Disparities in Cancer Screening Among the Foreign-Born Population in the United States: A Narrative Review

Abstract

Background: The foreign-born population in the United States has reached a record high over the last three years. Significant disparities in cancer screening rates exist among this population, resulting in later-stage diagnoses and worse outcomes. This narrative review explores the sociodemographic factors, barriers, and interventions influencing cancer screening rates among foreign-born individuals in the U.S. Methods: A comprehensive review of studies was conducted to assess colorectal, cervical, and breast cancer screening disparities among immigrants. Factors examined include length of residence, race and ethnicity, income, education, citizenship, insurance, usual source of care, language, medical literacy, and cultural barriers. Furthermore, the effectiveness of educational interventions, patient navigators, and at-home testing in addressing these screening disparities was evaluated. Results: Immigrants have lower screening rates for colorectal, cervical, and breast cancer compared to U.S.-born individuals, with the largest disparities observed in colorectal cancer. Factors influencing these gaps include shorter duration of residence, Asian ethnicity, and lower income and education levels. Lack of health insurance and of a usual source of care are currently the most significant barriers to screening. Interventions such as education, patient navigation, and at-home testing have shown moderate success in improving screening rates, though data on their effectiveness remain limited. Conclusions: Addressing cancer screening disparities within the U.S. foreign-born population is essential, especially as the immigrant population continues to reach record numbers. Targeted interventions are needed to improve screening among immigrant groups with the lowest completion rates. Future research on these interventions should prioritize larger sample sizes, longitudinal studies, and the utility of new technologies such as artificial intelligence.

Keywords: barriers to screening; breast cancer; cancer screening disparities; cervical cancer; colorectal cancer; foreign-born population.

Figure 1

Growth of the United States’ foreign-born population over time. Sources: Decennial Census for 1850 to 2000, American Community Survey for 2010 and 2020, and February current population survey for 2024. * The 2020 ACS shows only 43.5 million foreign-born residents—13.2% of the population; however, the Census Bureau reports that it does not have confidence in the 2020 ACS due to pandemic related issues. Averaging the 2019 and 2021 ACS shows a foreign-born number that was 45.1 million and 13.7% of the population.

Figure 2

PubMed search and study selection criteria.