Cancer Screening in Refugees and Immigrants: A Global Perspective

Abstract

Clinicians in the United States are trained to screen for cancer based on patient age, gender, family history, and environmental risk factors such as smoking. These cancers generally include, breast, cervical, colon, lung, and prostate cancers. We know that refugees and other immigrants to the United States experience dramatic disparities in cancer screening. Additionally, many immigrants experience elevated risks from infection-attributable cancers due to their country or region of origin. U.S.- based clinicians may not routinely consider these unique risk factors. Although this article focuses on refugees, it is also intended to guide clinicians caring for other foreign-born immigrant groups living in the United States (hereafter referred to as “immigrants”). The document contains two sections: 1) special considerations for U.S. Preventive Services Task Force guidelines cancer screening recommendations in immigrants and 2) cancer risks and screening recommendation unique to certain immigrant groups. Disparities in cancer screening and prevalence are often greater for specific immigrant groups than for broader racial or ethnic groups (e.g., Black, Asian, Hispanic) into which they may fit. Disaggregation of data by language or country of origin is useful to identify such disparities and to design intervention opportunities within specific communities that are culturally distinct and/or who have different environmental exposures. Unique cancer risks and disparities in screening support a nuanced approach to cancer screening for immigrant and refugee populations, which is the focus of this narrative review.

Early Detection of Cancers in the Era of Precision Oncology

“…Health disparities hinder the development of a universal biomarker-driven liquid biopsy [65]. Most biomarker data come from Caucasians, causing disparity in detection [67 ▪▪ ,68 ▪▪ ].…”

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

“…Compared with screening the entire population, a program targeting the population at high risk for some cancers can direct resources to those most likely to benefit and can potentially lead to better cost-effectiveness and lower false-positive cases . Despite fitting WHO’s criteria for a disease that screening should target, HNC screening has not been implemented in many jurisdictions due to a lack of systematic understanding on whether such a program would meet WHO’s standards, especially on enhancing survival …”

“…9 Despite fitting WHO's criteria for a disease that screening should target, 8 HNC screening has not been implemented in many jurisdictions due to a lack of systematic understanding on whether such a program would meet WHO's standards, especially on enhancing survival. [9][10][11][12][13][14][15][16][17][18] We aimed to gather international literature published between 2001 and 2022 to answer 3 questions: (1) what are common techniques used for adult HNC screening; (2) are they effective in increasing HNC detection, especially localized tumor detection; and (3) does screening improve overall and cancer-specific survival? Results of this review will provide general insights on the merits of HNC screening in addition to giving more specific guidance on whether such a program should be universal or risk targeted to meet the needs of populations with different existing prevalence of HNC.…”