Evaluating the uptake and disparities in colorectal cancer screening in Canada: a cross-sectional study using data from the Canadian Community Health Surveys

Adefemi, Kazeem (2024) Evaluating the uptake and disparities in colorectal cancer screening in Canada: a cross-sectional study using data from the Canadian Community Health Surveys. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Colorectal cancer (CRC) screening is recognised as a critical public health tool in reducing incidence and mortality of CRC, yet participation rates in Canada exhibit significant regional, racial, and sociodemographic disparities. Understanding these disparities and the various factors influencing screening behaviour is essential for developing targeted interventions and policies to increase equitable screening uptake and reduce the burden of CRC. Aim: This thesis explores the complexities of CRC screening uptake in Canada by examining regional variations, racial and sociodemographic disparities, and concurrent participation in multiple cancer screenings. Methods: Three studies were conducted using data from multiple cycles of the Canadian Community Health Survey (CCHS). The first study analysed CRC screening uptake in the Atlantic Provinces, focusing on changes in barriers and predictors of screening post-implementation of provincial CRC screening programs across the four provinces in the region. This study uses the 2010 and 2017 CCHS datasets, the most recent CCHS surveys with CRC screening data for all provinces. The second study explored racial and sociodemographic disparities in CRC screening at the national level, assessing participation rates across the different population groups, using the 2017 CCHS datasets. The third study investigated the factors influencing concurrent participation in breast, cervical, and CRC screenings among Canadian women eligible for all three screening programs, using the 2017 CCHS datasets. The methodologies for the studies all included cross-sectional analyses and in-depth statistical evaluations of survey data. Results: The first study found an increase in CRC screening uptake in the Atlantic Provinces from an average of 42% in 2010 to 54% in 2017, post-implementation of CRC screening programs, but with notable variations across the different provinces. The second study revealed a national CRC screening participation rate of 59.8%, with lower rates among lower income, immigrants, and certain minority groups, particularly South-East Asians and South Asians. The third study found that participation in both cervical and breast cancer screening (64%) was notably higher than CRC screening (53.7%), and only 27% of women participated in all three cancer screenings, with socioeconomic status and lifestyle factors being significant predictors of concurrent screening behaviors. Conclusions: This research provides a general understanding of CRC screening participation in Canada, highlighting the need for region-specific strategies, culturally sensitive health promotion, and integrated screening approaches. The findings underscore the importance of addressing both regional and sociodemographic disparities in CRC screening. This thesis contributes to public health knowledge by identifying key areas for intervention and future research, ultimately aiming to improve CRC screening uptake and reduce disparities in cancer care.

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