Management System and denominator from Public Health Unit population files used by Cancer Care Ontario, source to be documented by analyst.

Distributed by: the Ontario Breast Screening Program, posted annually to the APHEO listserv and available upon request from the Ontario Breast Screening Program central office at Cancer Care Ontario's Provincial Office.

Method of Calculation

Note that:

• PCCF+ is used to allocate women to public health units; for postal codes covering more than one
  public health unit, it randomly allocates women to public health units based on population weights.
• For the <1% of women for whom postal code is missing or invalid , public health unit is imputed based
  on postal code of the screening centre (Vicky Majpruz, Senior Research Associate, OBSP, February 2009).

 Basic Categories

• Geographic areas: province, public health unit, LHIN.
  

Indicator Comments

• Screening is checking for a disease or condition when there are no symptoms. Diagnosis is identifying a disease or condition from its signs and symptoms. Some cancer detection tests may be performed for either screening or diagnostic reasons.
• This indicator must be calculated from the Ontario Breast Screening Program's Integrated Client Management System by an analyst familiar with that dataset.
• Some assignments of women to public health units may be inaccurate because of random allocation of women whose postal codes cover more than one public health unit, or because of imputation based on postal code of screening centre (see Notes under "Method of Calculation"). 
• Women who are not screened through the OBSP may still be getting screened through their family doctors and facilities that provide mammography. The Screening Mammography indicator can be calculated to supplement the OBSP mammography indicator. Ontario's Cancer System Quality Index typically publishes a comparison of the proportion of Ontario women screened within and outside the OBSP; for 2005-2006, an estimated 54% of mammographic screening of Ontario women aged 50-69 occurred within the OBSP.¹ 
• The OBSP targets women aged 50-69 to be screened with mammography every two years. The Program offers high quality mammograms, physical breast examination at some locations, accessibility, screening reminders, and close monitoring for follow-up of abnormal screening results.² 
• The OBSP implements initiatives to increase participation rates, implement new technologies, and improve time to diagnosis.²
• The OBSP assists family physicians in facilitating follow-up by automatically booking the diagnostic tests recommended by the screening radiologist, if authorized by the family physician.²
• The OBSP is part of a national network of screening programs who collaborate on a common set of program performance measures.³
• OBSP key materials are translated into many languages. Special outreach projects promote the Program to ethnic communities and the visually impaired. A mobile van serves Northwestern Ontario.
• Not all public health units have OBSP sites; women may have to travel outside of their area to be screened in an OBSP site.
  

Cross-References to Other Indicators

• Cancer Incidence (Section 4B: Cancer Incidence and Early Detection of Cancer)
• Cancer Mortality (Section 4B: Cancer Incidence and Early Detection of Cancer)
• Screening Mammography (Section 4B: Cancer Incidence and Early Detection of Cancer)
  

Cited References

1. Cancer Care Ontario: Cancer System Quality Index: Breast cancer screening (mammography) participation, 2008. Available online: http://www.cancercare.on.ca/english/csqi2008/ (Accessed February 10, 2009). 
2. Cancer Care Ontario. Insight on Cancer - News and information on breast cancer and screening in Ontario. Toronto, ON: Canadian Cancer Society (Ontario Division), October 2007. 
3. Public Health Agency of Canada. Report from the Evaluation Indicators Working Group: Guidelines for Monitoring Breast Screening Program Performance - Second Edition. March, 2007. Available online at: http://www.phac-aspc.gc.ca/publicat/2007/gmbspp-ldsppdcs/index-eng.php#toc (Accessed February 10, 2009).