Uptake of cancer screenings among a multiethnic refugee population in North Texas, 2014-2018

Abstract

Background: Refugees are less likely than US born populations to receive cancer screenings. Building Bridges is a community health worker prevention program designed to increase refugee's cancer screening uptake. The purpose of this cross sectional analysis was to assess differences in uptake of cervical, breast, liver, and colorectal screens across six cultural groups.

Methods: Data was abstracted in 2018 for this analysis. Participants were categorized into six cultural groups (Myanmar, Central Africa, Bhutan, Somalia, Arabic Speaking Countries, and Other) to assess differences in sociodemographic measures and screening uptake. Uptake proportions were calculated for each cancer type (cervical, breast, liver, and colon) among eligible participants, by gender and cultural group. Differences in uptake across groups were assessed using stratified analysis and logistic regression. Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were calculated for each group to assess the association between screening completion and cultural group.

Findings: 874 refugees were asked about cancer screening history. The majority of participants were either 'never had been screened' or 'not up-to-date' for every cancer screening. Among age eligible, 82% had no prior pap exam within the past 3 years, 81% had no prior mammogram within the past year, 69% didn't know their Hepatitis B status and 87% never had a colon cancer screening. Overall, higher uptake of all types of cancer screenings was observed in Myanmar and Bhutanese groups, except colon cancer screening which was higher among Central African Region and Arabic Speaking participants.

Conclusion: Screening uptake varied by ethnic group and screening type. The program reached an under and never screened population, however, the proportion of refugees who received a cancer screening remained low compared to the US population. Diversity within refugee communities requires adaptation to specific cultural and linguistic needs to include new Americans in cancer elimination efforts.

Fig 1. Utilization of cancer screenings among Building Bridges program participants, by geographic origin, Fort Worth, Texas, March 2014 –September 2018 (N = 874).

*Colon cancer screening was offered to those enrolled after 1st March 2017 and met the age of eligibility. No participant from ‘Others’ group was eligible for colon cancer screening. ^a Includes participants from both Myanmar (n = 282) and Thailand (n = 3), ^b Includes participants from: Congo (n = 124), Rwanda (n = 50), Burundi (n = 17), Tanzania (n = 1), Uganda (n = 1), and Kenya (n = 1, who reported Swahili as native language), ^c Includes participants from both Bhutan (n = 135) and Nepal (n = 28), ^d Includes participants from both Somalia (n = 138) and Kenya (n = 3, who reported Somali as their native language), ^e Includes participants from Arabic speaking countries: Sudan (n = 43), Iraq (n = 12), Jordan (n = 4), Syria (n = 7), and, Egypt (n = 1), ^f Includes participants from: Afghanistan (n = 3), Angola (n = 1), Chad (n = 4), Eritrea (n = 7), Ethiopia (n = 7), Liberia(n = 1), and, Senegal (n = 1).