judy s caines, md frcp gerald h schaller, md frcp jennifer i payne, phd dolon chakravartty, mhsc gis...
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Judy S Caines, MD FRCPGerald H Schaller, MD FRCPJennifer I Payne, PhDDolon Chakravartty, MHSc
GIS as a Tool to Evaluate Breast Screening
International Breast Screening Network Biennial MeetingOttawa
May 11-12, 2006
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Outline
• Objectives• Nova Scotia Breast Screening Program
• Geographic Information Systems (GIS)
• Results
• Challenges/Opportunities
• Next Steps
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Map of Canada
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Nova Scotia Breast Screening Program
• Established in 1991: one fixed site - Halifax
• Targets women aged 50 - 69 (~ 100,000 women in 2001 Census)
• Modeled after the first Canadian program in BC (1988)
• Unique features of the NSBSP:
Dedicated workup sites all with Stereotactic Needle core biopsy (1991)
Physician assisted referral for abnormals (1991)
Central booking of all Mammo-screen and diagnostic (1999) - 80%
• 2005: 8 fixed sites + 3 mobile units (+last 2 fixed sites in 2006)
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NS BSP Fixed and Mobile Sites
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Growth of Screening Volume (1991-2005)
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0
2000
4000
6000
8000
10000
Year
Vo
lum
e
Halifax Sydney Yarmouth Dartmouth Truro
Amherst Bridgew ater Mobile 1 Mobile 2 Mobile 3
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Geographic Information Systems (GIS)
• Is a computer technology that uses a geographic information system as a framework for understanding a problem
• Links information to location, then layers different types of information to understand how they may work together
• Has been applied to analyze variations in health services utilization
• First time used to evaluate a provincial screening program
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Population Size & Location/Duration of Mobile Unit Visits
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Screening Participation Rates
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Scenario 1: Distance Traveled to Fixed Sites = 30km
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Scenario 2: Distance Traveled to Fixed Sites = 50km
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Scenario 3: Distance Traveled to Fixed Sites = 70km
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Challenges and Opportunities
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• Dynamic provision of breast screening services:
• 2 more fixed sites joining program in 2006
At that time, all screening & diagnostic mammography in theprovince will be part of the NSBSP-central booking will be 100%
• Introduction of full-field digital mammography in 2006 will increase capacity.
priorities: participation vs retention vs wait times
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Challenges and Opportunities
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priorities: participation vs retention vs wait times
• Increasing service capacity:
• What are current inequalities in participation/retention?
• What are current inequalities in wait times for both screening and diagnostic work-up?
• How to allocate capacity to address inequalities
Region-specific interventions?
• How to schedule mobile units to continually complement fixed sites?
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Next Steps
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• Use GIS in on-going surveillance of need for/use of screening - help target under-serviced populations
- participation versus retention
• Goal: use road-mapping approach to develop various scenarios for scheduling of mobile units
• Grant submission to Canadian Breast Cancer Foundation Atlantic Chapter (Dec 2005) for full-scale project
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Acknowledgements
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• Nova Scotia Department of Health
• Canadian Breast Cancer Foundation Atlantic Chapter
• Public Health Agency of Canada
• Department of Diagnostic Imaging, Queen Elizabeth II Health Sciences Centre
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NS BSP Fixed and Mobile Sites
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