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Breast and Colorectal Cancer Screening Barriers Among Immigrants and Refugees: A Mixed-Methods Study at Three Community Health Centres in Toronto, Canada

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Abstract

Mammography and fecal occult blood testing (FOBT) improve the detection, management, and prognosis of breast and colorectal cancer, respectively, but are underperformed in the recent immigrant and refugee population. We aimed to identify barriers to screening and potential solutions in this population. A mixed-methods study involving a retrospective chart review and focus group interviews was conducted, with data analyzed using univariate logistic regression and thematic analysis, respectively. Mammography completion was associated with greater time in Canada (p = 0.01) and region of origin (p = 0.04), while FOBT completion was associated with region of origin (p = 0.03). Barriers included time constraints, language and cultural differences, and poor interprofessional communication. This study of recent immigrants and refugees identifies barriers to screening and supports potential solutions including culturally-congruent peer workers, targeted screening workshops, and visual screening aids. Further work is needed to address the unique healthcare needs of this diverse and growing population.

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Acknowledgements

The authors would like to thank My Dang, Dr. Heather Sampson, and Christopher Meaney for their invaluable help in the conduct and analysis of this study. There are no relevant external funding sources to report and the authors declare they have no relevant conflicts of interest to report. Dr. Aisha Lofters is supported as a Clinician Scientist by the Department of Family and Community Medicine at the University of Toronto and at St. Michael’s Hospital, and by the Canadian Institutes of Health Research as a New Investigator.

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Author notes

  1. A. M. Wang and E. M. Yung have contributed equally to the writing of this manuscript.

Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    A. M. Q. Wang & E. M. Yung

  2. Access Alliance Multicultural Health and Community Services, Toronto, ON, Canada

    N. Nitti, Y. Shakya & A. K. M. Alamgir

  3. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    A. K. Lofters

  4. St. Michael’s Hospital Family Practice Unit, Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada

    A. K. Lofters

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Correspondence to A. K. Lofters.

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Appendix: Standardized focus group question sets used in both sessions

Appendix: Standardized focus group question sets used in both sessions

  1. 1.

    Views on the current screening climate at Access Alliance

    • With regards to colorectal cancer screening by FOBT and breast cancer screening by mammography, how do you think Access Alliance is meeting its goals?

  2. 2.

    Barriers to screening at Access Alliance

    • What do you think are some barriers to screening at Access Alliance (please discuss barriers faced by clients, barriers faced by providers, and system-level barriers)?

    • What do you think are some factors that might encourage screening?

  3. 3.

    Potential solutions and tools

    • Do you have any suggestions for a health promotion resource or tool that can improve the rates of cancer screening at Access Alliance?

    • Would you suggest that this tool be aimed at clients, providers, or at the organization level?

    • In the past, have there been other resources or tools that have been used at Access Alliance to improve cancer screening rates? Do you think they were effective?

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Wang, A.M.Q., Yung, E.M., Nitti, N. et al. Breast and Colorectal Cancer Screening Barriers Among Immigrants and Refugees: A Mixed-Methods Study at Three Community Health Centres in Toronto, Canada. J Immigrant Minority Health 21, 473–482 (2019). https://doi.org/10.1007/s10903-018-0779-5

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