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Bhargava S, Botteri E, Berthelsen M, Iqbal N, Randel KR, Holme Ø, Berstad P. Lower participation among immigrants in colorectal cancer screening in Norway. Front Public Health 2023; 11:1254905. [PMID: 37822535 PMCID: PMC10562536 DOI: 10.3389/fpubh.2023.1254905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Organized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups. Methods Between 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors. Results In total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04-1.23) and 1.82 (1.69-1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21-1.48) and 2.83 (2.55-3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia. Conclusion Participation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries.
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Affiliation(s)
- Sameer Bhargava
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Mona Berthelsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Nadia Iqbal
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | | | - Øyvind Holme
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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2
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Dassen RRE, Pelders S, de Munck L, Jager A, Hooning MJ, van Dam JH, Heemskerk-Gerritsen BAM. The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women. Breast 2023; 69:290-298. [PMID: 36940631 PMCID: PMC10034141 DOI: 10.1016/j.breast.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. METHODS We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). RESULTS In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. CONCLUSION Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.
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Affiliation(s)
- R R E Dassen
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - S Pelders
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - L de Munck
- Netherlands Comprehensive Cancer Organization, Research and Development, Utrecht, Netherlands
| | - A Jager
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - M J Hooning
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - J H van Dam
- Erasmus MC Cancer Institute, Oncological Surgery, Rotterdam, Netherlands
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3
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Woods RR, Kliewer EV, McGrail KM, Spinelli JJ. Stage-Specific Risk of Breast Cancer among Canadian Immigrant and Non-Immigrant Women. J Immigr Minor Health 2023; 25:232-236. [PMID: 35767203 DOI: 10.1007/s10903-022-01378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 04/30/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Breast cancer screening utilization varies across immigrant and non-immigrant populations. Recent studies have also suggested that some immigrant populations in Canada present with a higher frequency of later-stage breast cancer compared to non-immigrants. Our study aimed to augment prior research by presenting breast cancer stage distributions and stage-specific breast cancer incidence rates for immigrant and non-immigrants in British Columbia, Canada. METHODS We utilized a population-based cohort of more than 1.3 million women built from linked administrative health and immigration data sets. Age-standardized incidence rate ratios were generated to compare immigrant and non-immigrant groups. Poisson regression was used to assess the relative frequency of later stage diagnosis among immigrant groups compared to non-immigrants. RESULTS Indian and Chinese immigrants both showed significantly lower stage I and stage II-IV incidence rates compared to non-immigrants. However, Indian immigrants showed a higher frequency of later stage tumours at diagnosis compared to non-immigrants, while in contrast Chinese immigrants showed a lower frequency of later stage tumours. Filipino immigrants showed similar stage-specific rates and stage at diagnosis compared to non-immigrants. CONCLUSIONS Our findings highlight a need for continued surveillance of cancer among immigrant and non-immigrant populations and inquiry into reasons for differences in stage at diagnosis across groups.
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Affiliation(s)
- Ryan R Woods
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
- Cancer Control Research, BC Cancer, 2nd Floor, 675 W 10th Ave, V5Z 1L3, Vancouver, BC, Canada.
| | - Erich V Kliewer
- Cancer Control Research, BC Cancer, 2nd Floor, 675 W 10th Ave, V5Z 1L3, Vancouver, BC, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Shan T, Ran X, Li H, Feng G, Zhang S, Zhang X, Zhang L, Lu L, An L, Fu R, Sun K, Wang S, Chen R, Li L, Chen W, Wei W, Zeng H, He J. Disparities in stage at diagnosis for liver cancer in China. JOURNAL OF THE NATIONAL CANCER CENTER 2023. [DOI: 10.1016/j.jncc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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5
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Willén L, Berglund A, Bergström S, Isaksson J, Bergqvist M, Wagenius G, Lambe M. Patterns of care and outcomes in immigrants with non-small cell lung cancer. A population-based study (Sweden). PLoS One 2022; 17:e0278706. [PMID: 36520832 PMCID: PMC9754210 DOI: 10.1371/journal.pone.0278706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES While studies have found lower cancer risks and better cancer survival in immigrant populations, it is debated whether cancer care is offered on equal terms to all residents regardless of background. Our aim was to study patterns of care and outcomes in immigrants in a country with a tax-financed universal health care system. MATERIAL AND METHODS We used a population-based database to compare clinical presentation, management and mortality between Swedish-born and immigrant patients with non-small cell lung cancer (NSCLC). Analyses were adjusted for potential confounders. RESULTS We identified 40,075 patients diagnosed with NSCLC of which 84% were born in Sweden, 7% in Nordic and 9% in Non-Nordic countries. Non-Nordic immigrants were to a higher extent male, smokers, younger at diagnosis, had a better performance status and a higher educational level. No differences were seen regarding comorbidity burden or stage at diagnosis. Non-Nordic immigrants more often underwent positron emission tomography (PET) (aHR 1.32; 95% CI 1.19-1.45) and were more often discussed in a multidisciplinary team setting (aHR 1.30; 95% CI 1.17-1.44). There were no differences in treatment modalities following adjustment for age, with the exception of concurrent chemoradiotherapy in stage IIIA disease which was more common in Non-Nordic immigrants (aOR 1.34; 95% CI 1.03-1.74). Both overall and cause specific survival in non-metastatic disease were higher among Non-Nordic immigrants. Overall mortality in stage I-II: HR 0.81; 95% CI 0.73-0.90 and stage IIIA: HR 0.75; 95% CI 0.65-0.86. Following full adjustments, cause-specific mortality in stage I-II was aHR 0.86, 95% CI 0.75-0.98. CONCLUSION Taken together, only minor differences in management and outcomes were observed between Swedish-born and immigrant patients. We conclude that lung cancer care is offered on equal terms. If anything, outcomes were better in Non-Nordic immigrants with early stage NSCLC.
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Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Pulmonary Medicine, Gävle Hospital, Gävle, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Michael Bergqvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Section of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center Central Sweden, Uppsala, Sweden
- * E-mail:
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Bhargava S, Czapka E, Hofvind S, Kristiansen M, Diaz E, Berstad P. Polish immigrants’ access to colorectal cancer screening in Norway – a qualitative study. BMC Health Serv Res 2022; 22:1332. [DOI: 10.1186/s12913-022-08719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
The Norwegian colorectal cancer (CRC) screening programme started in May 2022. Inequities in uptake of CRC screening is a concern, and we expect that immigrants are at risk of non-uptake. Immigrants from Poland are the most populous immigrant group in Norway. The purpose of this study was to identify and explore factors that may facilitate Polish immigrants’ access to the Norwegian CRC screening programme.
Material and methods
This study was based on qualitative interviews with ten Polish immigrants in Norway. The participants represented a convenience sample that varied in terms of gender, education, employment, time in Norway, place of residence, Norwegian language skills and ties to the Norwegian-Polish community. We performed thematic content analysis to understand CRC screening from the perspective of Polish immigrants, using transnationalism and Levesque’s conceptualization of accessibility as theoretical frameworks.
Results
We grouped our findings into three themes; “understanding of CRC development and the need to access health care”, “binationalism” and “improving accessibility through information”. Within these themes, various factors influenced the participants’ accessibility to CRC screening, namely knowledge about the screening and about causes, development and prevention of the disease, language, choice of screening country, trust in health personnel’s competence, information needs, methods and sources, as well as participants’ perception of the faecal immunochemical test screening user manual. These factors were further influenced by communication between the Polish community in Norway and Poland, as well as travel between the countries.
Conclusion
We identified several factors that can be targeted with an aim to increase Polish immigrants’ access to the Norwegian CRC screening programme. Effective measures could include increasing cultural competence among health care providers and providing information in Polish through Polish-speaking health care professionals, general practitioners and internet portals used by the Polish-speaking community. Focusing on accessibility in a transnational setting, our findings may be of interest for policy makers and service providers planning preventive health measures for immigrants.
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Lofterød T, Frydenberg H, Veierød MB, Jenum AK, Reitan JB, Wist EA, Thune I. The influence of metabolic factors and ethnicity on breast cancer risk, treatment and survival: The Oslo ethnic breast cancer study. Acta Oncol 2022; 61:649-657. [PMID: 35348396 DOI: 10.1080/0284186x.2022.2053573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast cancer risk remains higher in high-income compared with low-income countries. However, it is unclear to what degree metabolic factors influence breast cancer development in women 30 years after immigration from low- to a high-incidence country. METHODS Using Cox regression models, we studied the association between pre-diagnostic metabolic factors and breast cancer development, and whether this association varied by ethnicity among 13,802 women participating in the population-based Oslo Ethnic Breast Cancer Study. Ethnic background was assessed and pre-diagnostic metabolic factors (body mass index, waist:hip ratio, serum lipids and blood pressure) were measured. A total of 557 women developed invasive breast cancer, and these women were followed for an additional 7.7 years. RESULTS Among women with an unfavorable metabolic profile, women from south Asia, compared with western European women, had a 2.3 times higher breast cancer risk (HR 2.30, 95% CI 1.18-4.49). Compared with the western European women, the ethnic minority women were more likely to present with triple-negative breast cancer (TNBC) (OR 2.11, 95% CI 0.97-4.61), and less likely to complete all courses of planned taxane treatment (OR 0.26, 95% CI 0.08-0.82). Among TNBC women, above-median triglycerides:HDL-cholesterol (>0.73) levels, compared with below-median triglycerides:HDL-cholesterol (≤0.73) levels, was associated with 2.9 times higher overall mortality (HR 2.88, 95% CI 1.02-8.11). CONCLUSIONS Our results support the importance of metabolic factors when balancing breast cancer prevention and disease management among all women, and in particular among non-western women migrating from a breast cancer low-incidence to a high-incidence country.
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Affiliation(s)
- Trygve Lofterød
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
| | - Hanne Frydenberg
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
| | - Marit B. Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jon B. Reitan
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
| | - Erik A. Wist
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inger Thune
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Health Services, UiT The Arctic University of Norway, Oslo, Norway
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8
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Thy JE, Bhargava S, Larsen M, Akslen LA, Hofvind S. Early screening outcomes among non-immigrants and immigrants targeted by BreastScreen Norway, 2010-2019. Scand J Public Health 2022:14034948221078701. [PMID: 35361004 DOI: 10.1177/14034948221078701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS This study aimed to analyse results on early screening outcomes, including recall and cancer rates, and histopathological tumour characteristics among non-immigrants and immigrants invited to BreastScreen Norway. METHODS We included information about 2, 763,230 invitations and 2,087,222 screening examinations from 805,543 women aged 50-69 years who were invited to BreastScreen Norway between 2010 and 2019. Women were stratified into three groups based on their birth country: non-immigrants, immigrants born in Western countries and immigrants born in non-Western countries. Age-adjusted regression models were used to analyse early screening outcomes. A random intercept effect was included in models where women underwent several screening examinations. RESULTS The overall attendance was 77.5% for non-immigrants, 68% for immigrants from Western countries and 51.5% for immigrants from non-Western countries. The rate of screen-detected cancers was 5.9/1000 screening examinations for non-immigrants, 6.3/1000 for immigrants from Western countries and 5.1/1000 for immigrants from non-Western countries. Adjusted for age, the rate did not differ statistically between the groups (p=0.091). The interval cancer rate was 1.7/1000 screening examinations for non-immigrants, 2.4/1000 for immigrants from Western countries and 1.6/1000 for non-Western countries (p<0.001). Histological grade was less favourable for screen-detected cancers, and subtype was less favourable for interval cancers among immigrants from non-Western countries versus non-immigrants. CONCLUSIONS There were no differences in age-adjusted rate of screen-detected cancer among non-immigrants and immigrants from Western countries or non-Western countries among women attending BreastScreen Norway between 2010 and 2019. Small but clinically relevant differences in histopathological tumour characteristics were observed between the three groups.
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Affiliation(s)
| | - Sameer Bhargava
- Cancer Registry of Norway, Norway.,Division of Oncology, Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Norway
| | | | - Lars A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Norway.,Department of Health and Care Sciences, UiT The Arctic University of Norway, Norway
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Vaz J, Midlöv P, Eilard MS, Eriksson B, Buchebner D, Strömberg U. Targeting population groups with heavier burden of hepatocellular carcinoma incidence: a nationwide descriptive epidemiological study in Sweden. Int J Cancer 2022; 151:229-239. [PMID: 35253900 PMCID: PMC9314808 DOI: 10.1002/ijc.33993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
Contemporary European studies examining associations between socioeconomic status and hepatocellular carcinoma (HCC) incidence are scarce. We aimed to target population groups with a heavier burden of HCC by assessing associations of individual‐level sociodemographic variables and neighbourhood deprivation with all‐stage and stage‐specific HCC incidence rates (IR). Patient and population data stratified by calendar year (2012‐2018), sex, age (5‐year groups), household income (low, medium and high), country of birth (Nordic, non‐Nordic) and neighbourhood deprivation (national quintiles Q1‐Q5) were retrieved from Swedish registers. HCC stages were defined by Barcelona Clinic Liver Cancer stages 0 to A (early‐stage) and B to D (late‐stage). IR (per 100 000 person‐years) were estimated by Poisson regression models. Men had four times higher IR than women. IRs increased markedly with lower household income as well as with neighbourhood deprivation. Seven times higher IR was observed among people with a low household income living in the most deprived neighbourhoods (IR 3.90, 95% confidence interval [CI] 3.28‐4.64) compared to people with a high household income living in the least deprived neighbourhoods (IR 0.58, 95% CI 0.46‐0.74). The gradient across income categories was more pronounced for late‐stage than early‐stage HCC. IR reached 30 (per 100 000 person‐years) for people in the age span 60 to 79 years with low income and 20 for 60 to 79 year old people living in the most deprived neighbourhoods (regardless of income). Men with low household income and/or living in the most deprived neighbourhoods might be considered as primary targets in studies evaluating the cost‐effectiveness of screening for early‐stage HCC detection.
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Affiliation(s)
- Juan Vaz
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research Lund University Malmö Sweden
- Department of Internal Medicine Halland Hospital Halmstad Halmstad Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research Lund University Malmö Sweden
| | - Malin Sternby Eilard
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg
- Transplantation Center Sahlgrenska University Hospital Gothenburg Sweden
| | - Berne Eriksson
- Krefting Research Centre, Institute of Medicine University of Gothenburg Gothenburg Sweden
- Department of Research and Development, Region Halland Halmstad Sweden
| | - David Buchebner
- Department of Internal Medicine Halland Hospital Halmstad Halmstad Sweden
| | - Ulf Strömberg
- Department of Research and Development, Region Halland Halmstad Sweden
- Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Hraiech S, Pauly V, Orleans V, Auquier P, Boyer L, Papazian L, Azoulay E. Undocumented migrants in French intensive care units in 2011-2018: retrospective nationwide study. Intensive Care Med 2022; 48:290-299. [PMID: 35044486 DOI: 10.1007/s00134-021-06606-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Whether undocumented migrants admitted to intensive care units (ICUs) have specific features is unknown. We aimed to determine the features and outcomes of undocumented migrants admitted to French ICUs. METHODS We retrospectively included all undocumented adult migrants admitted in 2011-2018 and compared them to the general ICU population. We also compared these two groups matched on age, sex, severity, comorbidities, reason for ICU admission and public/private hospital. RESULTS We identified 14,554 ICU stays, with an increase from 2 to 4‰ of all ICU admissions over time. Shock (16.7%), post-operative care (13.8%), and trauma (10.5%) were the main reasons for ICU admission. Compared to general ICU patients, migrants were younger and had greater disease severity. After adjustment on age and sex, the following were more common in migrants: shock (OR 1.2 [1.14-1.25]; P < 0.0001), infections (1.48 [1.38-1.54]; P < 0.001), acute respiratory failure (1.09 [1.03-1.15]; P = 0.006), acute kidney injury (1.12 [1.05-1.19]; P < 0.001), obstetric events (1.53 [1.66-1.81]; P < 0.0001), and neurological deficits (1.19 [1.12-1.27]; P < 0.0001). In the matched study, migrants more often required vasopressors, mechanical ventilation, and renal replacement therapy; had longer ICU stays (median 4 [2-8] vs. 4 [2-7] days; P < 0.0001) and hospital stays (10 [5-20] vs. 8 [4-15]; P < 0.0001) and had higher hospital costs (14.2 ± 23.6 vs. 13.4 ± 11.5 K€; P < 0.0001). Hospital mortality was similar (6.7% vs. 6.6%; P = 0.69). CONCLUSION Admissions of undocumented migrants to French ICUs doubled from 2011 to 2018. The patients were younger and, although sicker, achieved similar outcomes to those in general ICU patients.
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Affiliation(s)
- Sami Hraiech
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, Marseille, France. .,Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005, Marseille, France. .,Department of Medical Information, AP-HM, Marseille, France.
| | - Vanessa Pauly
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005, Marseille, France.,Department of Medical Information, AP-HM, Marseille, France
| | - Véronica Orleans
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005, Marseille, France.,Department of Medical Information, AP-HM, Marseille, France
| | - Pascal Auquier
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005, Marseille, France.,Department of Medical Information, AP-HM, Marseille, France
| | - Laurent Boyer
- Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005, Marseille, France.,Department of Medical Information, AP-HM, Marseille, France
| | - Laurent Papazian
- Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, Marseille, France.,Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille Université, 27 Boulevard Jean-Moulin, 13005, Marseille, France.,Department of Medical Information, AP-HM, Marseille, France
| | - Elie Azoulay
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
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11
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Hjerkind KV, Johansson ALV, Trewin CB, Russnes HG, Ursin G. Incidence of breast cancer subtypes in immigrant and non-immigrant women in Norway. Breast Cancer Res 2022; 24:4. [PMID: 35012613 PMCID: PMC8751256 DOI: 10.1186/s13058-021-01498-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/20/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Breast cancer incidence differs between non-immigrants and immigrants from low- and middle-income countries. This study investigates whether immigrants also have different subtype-specific incidences. METHODS We used national health registries in Norway and calculated subtype-specific incidence rate ratios (IRRs) for invasive breast cancer among women aged 20-75 and 20-49 years between 2005 and 2015. Immigrant groups were classified by country of birth broadly defined based on WHO regional groupings. Subtype was defined using estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) status as luminal A-like (ER+ PR+ HER2-), luminal B-like/HER2- (ER+ PR- HER2-), luminal B-like/HER2+ (ER+ PR any HER2+), HER2+ (ER-PR-HER2+) and triple-negative breast cancer (TNBC) (ER-PR-HER2-). RESULTS Compared to non-immigrants, incidence of the luminal A-like subtype was lower in immigrants from Sub-Saharan Africa (IRR 0.43 95% CI 0.28-0.66), South East Asia (IRR 0.63 95% CI 0.51-0.79), South Asia (IRR 0.67 95% CI 0.52-0.86) and Eastern Europe (IRR 0.86 95% CI 0.76-0.99). Immigrants from South Asia had higher rates of HER2 + tumors (IRR 2.02 95% CI 1.26-3.23). The rates of TNBC tended to be similar regardless of region of birth, except that women from South East Asia had an IRR of 0.54 (95% CI 0.32-0.91). CONCLUSIONS Women from Eastern Europe, Sub-Saharan Africa and Asia had different subtype-specific incidences compared to women from high-income countries (including non-immigrants). These differences in tumor characteristics between immigrant groups should be taken into consideration when planning preventive or screening strategies.
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Affiliation(s)
- Kirsti V. Hjerkind
- grid.418941.10000 0001 0727 140XDepartment of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Anna L. V. Johansson
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 171 77 Stockholm, Sweden ,grid.418941.10000 0001 0727 140XCancer Registry of Norway, Postbox 5313, 0304 Majorstuen, Oslo, Norway
| | - Cassia B. Trewin
- grid.418941.10000 0001 0727 140XDepartment of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Hege G. Russnes
- grid.55325.340000 0004 0389 8485Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, 0424 Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Pathology, Oslo University Hospital, 0424 Oslo, Norway
| | - Giske Ursin
- grid.418941.10000 0001 0727 140XCancer Registry of Norway, Postbox 5313, 0304 Majorstuen, Oslo, Norway ,grid.42505.360000 0001 2156 6853Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.5510.10000 0004 1936 8921Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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12
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Disparities in stage at diagnosis for five common cancers in China: a multicentre, hospital-based, observational study. THE LANCET PUBLIC HEALTH 2021; 6:e877-e887. [DOI: 10.1016/s2468-2667(21)00157-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
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13
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Hraiech S, Papazian L, Azoulay E. Migrants in the intensive care unit: time to show we care. Intensive Care Med 2020; 47:473-475. [PMID: 33231732 DOI: 10.1007/s00134-020-06318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Sami Hraiech
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS - Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Paris, France
| | - Laurent Papazian
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS - Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Paris, France
| | - Elie Azoulay
- Service de Médecine Intensive Et Réanimation, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.
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14
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Trewin CB, Hjerkind KV, Johansson ALV, Strand BH, Kiserud CE, Ursin G. Socioeconomic inequalities in stage-specific breast cancer incidence: a nationwide registry study of 1.1 million young women in Norway, 2000-2015. Acta Oncol 2020; 59:1284-1290. [PMID: 32319848 DOI: 10.1080/0284186x.2020.1753888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Women with high socioeconomic status (SES) have the highest incidence rates of breast cancer. We wanted to determine if high SES women only have higher rates of localized disease, or whether they also have higher rates of non-localized disease. To study this, we used data on a young population with universal health care, but not offered screening. MATERIAL AND METHODS Using individually linked registry data, we compared stage-specific breast cancer incidence, by education level and income quintile, in a Norwegian cohort of 1,106,863 women aged 30-48 years during 2000-2015 (N = 7531 breast cancer cases). We calculated stage-specific age-standardized rates and incidence rate ratios and rate differences using Poisson models adjusted for age, period and immigration history. RESULTS Incidence of localized and regional disease increased significantly with increasing education and income level. Incidence of distant stage disease did not vary significantly by education level but was significantly reduced in the four highest compared to the lowest income quintile. The age-standardized rates for tertiary versus compulsory educated women were: localized 28.2 vs 19.8, regional 50.8 vs 40.4 and distant 2.3 vs 2.6 per 100,000 person-years. The adjusted incidence rate ratios (tertiary versus compulsory) were: localized 1.40 (95% CI 1.25-1.56), regional 1.25 (1.15-1.35), distant 0.90 (0.64-1.26). The age-standardized rates for women in the highest versus lowest income quintile were: localized 28.9 vs 17.7, regional 52.8 vs 41.5 and distant 2.3 vs 3.2 per 100,000 person-years. The adjusted incidence rate ratios (highest versus lowest quintile) were: localized 1.63 (1.42-1.87), regional 1.27 (1.09-1.32), distant 0.64 (0.43-0.94). CONCLUSION Increased breast cancer rates among young high SES women is not just increased detection of small localized tumors, but also increased incidence of tumors with regional spread. The higher incidence of young high SES women is therefore real and not only because of excessive screening.
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Affiliation(s)
- Cassia Bree Trewin
- Norwegian National Advisory Unit on Women’s Health, Oslo University Hospital, Oslo, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anna Louise Viktoria Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Cancer Registry of Norway, Oslo, Norway
| | - Bjørn Heine Strand
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilie Essholt Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Hjerkind KV, Larsen IK, Aaserud S, Møller B, Ursin G. Cancer incidence in non-immigrants and immigrants in Norway. Acta Oncol 2020; 59:1275-1283. [PMID: 32930622 DOI: 10.1080/0284186x.2020.1817549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Major cancers are associated with lifestyle, and previous studies have found that the non-immigrant populations in the Nordic countries have higher incidence rates of most cancers than the immigrant populations. However, rates are changing worldwide - so these differences may disappear with time. Here we present recent cancer incidence rates among immigrant and non-immigrant men and women in Norway and investigate whether previous differences still exist. MATERIAL AND METHODS We took advantage of a recent change in the Norwegian Cancer Registry regulations that allow for the registry to have information on country of birth. The number of person years for 2014-2018 was aggregated for every combination of sex, five-year age-group and country of birth, by summing up each year's population in these groups. The number of cancer cases was then counted for the same groups, and age-standardised incidence rates calculated by weighing the age-specific incidence rates by the Nordic and World standard populations. Further, we calculated incidence rate ratios using the non-immigrant population as a reference. RESULTS Immigrants from Eastern Europe, the Middle East, Africa and Asia had lower incidence of total cancer compared to the non-immigrant population in Norway and immigrants born in the other Nordic or high-income countries. However, some cancers were more common in certain immigrant groups. Asian men and women had threefold the incidence of liver cancer than non-immigrant men and women. Men from the other Nordic countries and from Eastern Europe had higher lung cancer rates than non-immigrant men. CONCLUSION National registries should continuously monitor and present cancer incidence stratified on important population subgroups such as country of birth. This can help assess population subgroup specific needs for cancer prevention and treatment, and could eventually help reduce the morbidity and mortality of cancer.
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Affiliation(s)
| | - Inger K. Larsen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Stein Aaserud
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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16
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Herbach EL, Weeks KS, O'Rorke M, Novak NL, Schweizer ML. Disparities in breast cancer stage at diagnosis between immigrant and native-born women: A meta-analysis. Ann Epidemiol 2020; 54:64-72.e7. [PMID: 32950654 DOI: 10.1016/j.annepidem.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/10/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To synthesize existing observational evidence to identify disparities in stage at breast cancer diagnosis between foreign- and native-born women. We hypothesized immigrant women would be less likely than natives to be diagnosed at a localized stage. METHODS Systematic searches for studies detailing stage at breast cancer diagnosis by birthplace in PubMed, Embase, and Web of Science yielded 11 relevant cohort studies from six countries. Odds ratios were pooled using random effects models. RESULTS Foreign-born women were 12% less likely to be diagnosed with breast cancer at a localized stage than natives (OR 0.88, 95% CI 0.82-0.95). A similar disadvantage was observed in immigrants from Asia, Eastern Europe, Latin America and the Caribbean, and developing or in transition nations; immigrants from developed countries experienced the least disparity. CONCLUSIONS This meta-analysis confirmed the presence of significant differences in breast cancer stage at diagnosis as per nativity. Across diverse immigrant groups and host countries, foreign-born women were significantly less likely to be diagnosed with localized breast cancer than native women; the magnitude of the disparity varied by region and economic condition of immigrants' birthplace.
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Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
| | - Kristin S Weeks
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Michael O'Rorke
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Nicole L Novak
- Department of Community and Behavioral Health, University of Iowa, Iowa City
| | - Marin L Schweizer
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City; Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA
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17
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Thøgersen H, Møller B, Åsli LM, Bhargava S, Kvåle R, Fjellbirkeland L, Robsahm TE, Aaserud S, Babigumira R, Larsen IK. Waiting times and treatment following cancer diagnosis: comparison between immigrants and the Norwegian host population. Acta Oncol 2020; 59:376-383. [PMID: 31920119 DOI: 10.1080/0284186x.2019.1711167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There are concerns about timely access to appropriate cancer treatment for the growing immigrant population in Norway. This study aims to compare waiting times between cancer diagnosis and start of cancer treatment, as well as treatment patterns between immigrants in Norway and the host population.Material and methods: We performed a nationwide, registry-based study with individual-level data, including 213,320 Norwegians and 8324 immigrants diagnosed with breast, colorectal, lung or prostate cancer in 1990-2014. Differences in time from diagnosis to treatment and in treatment patterns were described for the selected cancer sites. The Cox and logistic regressions were used to adjust for patient and tumour characteristics.Results: After adjustment for covariates, hazard ratios for time from diagnosis to treatment for non-Western immigrants compared to Norwegians were 0.88 (95% confidence interval (CI): 0.82-0.95) for breast cancer and 0.84 (95% CI: 0.75-0.95) for lung cancer, indicating longer waiting times. Treatment patterns in the four major cancer sites were similar among immigrants and the Norwegian host population, except for breast cancer, where women from East and South Asia received less breast-conserving surgery than the Norwegian host population (adjusted odds ratios 0.65 (95% CI: 0.46-0.93) for East Asians and 0.75 (95% CI: 0.50-1.13) for South Asians).Conclusions: The present study reports delayed treatment for lung and breast cancer among immigrants from non-Western countries in Norway. Systematic differences in cancer treatment were not detected. However, less breast-conserving surgery among breast cancer patients from Asia compared to Norwegians was observed.
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Affiliation(s)
- Håvard Thøgersen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Linn Merete Åsli
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Sameer Bhargava
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Rune Kvåle
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Division for Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - Lars Fjellbirkeland
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Stein Aaserud
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Ronnie Babigumira
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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18
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Bhargava S, Hofvind S, Moen K. Gender, letters, relatives, and God: mediating actors in mammographic screening among Pakistani women in Norway. Acta Radiol Open 2019; 8:2058460119875015. [PMID: 31548913 PMCID: PMC6743200 DOI: 10.1177/2058460119875015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pakistani immigrant women in Norway have lower attendance rates in the national breast cancer screening program (BreastScreen Norway) compared to non-immigrants and immigrants from most other countries. PURPOSE To identify and explore human and non-human actors that play a role for Pakistani immigrant women's attendance in the program. MATERIAL AND METHODS Qualitative interviews with 16 Norwegian-Pakistani women in 2017 and 2018. Inspired by Latour, we explored how human and non-human actors act and interact when Pakistani immigrant women consider attendance in BreastScreen Norway. RESULTS Among the actors found to play a significant role in the relationship between Pakistani immigrant women and the screening program were trust in the healthcare system and breast cancer screening, the gender of the screening radiographer, the written information received from the screening program, family life, daughters, general practitioners, non-governmental organizations, religious beliefs, private service providers, monetary expenses, accessibility, worries, and digital tools. CONCLUSION Many human and non-human actors work to shape and influence Pakistani immigrant women's screening attendance, or lack thereof, for instance by creating thoughts, promoting opportunities, raising doubts and generating worries, thus variously encouraging, enabling, facilitating, discouraging or preventing attendance in organized breast cancer screening.
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Affiliation(s)
- Sameer Bhargava
- Cancer Registry of Norway, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway.,Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Performance measures among non-immigrants and immigrants attending BreastScreen Norway: a population-based screening programme. Eur Radiol 2019; 29:4833-4842. [PMID: 30762109 DOI: 10.1007/s00330-019-6009-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To explore performance measures among non-immigrants and immigrants attending BreastScreen Norway. METHODS We analysed data from 2,951,375 screening examinations among non-immigrants and 153,026 among immigrants from 1996 to 2015. Immigrants were categorised into high- and low-incidence countries according to the incidence of breast cancer in their birth country. Performance measures, including attendance and recall rates, rates of screen-detected cancer (SDC) and interval breast cancer (IBC), positive predictive value (PPV) and histopathological tumour characteristics, were analysed. We used Fisher's exact model and t tests for descriptive statistics, and Poisson regression, adjusting for age and screening history, comparing results for non-immigrants versus immigrants. RESULTS Attendance rates were 78% for non-immigrants and 56% for immigrants (p < 0.001). Rates of prevalent screens were 24% for non-immigrants and 32% for immigrants (p < 0.001). Immigrants from low-incidence countries were younger at diagnosis than non-immigrants (57 years versus 60 years, p < 0.001). Recall rates were 3.1% for non-immigrants and 3.8% for immigrants (p < 0.001), while PPVs were 17% and 14% (p < 0.001), respectively. IBCs in immigrants from low-incidence countries were more often triple negative (RRadj 1.81, 95% CI 1.11-2.94) than those in non-immigrants. Both SDC and IBC in immigrants from low-incidence countries tended more often to be histological grade 3 than those in non-immigrants. CONCLUSION Immigrants had lower attendance rates, higher recall rates and lower PPV than non-immigrants. The optimal age range and screening interval for immigrant women from low-incidence countries need to be further investigated. KEY POINTS • Immigrants from countries with a low incidence of breast cancer had their breast cancer diagnosed at a younger age than non-immigrants. • Interval breast cancers detected in immigrants from countries with a low incidence of breast cancers were more often triple negative than those in non-immigrants. • The optimal age range and screening interval for immigrant women from low-incidence countries and non-immigrants might differ.
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20
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Thøgersen H, Møller B, Robsahm TE, Babigumira R, Aaserud S, Larsen IK. Differences in cancer survival between immigrants in Norway and the host population. Int J Cancer 2018; 143:3097-3105. [PMID: 29987865 DOI: 10.1002/ijc.31729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022]
Abstract
Cancer survival is an important indicator for quality of cancer care. We sought to determine if there are differences in cancer survival between immigrants and the host population in Norway. We performed a nationwide registry-based study comprising subjects diagnosed with cancer between 1990 and 2014, and followed until the end of 2016. Survival was estimated for 13 cancer sites with cause-specific survival. Adjustments were made for common confounders (age, sex, year of diagnosis and place of residence) and defined mediators (stage at diagnosis, comorbidity and socioeconomic factors). A total of 500,255 subjects were available for analysis, of which 11,252 were Western and 8,701 non-Western immigrants. We did not find differences in cancer survival between Western immigrants and Norwegians, while non-Western immigrants, with some exceptions, had similar or better survival. Better lung cancer survival in non-Western immigrants than Norwegians was notable (hazard ratio (95% confidence interval): 0.78 (0.71-0.85)), and not explained by defined mediators. Immigrants from Eastern Europe and Balkan with melanoma (hazard ratio: 1.54 (1.12-2.12)) and prostate cancer (hazard ratio: 1.34 (1.08-1.67)), and possibly from sub-Saharan Africa with breast cancer (hazard ratio: 1.41 (0.94-2.12)) had worse survival than Norwegians. The results suggest that immigrants in Norway have good cancer survival relative to the host population. Poor survival in immigrants from Eastern Europe and Balkan with melanoma and prostate cancer, and sub-Saharan Africa with breast cancer might be a concern.
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Affiliation(s)
- Håvard Thøgersen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Ronnie Babigumira
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Stein Aaserud
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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21
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Lower attendance rates in BreastScreen Norway among immigrants across all levels of socio-demographic factors: a population-based study. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0937-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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22
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Robsahm TE, Helsing P, Nilssen Y, Vos L, Rizvi SMH, Akslen LA, Veierød MB. High mortality due to cutaneous melanoma in Norway: a study of prognostic factors in a nationwide cancer registry. Clin Epidemiol 2018; 10:537-548. [PMID: 29780262 PMCID: PMC5951132 DOI: 10.2147/clep.s151246] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to examine why Norway has the highest rate of mortality due to cutaneous melanoma (CM) in Europe. The Norwegian Malignant Melanoma Registry (NMMR) enables the study of clinical and histopathological characteristics of patients who die due to CM. Results The NMMR and the Norwegian Cause of Death Registry provided data on the clinical and histopathological factors as well as the date and cause of death, through June 2015 for all first invasive CMs diagnosed in 2008–2012 (n=8087). Cox regression was used to estimate associations between clinical and pathological factors and CM-specific death. Multiple imputation was used to handle missing data. Results The CMs were equally distributed between men (49.9%) and women (50.1%), and the median follow-up was 4.0 years (range: 0.08–7.5 years). Trunk was the most common anatomic site (48%), superficial spreading melanoma was the dominant melanoma subtype (68.2%), median Breslow thickness was 1.0 mm, ulceration was present in 23% of CMs, and 91.8% of cases were in a local clinical stage at diagnosis. Compared to women, men were diagnosed at a higher age, with thicker and more-often-ulcerated tumor, and more often were in advanced clinical stages. During follow-up, 1015 patients died due to CM, representing 52.8% of all deaths. The nodular subtype made up the dominant proportion of fatal CM cases (55.3% in women, 64.6% in men). Sex, age, anatomic site (trunk), T-stage, ulceration, clinical stage, and having a second primary CM were associated with increased risk of CM-specific death. Conclusion Our data suggest that the high rate of mortality due to CM observed in Norway is attributable to the more advanced stage of the disease at diagnosis. Most high-risk cases occurred in male patients ≥70 years of age. Efforts to improve awareness and secondary prevention of CM, including warning signs of all melanoma subtypes, are required urgently and should be targeted toward men in particular.
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Affiliation(s)
| | - Per Helsing
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Linda Vos
- Cancer Registry of Norway, Oslo, Norway
| | - Syed Mohammad H Rizvi
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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