Abstract
CONTEXT: Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace.
OBJECTIVE: To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening.
DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using 1998 data from the National Health Interview Survey.
MAIN OUTCOME MEASURES: Completion of cervical, breast, or colorectal cancer screening.
RESULTS: Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents.
CONCLUSION: Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schmidley AD. Profile of the Foreign-Born Population in the United States: 2000. US Census Bureau, Current Population Reports. Series P23-206. Washington, DC: US Government Printing Office; 2001.
Fruchter RG, Remy JC, Burnett WS, Boyce JG. Cervical cancer in immigrant Caribbean women. Am J Public Health 1986;67:797–9.
Maxwell AE, Bastani R, Warda US. Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Am J Prev Med. 2000;18:62–8.
Tu SP, Yasui Y, Kuniyuki A, et al. Breast cancer screening among Cambodian American women. Cancer Detect Prev. 2000;24:549–63.
Taylor VM, Schwartz SM, Jackson JC, et al. Cervical cancer screening among Cambodian American women. Cancer Epidemiol Biomarkers Prev. 1999;8:541–6.
Fruchter RG, Wright C, Habenstreit B, Remy JC, Boyce JG, Imperato PJ. Screening for cervical and breast cancer among Caribbean immigrants. J Community Health 1985;10:121–35.
Schulmeister L, Lifsey DS. Cervical cancer screening knowledge, behaviors, and beliefs of Vietnamese women. Oncol Nurs Forum. 1999;26:879–87.
Kagawa-Singer M, Pourat N. Asian American and Pacific Islander breast and cervical carcinoma screening rates and healthy people 2000 objectives. Cancer 2001;89:696–705.
Fulton JP, Rakowski W, Jones AC. Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women. Public Health Rep. 1995;110:476–82.
Perez-Stable EJ, Otero Sabogal R, Sabogal F, Mcphee SJ, Hiatt RA. Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan. Arch Intern Med. 1994;154:1073–81.
Coughlin SS, Uhler RJ. Breast and cervical cancer screening practices among Hispanic women in the United States and Puerto Rico, 1998–99. Prev Med. 2002;34:242–51.
Coughlin SS, Uhler RJ. Breast and cervical cancer screening practices among Asian and Pacific Islander women in the United States, 1994–1997. Cancer Epidemiol Biomarkers Prev. 2000;9:597–603.
Thamer M, Rinehart C. Public and private health insurance of US foreign-born residents: implications of the 1996 welfare reform law. Ethn Health. 1998;3:19–29.
Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20:247–56.
Fox SA. The importance of physician communication on breast cancer screening of older women. Arch Intern Med. 1994;154:2058–68.
Fox SA. The effect of physician-patient communication on mammography utilization by different ethnic groups. Med Care. 1991;1065–82.
Woloshin S, Schwartz LM, Katz SJ, Welch HG. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997;12:472–7.
Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventative services by Hispanics: findings from HHANES 1982–1984. Am J Public Health. 1990;80(suppl):11–9.
National Center for Health Statistics. 1998 National Health Interview Survey. Available at: http://www.cdc.gov/nchs/nhis.htm. Accessed June 10, 2002.
US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore: Williams & Wilkins; 1996.
Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual. Release 7.5. NC: Research Triangle Institute, Research Triangle Park; 1997.
Juon HS, Choi Y, Kim MT. Cancer screening behaviors among Korean-American women. Cancer Detect Prev. 2000;24:589–601.
Mcphee SJ, Stewart S, Brock KC, Bird JA, Jenkins CN, Pham GQ. Factors associated with breast and cervical cancer screening practices among Vietnamese American women. Cancer Detect Prev. 1997;1:510–21.
Shankar S, Figueroa-Valles N. Cancer knowledge and misconceptions: a survey of immigrant Salvadorean women. Ethn Dis. 1999;9:201–11.
Phipps E, Cohen MH, Sort R, Braitman LE. A pilot study of cancer knowledge and screening behaviors of Vietnamese and Cambodian women. Health Care Women Int. 1999;20:195–207.
Tanjasiri SP, Sablan-Santos L. Breast cancer screening among Chamorro women in southern California. J Womens Health Gend Based Med. 2001;10:479–85.
Peragallo NP, Fox PG, Alba ML. Breast care among Latino immigrant women in the US. Health Care Women Int. 1998;19:165–72.
Pettersson F, Bjorkholm E, Naslund I. Evaluation of screening for cervical cancer in Sweden: trends in incidence and mortality 1958–80. Int J Epidemiol. 1985;14:521–7.
Sobue T, Suzuki T, Hashimoto S, Yokoi N, Fujimoto I. A case-control study of the effectiveness of cervical cancer screening in Osaka, Japan. Jpn J Cancer Res. 1988;79:1269–75.
Anonymous. Update: National breast and cervical cancer early detection program: July 1991–September 1995. MMWR. 1996;45:484–7.
Nystron L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet. 2002;359:909–19.
Jorgensen OD, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut. 2002;50:29–32.
Selby JV, Friedman GD, Quesenberry CP, Weiss NS, Quesenberry CP Jr. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–7.
Choe JH, Koepsell TD, Heagerty PJ. Differences in colorectal cancer survival between foreign-born and US-born Asian Americans and Pacific Islanders. J Gen Intern Med. 2002;17(suppl):154 (Abstract).
Hedeen AN, White E, Taylor V. Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer. Am J Public Health. 1999;89:1248–52.
Hedeen AN, White E. Breast cancer size and stage in Hispanic American women, by birthplace: 1992–95. Am J Public Health. 2001;91:122–5.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Goel is supported by an institutional National Research Service Award (5T32PE11001-13) and by the Ryoichi Sasakawa Fund. Dr. Wee is supported by a career development award from the National Institute of Diabetes, Digestive and Kidney Diseases (K23DK02962-02). Dr. McCarthy is the recipient of a First Independent Research and Transition Award from the National Cancer Institute (R29 CA79052). Dr. Ngo-Metzger is supported by the National Cancer Institute Asian American Network for Cancer Awareness, Research and Training (U01 CA86322). Dr. Phillips is supported by a Mid-Career Investigator Award from the National Institutes of Health (K24 AT00589-01A1).
Rights and permissions
About this article
Cite this article
Goel, M.S., Wee, C.C., McCarthy, E.P. et al. Racial and ethnic disparities in cancer screening the importance of foreign birth as a barrier to care. J GEN INTERN MED 18, 1028–1035 (2003). https://doi.org/10.1111/j.1525-1497.2003.20807.x
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2003.20807.x