Exploring the Differences in Severity of Cervical Dysplasia between Ontario Residents and Refugees: A Retrospective Cohort Study.

OBJECTIVES

Most refugees living in Canada have never had cervical cancer screening. The objective of this study was to compare the histologic grade of cervical dysplasia at the first colposcopy visit between refugees and Ontario residents.

METHODS

Using a retrospective cohort design, we compared grades of dysplasia for patients presenting to their initial colposcopy visit for abnormal Pap cytology between those insured with coverage granted by the Federal government to refugees [the Interim Federal Health Program (IFHP)], and age-matched patients insured under the Ontario Health Insurance Plan (OHIP) at 2 tertiary care colposcopy clinics in Toronto, Canada between January 1, 2015 and February 1, 2020. The primary outcome was the severity of cervical dysplasia on pathology results.

RESULTS

Forty-one IFHP patients and 82 age-matched OHIP patients met the inclusion criteria. There was no significant difference in the cytology grade at referral. IFHP patients were significantly less likely to have received human papillomavirus vaccination (2.4% vs. 26%, P = 0.004), more likely to be living with HIV (29% vs. 0%, P < 0.001), and more likely to have high-grade dysplasia or cancer on final biopsy (OR 1.4; 1.06-1.85, P = 0.023) compared with patients with OHIP coverage.

CONCLUSIONS

Refugees insured via IFHP are at greater risk of cervical cancer with lower human papillomavirus immunization rates and higher rates of HIV compared to Ontario residents. Furthermore, they are significantly more likely to have higher-grade dysplasia on pathology. These findings signify the importance of advocating for primary and early secondary prevention for refugees.