With recent changes in environmental factors among Africans in South Africa, how have cancer occurrences been affected?

A Review of Health Survey Research for People with Refugee Background Resettled from Africa: Research Gaps and Methodological Issues

We reviewed 27 studies on adults with a refugee background resettled from Africa published between 1999 and 2017 to appraise their methodological issues for survey research. Out of 27 studies, eleven used a single sampling method (referral = 1, convenience = 10), and 16 relied on multiple sampling methods, many of which were combinations of referral and convenience. The two most salient recruitment strategies found were building trusted relationships with the community (n = 15), and using recruiters who were culturally and linguistically matched to the refugee communities of interest (n = 14). Fifteen studies used existing data collection instruments, while in 13 studies, researchers developed their own data collection instruments. In-person or phone interviews using bilingual interviewers (n = 21) were the most frequently used mode of data collection, followed by a self-administered survey (n = 7). Our review presents methodological gaps in current refugee health studies, such as limited use of probability sampling approach due to system barriers, lack of information in community engagement and recruitment processes, and insufficient considerations of unique culture and experiences of refugee communities when developing or adapting the instruments. Efforts can be made to guide and facilitate appropriate reporting and development of more scientifically robust survey methodologies for refugee health studies, as well as to improve registration system infrastructure that may help identify these hidden populations more effectively.

Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: analysis of the World Health Survey

Background

Breast and Cervical cancer are the two most common cancers among women in developing countries. Regular screening is the most effective way of ensuring that these cancers are detected at early stages; however few studies have assessed factors that predict cancer screening in developing countries.

Purpose

To assess the influence of household socio-economic status (SES), healthcare access and country level characteristics on breast and cervical cancer screening among women in developing countries.

Methods

Women ages 18–69 years (cervical cancer screening) and 40–69 years (breast cancer screening) from 15 developing countries who participated in the 2003 World Health Survey provided data for this study. Household SES and healthcare access was assessed based on self-reported survey responses. SAS survey procedures (SAS, Version 9.2) were used to assess determinants of breast and cervical cancer screening in separate models.

Results

4.1% of women ages 18–69 years had received cervical cancer screening in the past three years, while only 2.2% of women ages 40–69 years had received breast cancer screening in the past 5 years in developing countries. Cancer screening rates varied by country; cervical cancer screening ranged from 1.1% in Bangladesh to 57.6% in Congo and breast cancer screening ranged from 0% in Mali to 26% in Congo. Significant determinants of cancer screening were household SES, rural residence, country health expenditure (as a percent of GDP) as well as healthcare access.

Discussion

A lot more needs to be done to improve screening rates for breast and cervical cancer in developing countries, such as increasing health expenditure (especially in rural areas), applying the increased funds towards the provision of more, better educated health providers as well as improved infrastructure.

Racial and ethnic disparities in breast cancer: a multilevel perspective

Although the etiology of racial and ethnic disparities in breast cancer is complex, the studies reviewed here suggest many possible culprits. In the authors' model, outcomes at the cellular level reflect not only genetic constitution and the hormonal milieu but also the interactions of predictors at multiple levels. At the societal level, important predictors include toxin and hormone exposure, access to care, quality of care, and social support. At the individual level, reproductive history, exogenous hormone use, diet,exercise, and response to stress all may influence cellular outcomes. The smooth transition from normal cell function to apoptosis occurs when the interactions between factors at the societal, individual, and cellular levels are harmonious. Perturbations at the societal level, however, such as inferior quality of care, or at the individual level, such as exogenous hormone use,can have profound effects on cell biology and predispose to neoplasia. When these perturbations are systematic and vary by race or ethnicity, disparities in breast cancer incidence and mortality result. Increasing incidence of breast cancer among both men and women likely reflects important trends at the societal and individual levels. These trends may include increased toxin exposure, increased obesity, and changes in the timing and number of births. Efforts to reduce breast cancer incidence and disparities must consider societal and individual factors and the important effects these factors can have on normal cell function.