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Njor SH, Heinävaara S, Stefansdóttir H, Nygård M, Guðmundsdóttir EM, Bhargava S, Leivonen A, Campbell S, Søborg B, Hofvind S, Sarkeala T, Vejborg I, Lamminmäki M. Differences in mammography screening attendance among non-Western immigrants in Denmark, Finland, Iceland and Norway. Prev Med Rep 2023; 36:102516. [PMID: 38116274 PMCID: PMC10728433 DOI: 10.1016/j.pmedr.2023.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Several studies have shown that attendance rates are lower among non-Western immigrants than among natives. As the Nordic countries have quite similar health systems and populations but also differences in the organisation of their organised mammography screening programmes, differences in attendance rates could highlight organisational factors that might increase the attendance rates. Mammography screening is offered free of charge in Denmark and Finland, but not in Iceland and Norway. Contrarily to the other countries, Iceland do not send out pre-booked appointment. The study population included natives and non-Western immigrants aged 50-69 years, who had at least one invitation to the national mammography screening programmes in Denmark (2008-2017), Finland (2001-2017), Iceland (2001-2020) or Norway (2001-2015). Relative risks (RRs) of attendance were estimated and adjusted for age group and calendar period. The study population included 116.033 non-Western immigrants and more than 2 million natives. The attendance rates were significantly lower among non-Western immigrants than among natives, with an adjusted relative risk of 0.81/0.80 in Denmark and Finland, 0.62 in Norway, and 0.40 in Iceland. The lower attendance rates among immigrants in Norway and Iceland did not seem to be due to differences in birth country, immigration age, or educational level, but might be explained by organisational factors. Offering free-of-charge mammography screening in Norway and Iceland and/or including a pre-booked appointment in the invitation letters in Iceland might increase the attendance rate among non-Western immigrants.
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Affiliation(s)
- Sisse Helle Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Finland
| | | | - Mari Nygård
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | | | - Sameer Bhargava
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | | | | | - Bo Søborg
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Denmark
| | - Solveig Hofvind
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway
| | | | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University Hospital Herlev, Gentofte, Denmark
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Sarkeala T, Lamminmäki M, Nygård M, Njor SH, Virtanen A, Leivonen A, Hirvonen E, Toikkanen S, Campbell S, Stefansdóttir H, Ursin G, Heinävaara S. Cervical, liver and stomach cancer incidence and mortality in non-Western immigrant women: a retrospective cohort study from four Nordic countries. Acta Oncol 2023; 62:977-987. [PMID: 37594889 DOI: 10.1080/0284186x.2023.2245557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Cervical, liver and stomach cancers are the most common infection-associated malignancies and the leading cause of morbidity in non-Western regions. We compared the incidence and mortality of these cancers between non-Western immigrant and non-immigrant Nordic female populations. We also analysed the effect of age at immigration, duration of residence and education on cancer burden. MATERIAL AND METHODS Study population consisted of women residents in Denmark, Finland, Iceland and Norway in 1973-2020. Non-Western women contributed 3.1% of the total 260 million person-years at risk. All women were followed from their 20th birthday, or from the date of immigration if after, until the date of their first primary cancer diagnosis, death, emigration, or the end of the country-specific study period. All data were adjusted for 10-year age groups and calendar periods, and immigrant data was further broken down by region of birth, age at immigration and education level. Country-specific estimates were produced by multivariable Poisson regression and pooled in Finland with a random effects model. RESULTS Altogether, there were 60 982 cases of cervical, liver and stomach cancer in the study population, causing 36 582 deaths. The immigrant women had significantly higher liver (rate ratio [RR] 1.78, 95% confidence interval (CI) 1.03-3.06) and stomach cancer incidence (RR 1.68, CI 1.29-2.18), and stomach cancer mortality (RR 1.49, CI 1.17-1.92) than non-immigrant women. In the immigrant population, high education was related to lower incidence and mortality of studied cancers. The rate ratio of cervical cancer decreased with duration of residence and increased with rising age at immigration. CONCLUSION Due to the increased incidence and mortality of infection-related cancers and changes in cancer patterns by age at immigration and duration of residence, attention should be paid to targeted health care services for immigrants. Special efforts should be given to women who have spent their youth in high-risk areas.
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Affiliation(s)
| | | | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anni Virtanen
- Finnish Cancer Registry, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Aku Leivonen
- Finnish Cancer Registry, Helsinki, Finland
- Data and Analytics Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Lamminmäki M, Leivonen A, Heinävaara S, Nygård M, Ursin G, Campbell S, Stefansdóttir H, Hirvonen E, Toikkanen S, Vejborg IMM, Njor SH, Sarkeala T. A population-based cohort study on changes in breast, lung and colorectal cancer incidence and mortality among non-Western immigrant women. BMC Cancer 2023; 23:665. [PMID: 37452314 PMCID: PMC10349457 DOI: 10.1186/s12885-023-11140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Cancer risk varies geographically, and migrants are influenced by different risk factors before, during and after migration. Increased migration from non-Western countries to the Nordic countries calls for a better understanding of the migrants' cancer risk and the change in risk patterns over time. The aim of this study was to compare the incidence and mortality of breast, colorectal and lung cancer between non-Western immigrant and the native female population in Denmark, Finland, Iceland, and Norway. MATERIAL AND METHODS Data from national registries were processed and pre-analysed in each country. Multivariate Poisson regression models were used to model the relative differences in incidence and mortality as rate ratios (RR). The country-specific estimates and summary statistics were pooled together using a random effects model. RESULTS Non-Western immigrant women had significantly lower breast (RR 0.71, 0.65-0.78), colorectal (RR 0.72, 0.57-0.92) and lung (RR 0.55, 0.42-0.72) cancer incidence rates than native women, and the risk of these cancers among immigrant women increased with duration of residence. Differences were parallel in breast, colorectal and lung cancer mortality (RR 0.64, 0.55-0.74; RR 0.66, 0.48-0.92; RR 0.51, 0.34-0.79). Among immigrant women, higher education increased the risk for breast cancer and decreased it for lung cancer. CONCLUSION The results significantly complement and add to the previous findings of cancer burden and cancer burden transition among migrants and provide evidence of a prolonged cancer risk advantage among non-Western immigrant women. However, the findings show an increasing risk of lifestyle-related cancers with increasing duration of residence in the host country. Further studies are needed to discover underlying reasons for this phenomenon.
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Affiliation(s)
| | - Aku Leivonen
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
- Data and Analytics Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Giske Ursin
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
- Cancer Registry of Norway, Oslo, Norway
| | | | | | - Elli Hirvonen
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| | - Salla Toikkanen
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| | - Ilse Merete Munk Vejborg
- Department of Breast Examinations, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tytti Sarkeala
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
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