Being a woman might be tougher than you think. A study released this August as part of the Project for an Ontario Women’s Health Evidence-Based Report (POWER) has pointed to some of the major gaps in cancer screening and follow-up for Ontario women.

The study is one chapter in a comprehensive multi-year project focusing on women’s health and differences in care based on ethnicity, geography, and socioeconomic factors. According to principal investigator and U of T professor Arlene Bierman, “We looked at two of the most common causes of cancer in women—that affect both men and women—which was lung and colorectal cancer. We also looked at cancers that are specific to women, that is breast, cervical, and ovarian cancer. We tried to get the continuum of care: from screening through diagnosis, treatment, follow-up, as well as end-of-life care.”

The study’s results indicate that low-income women are consistently less likely to get screened for breast, cervical, and colorectal cancer. This pattern held across all of the Local Health Integration Networks in the province.

“Our study didn’t look directly at the reasons why low-income women are less likely to be screened,” says Bierman, “but there’s actually fairly large literature on this, and there are multiple reasons. There are individual-level reasons [such as] more barriers to care. There might be provider-level reasons: low-income women might have more medical problems; they tend to be sicker. And so maybe the doctors are busy taking care of their other problems and the Pap smear falls down the list.”

But low income isn’t the only factor at work: many women of all socioeconomic backgrounds who were found to have low-grade lesions or inadequate Pap smears did not receive the follow-up care they needed.

“All women are falling through the cracks, whether they’re low-income or not,” says Bierman. “So there are two separate issues.”

The study’s findings will be used to help close the gaps in women’s health care in Ontario. “We think that there’s a good message for improvement: that we can target low-income women to increase screening rates, and we can also put systems in place to make sure that all women do get followed once they’re screened,” says Bierman. “It’s not enough to increase screening rates. We also have to make sure that once people are screened, if something is picked up, that the follow-up is done.”

Luckily, there was also a bright side to the research. “One of the good-news findings is that once you get in the cancer system, the treatment is fairly equitable, for men and women, [regardless of] income,” says Bierman.

As a comprehensive report, the POWER study looks at the leading causes of morbidity and mortality in women. So far, POWER has released three chapters covering such topics as population health and the burden of illness, cancer, and depression. Over the next year, the POWER research team will release chapters on heart disease, diabetes, HIV infection, and reproductive health.

“Our goal in doing this is to develop a tool to help policy makers and providers reduce health inequities among women in Ontario,” says Bierman. “The other thing that’s important to know is because we’re looking at women and at gender differences, we actually have data on men as well, and we’re finding areas where we really need to pay attention to men’s health as well as women’s health.

“I think there is a lot of interest in improving and transforming the health system. We know that there have been problems, but what we really wanted to do was find out how well we were doing now, where there were gaps by gender, and where there were gaps by income and other socioeconomic factors like ethnicity—so that we can look at these and make strategic decisions: what do we have to target for improvement in Ontario?”

All the POWER study materials, including the cancer chapter and research highlights, are available for download at

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