Cancer screening among migrants in an Australian cohort; cross-sectional analyses from the 45 and Up Study

Incidence profile of four major cancers among migrants in Australia, 2005-2014

PURPOSE

To compare the incidence profile of four major cancers in Australia by place of birth.

METHODS

In this retrospective population-based cohort study, the analysis included 548,851 residents diagnosed with primary colorectum, lung, female breast, or prostate cancer during 2005-2014. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were calculated for migrant groups relative to Australian-born.

RESULTS

Compared with Australian-born residents, most migrant groups had significantly lower incidence rates for cancers of the colorectum, breast and prostate. The lowest rates of colorectal cancer were among males born in Central America (IRR = 0.46, 95% CI 0.29-0.74) and females born in Central Asia (IRR = 0.38, 95% CI 0.23-0.64). Males born in North-East Asia had the lowest rates of prostate cancer (IRR = 0.40, 95% CI 0.38-0.43) and females born in Central Asia had the lowest rates of breast cancer (IRR = 0.55, 95% CI 0.43-0.70). For lung cancer, several migrant groups had higher rates than Australian-born residents, with the highest rates among those from Melanesia (males IRR = 1.39, 95% CI 1.10-1.76; females IRR = 1.40, 95% CI 1.10-1.78).

CONCLUSIONS

This study describes cancer patterns among Australian migrants, which are potentially helpful in understanding the etiology of these cancers and guiding the implementation of culturally sensitive and safe prevention measures. The lower incidence rates observed for most migrant groups may be maintained with continued emphasis on supporting communities to minimize modifiable risk factors such as smoking and alcohol consumption and participation in organized cancer screening programmes. Additionally, culturally sensitive tobacco control measures should be targeted to migrant communities with high lung cancer incidence rates.

Men of refugee and migrant backgrounds in Australia: a scoping review of sexual and reproductive health research

Australia's National Men's Health Strategy 2020-2030 identifies refugee and migrant men from culturally and lingustically diverse backgrounds as priority groups for sexual and reproductive health (SRH) interventions. The paucity of SRH research focusing on refugee and migrant men is a significant gap to advance men's health and policy. Hence, this review aimed to synthesise the available evidence on refugee and migrant men's SRH needs, understandingsand experiences of accessing services after resettlement in Australia. A systematic search of peer reviewed literature in PubMed, Scopus, and PsyInfo was made. A World Health Organization framework for operationalising sexual health and its relationship with reproductive health was used to map the identified studies. The socio-ecological framework was applied to thematically synthesise data extracted from individual studies and identify factors that influence the SRH of refugee and migrant men. We included 38 papers in the review. The majority of sexual health studies (16) were about sexually transmitted infections (STIs), mainly HIV (12), followed by sexual health education and information (5) and sexual functioning (3). Reproductive health studies focused on contraceptive counselling and provision (3), antenatal, intrapartum and postnatal care (1) and safe abortion care (1). Several factors influenced refugee and migrant men's SRH, including a lack of access to SRH information, language barriers and stigma. We found that SRH literature on refugee and migrant men focuses on STIs, meaning other areas of SRH are poorly understood. We identified key gaps in research on experiences of, and access to, comprehensive SRH care.

Colorectal cancer and country of birth in New South Wales, Australia: All-of-population data for prioritising health service delivery and research

INTRODUCTION

Cancer care and outcomes differ across cultural groups in Australia. Quantifying these differences facilitates prioritisation and targeting of services and research. All-of-population data are needed by health agencies to understand and fulfil their cancer-control responsibilities. Compiling these data can be challenging while maintaining privacy. We have used data linkage to gain population-wide colorectal cancer data on stage (degree of spread), treatment, and survival in New South Wales (NSW), Australia, by country of birth (COB), and consider service implications.

METHODS

We studied colon and rectal cancers diagnosed in 2003-2016 and recorded on the NSW Cancer Registry (n = 41,575), plus linked hospital data and data from Australian Medical and Pharmaceutical Benefits payments, other treatment data and death records. Outcomes for 12 COB categories were analysed using multiple logistic and proportional hazards regression, with Australia as the reference category.

RESULTS

Compared with Australian born, the adjusted odds ratio for distant spread of colon cancer was higher for people born in Lebanon and the United Kingdom. Treatment was less common for people born in China (surgery), Germany (systemic), Italy (surgery), New Zealand (any treatment) and Vietnam (all treatments), while treatment for rectal cancer was more common for people born in Italy (surgery), United Kingdom (radiotherapy, systemic therapy), and Vietnam (surgery), and less frequent for people born in China (radiotherapy). Adjusted 5-year survival was higher for people born in China, Italy, Vietnam, Greece (colon), Lebanon (colon) and other non-English speaking countries. More advanced stage was negatively related to having surgery and survival.

CONCLUSIONS

This study illustrates how linked data can enable comparisons of multiple outcomes for colorectal cancer by country of birth across an entire population. Results disclose "big picture" variations in population characteristics, stage, treatment and survival. This will enable better targeting and prioritisation of services and inform research priorities to address disparities.

Cancer patient knowledge about and behavioral intentions after germline genome sequencing

OBJECTIVES

Germline genome sequencing (GS) is becoming mainstream in cancer diagnosis and risk management. Identifying knowledge gaps and determinants of health behavior change intentions will enable effective targeting of educational and management strategies to translate genomic findings into improved cancer outcomes.

METHODS

Probands diagnosed with cancer of likely genetic origin that consented to but not yet undergone GS, and their biological relatives, completed a cross-sectional questionnaire assessing GS knowledge and hypothetical intention to change behaviors.

RESULTS

Probands (n = 348; 57% university educated) and relatives (n = 213; 38% university educated) had moderate GS knowledge levels, with greater knowledge associated with higher education. Both populations reported high behavioral change intentions, significantly associated with being female (p = 0.01) and greater perceived importance of GS (p < 0.001), and for probands: being from English-speaking households (p = 0.003), higher socio-economic status (p = 0.01) and greater self-efficacy (p = 0.02).

CONCLUSIONS

Increasing GS knowledge will enable realistic participant expectations surrounding germline GS. Actual behavior change should be monitored to determine whether increased cancer risk knowledge results in altered cancer-related behavior and ultimately, cancer outcomes.

PRACTICE IMPLICATIONS

Educational resources should target specific populations to ensure informed decision-making and expectation management. Support tools facilitating and maintaining behavioral change may be needed to achieve improved cancer patient outcomes.

Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis

BACKGROUND

Population trends in PSA testing and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA testing, prostate cancer incidence and mortality in Australia and factors that influence them.

METHODS

We calculated and described standardised time trends in PSA tests, prostate biopsies, treatment of benign prostatic hypertrophy (BPH) and prostate cancer incidence and mortality in Australia in men aged 45-74, 75-84, and 85 + years.

RESULTS

PSA testing increased from its introduction in 1989 to a peak in 2008 before declining in men aged 45-84 years. Prostate biopsies and cancer incidence fell from 1995 to 2000 in parallel with decrease in trans-urethral resections of the prostate (TURP) and, latterly, changes in pharmaceutical management of BPH. After 2000, changes in biopsies and incidence paralleled changes in PSA screening in men 45-84 years, while in men ≥85 years biopsy rates stabilised, and incidence fell. Prostate cancer mortality in men aged 45-74 years remained low throughout. Mortality in men 75-84 years gradually increased until mid 1990s, then gradually decreased. Mortality in men ≥ 85 years increased until mid 1990s, then stabilised.

CONCLUSION

Age specific prostate cancer incidence largely mirrors PSA testing rates. Most deviation from this pattern may be explained by less use of TURP in management of BPH and consequent less incidental cancer detection in TURP tissue specimens. Mortality from prostate cancer initially rose and then fell below what it was when PSA testing began. Its initial rise and fall may be explained by a possible initial tendency to over-attribute deaths of uncertain cause in older men with a diagnosis of prostate cancer to prostate cancer. Decreases in mortality rates were many fold smaller than the increases in incidence, suggesting substantial overdiagnosis of prostate cancer after introduction of PSA testing.

Equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia: a scoping review

International evidence suggests migrants experience inequitable access, outcomes and treatment quality across the cancer care continuum. There is currently limited research assessing equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia. A detailed protocol and search strategy were developed and used to identify all relevant literature, utilising the Joanna Briggs Institute Reviewer’s Manual. Systematic searching was conducted via multiple databases and identified studies were screened against pre-identified inclusion and exclusion criteria. 71 studies met the inclusion criteria for analysis. Most studies examined cancer detection via screening. Very few studies examined cancer prevention, diagnosis, treatment or palliative care. Most studies focused on patient-sided barriers to care and there was a paucity of information regarding institutional barriers to health. Cancer-related outcomes were seldom examined, and most studies were qualitative or behavioral analysis. Results highlighted significant communication issues spanning the cancer care continuum and a context of inadequate support for both patients and clinicians. There is a demonstrable need to examine equity in access and outcomes for culturally and linguistically diverse cancer populations. This requires the identification of cancer-related disparities and an examination of institutional barriers to care. Through addressing this dearth of information, future research and health policy can support the operationalisation of health equity.

Understanding the participation of breast screening among women born in predominantly Muslim countries living in Victoria, Australia from record-linkage data

BACKGROUND

Early detection of breast cancer can improve survival rates and decrease mortality rates. This study investigates whether there are significant differences in participation in breast screening among women born in Muslim countries compared to women born in Non-Muslim countries and Australia.

METHODS

Screening data from January 1st, 2000 to December 31st, 2013 from the Breast Screen Victoria Registry (BSV) was linked with hospital records from the Victorian Admitted Episodes Dataset (VAED). Countries having more than 50% of their population as Muslim were categorised as Muslim countries. Age adjusted rates were calculated for women born in Muslim and Non-Muslim countries and compared with the Australian age adjusted rates. Logistic regression assessed the association between screening status and other factors which include country of birth, marital status, age and socio-economic status.

RESULTS

Women born in Muslim countries (Odds Ratio (OR) = 0.70, 95%CI = 0.68-0.72) and in other Non-Muslim countries (OR = 0.87, 95%CI = 0.86-0.88) had lower odds of participation in breast screening than Australian born women. Women aged 60-64 years (OR = 1.42, 95%CI = 1.40-1.44) had higher odds of participation in the BreastScreen program than 50-54 age group.

CONCLUSION

This study provides valuable insights to understanding breast screening participation among women born in Muslim countries residing in Victoria. This population level study contributes to the broader knowledge of screening participation of women born in Muslim countries, an understudied population group in Australia and across the world. This study has implications for breast screening programs as it highlights the need for culturally sensitive approaches to support breast screening participation among women born in Muslim countries.

Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia

INTRODUCTION

With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods. METHODS AND ANALYSIS: Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments.

ETHICS AND DISSEMINATION

Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.

The impact of translated reminder letters and phone calls on mammography screening booking rates: Two randomised controlled trials

INTRODUCTION

Participation in mammographic screening for breast cancer in Australia is approximately 54% among the general population, but screening among women from some culturally and linguistically diverse (CALD) backgrounds is lower. BreastScreen Victoria apply strategies to increase screening including reminder letters and phone calls; however, these are usually provided in English. Using intervention strategies generated from the Ophelia (OPtimise HEalth LIteracy and Access) community co-design process, translated mammography reminder letters and in-language phone calls were tested within two randomised control trials (RCTs).

METHODS AND ANALYSIS

Women aged 50-75 years who were due for their 2-yearly screening mammography (for RCT#1) or were under-screened, i.e. ≥27 months since last screen (for RCT#2) were randomised into intervention or control groups. RCT#1 compared sending women routine reminder letters (English only) with translated (Arabic or Italian) letters. RCT#2 compared reminder telephone calls to women in their preferred language (Arabic or Italian) to no telephone call. The primary outcome for each trial was screening booking rates within 14-days. Primary outcomes were tested using Pearson's chi-square test. Rates within language group (incidence ratio: IR) were compared using the Cochran-Mantel-Haenszel test.

RESULTS

For RCT#1 (letters) 1,032 women were randomised into the intervention arm or to usual care. Uptake of screening bookings was similar between both groups, with no differences observed by language group. For RCT#2 (phone calls), 195 women were randomised to the intervention group or to usual care. Overall, 64.2% of women in the intervention arm and 6% in the control arm booked a screening appointment within 14 days (p<0.0001). The IR (95%CI) of booking was 10.1 (3.9, 26.3) times higher among Italian women, and 11.6 (2.9, 46.5) times higher among Arabic women in the intervention compared to usual care groups.

DISCUSSION AND CONCLUSION

A service improvement initiative derived from community members and breast screen providers was found to be highly effective. This evidence informed the service provider, BreastScreen Victoria, who have implemented these improvements into routine practice to improve screening among CALD groups and reduce health inequalities.

Can we address cancer disparities in immigrants by improving cancer literacy through English as a second language instruction?

In many Western countries, immigrants exhibit disparities in cancer incidence and mortality, and variable uptake of cancer prevention services. New immigrants may not be aware of cancer risks pertinent to their new country, or prevention resources. Traditional cancer prevention health messaging may not be accessible for cultural, language, or literacy reasons. New methods are needed. In North America, health message delivery via English classes for immigrants is showing potential as an efficacious and a feasible way to reach immigrants at the same time improving language skills. Interventions published to date are promising but limited in their ability to generalize or be adapted to a variety of populations and settings. This concept paper aims to synthesize previous findings and identify ways to improve and advance the translation potential of this approach. We propose that this could be achieved by (i) using a translation framework to guide intervention planning, development, implementation, and evaluation; (ii) encouraging and evaluating health message spread throughout language learners' social networks; and (iii) incorporating cultural sensitivity into the curriculum. A pilot project following these recommendations is planned for Australia and will be discussed. These recommendations could serve as a framework to fit the requirements of immigrant language programs in other countries and other health topics.

Reducing infectious disease inequities among migrants

BACKGROUND

migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies.

METHODS

This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care.

RESULTS

For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials.

CONCLUSIONS

Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.

Feasibility of using respondent-driven sampling to recruit participants in superdiverse neighbourhoods for a general health survey

OBJECTIVES

Respondent-driven sampling (RDS), a modified chain-referral system, has been proposed as a strategy for reaching 'hidden' populations. We applied RDS to assess its feasibility to recruit 'hard-to-reach' populations such as migrants and the unemployed in a general health survey and compared it to register-based sampling (RBS).

METHODS

RDS was applied parallel to standard population RBS in two superdiverse neighbourhoods in Bremen, Germany. Prevalences of sample characteristics of interest were estimated in RDS Analyst using the successive sampling estimator. These were then compared between the samples.

RESULTS

Only 115 persons were recruited via RDS compared to 779 via RBS. The prevalence of (1) migrant background, (2) unemployment and (3) poverty risk was significantly higher in the RDS than in the RBS sample. The respective estimates were (1) 51.6 versus 32.5% (95% CI_RDS 40.4-62.7), (2) 18.1 versus 7.5% (95% CI_RDS 8.4-27.9) and (3) 55.0 versus 30.4% (95% CI_RDS 41.3-68.7).

CONCLUSIONS

Although recruitment was difficult and the number of participants was small, RDS proved to be a feasible method for reaching migrants and other disadvantaged persons in our study.

Exploring disparities in receipt of adjuvant chemotherapy in culturally and linguistically diverse groups: an Australian centre's experience

BACKGROUND

Globally, racial and ethnic disparities exist in treatments and outcomes for cancer patients. In Australia, there are few published data related to cancer patients from culturally and linguistically diverse (CALD) backgrounds.

AIM

To explore disparities in adjuvant chemotherapy utilisation in cancer patients from CALD groups.

METHODS

Retrospective analysis of patients who were recommended adjuvant chemotherapy for early stage breast cancer or early stage colorectal cancer between July 2011 and October 2014 was performed. Rates of adjuvant chemotherapy uptake were analysed between those who identified English as their first-preferred language, versus those who did not, as well as between patients who were born in a country where English is the main language (non-CALD), versus those born in a country where English is not the main language (CALD).

RESULTS

Two hundred and eleven patients were identified. One hundred and forty-three (67.7%) patients had early stage breast cancer and 68 (32.2%) patients had early stage colorectal cancer. No difference was detected in the acceptance of adjuvant chemotherapy between non-CALD (80.9%) and CALD patients (81.3%, P = 0.984) or between patients who identified English as their first-preferred language (80.8%) and those who did not (81.8%, P = 0.870). There was no difference in the rate of chemotherapy completion, with 75.6% completion in the non-English-speaking group and 81.1% in the English-speaking group (P = 0.426).

CONCLUSION

No difference was observed in adjuvant chemotherapy utilisation in patients who identified English as their first-preferred language compared to those who did not, as well as between non-CALD and CALD groups. This is the first study to assess these differences in Australia.

Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population-based study

Breast cancer screening programs operate across Canada providing mammography to women in target age groups with the goal of reducing breast cancer mortality through early detection of tumors. Disparities in breast screening participation among socio‐demographic groups, including immigrants, have been reported in Canada. Our objectives were to: (1) assess breast screening participation and retention among immigrant and nonimmigrant women in British Columbia (BC), Canada; and (2) to characterize factors associated with screening among screening‐age recent immigrant women in BC. We examined 2 population‐based cohorts of women eligible for breast screening participation (537 783 women) and retention (281 052 women) using linked health and immigration data. Breast screening rates were presented according to socio‐demographic and health‐related variables stratified by birth country. Factors associated with screening among recent immigrant women were explored using Poisson regression. We observed marked variation in screening participation across birth country cohorts. Eastern European/Central Asian women showed low participation (37.9%) with rates from individual countries ranging from 35.0% to 49.0%. Participation rates for immigrant women from the most common birth countries, such as China/Macau/Hong Kong/Taiwan (45.7%), India (44.5%), the Philippines (45.9%), and South Korea (39.0%), were lower than the nonimmigrant rates (51.2%). Retention rates showed less variation by birth country; however, some disparities between immigrant and nonimmigrant groups persisted. Associations between screening indicators and study factors varied considerably across immigrant groups. Primary care physician visits were consistently positively associated with screening participation; this variable was also the only predictor associated with screening within each of the groups of recent immigrants. Our study provides unique data on both screening participation and retention among Canadian immigrant women compiled by individual country of birth. Our results are further demonstration that screening disparities exist among immigrant populations as well as in comparison with nonimmigrant women.

Factors associated with participation in colorectal cancer screening in Australia: Results from the 45 and Up Study cohort

The Australian Government's National Bowel Cancer Screening Program (NBCSP) was introduced in 2006 to provide free home-based immunochemical faecal occult blood test (iFOBT) to eligible Australians turning 55 and 65years in that year. With the gradual inclusion of additional age cohorts, the rollout of the NBCSP is being implemented in the context of a degree of opportunistic or de facto screening. This study investigated factors associated with self-reported ever-uptake of the NBCSP and of any CRC screening using follow-up questionnaire data from 105,897 Australians aged ≥45years enrolled in the 45 and Up Study in New South Wales, Australia. Of the 91,968 study participants with information on CRC screening behaviour, 70,444 (76.6%) reported ever-uptake of any CRC screening. 63,777 study participants were eligible for a NBCSP invitation, of these 33,148 (52.0%) reported ever-uptake of screening through the NBCSP. Current smoking (RR=0.86, 0.83-0.90), non-participation in breast cancer screening (female) or PSA testing (male) (RR=0.84, 0.81-0.86), poor self-reported health (RR=0.89, 0.86-0.91), lower levels of education (RR=0.91, 0.90-0.93), and not speaking English at home (RR=0.88, 0.85-0.91) were associated with reduced ever-uptake of screening within the NBCSP and of any CRC screening. Individuals with a family history of CRC were less likely to screen through the NBCSP (RR=0.71, 0.69-0.73), but more likely to participate in any CRC screening (RR=1.18, 1.17-1.19). Smokers, disadvantaged groups and those with non-English speaking backgrounds are less likely to have ever-participated in organised screening through the NBCSP or in any form of CRC screening, supporting efforts to improve participation in these groups.

Fatalism and health promoting behaviors in Chinese and Korean immigrants and Caucasians

Fatalism has been associated with non-adherence to health behavior in the past. This study compared fatalism of Chinese and Korean immigrants with native-born Caucasians (N = 309) and examined whether the relationship between fatalism and exercise, nutrition and medical screening would be moderated by ethnicity. Chinese reported higher fatalism than Caucasians and Koreans. Higher fatalism was associated with greater exercise among Chinese and Koreans, but less reported exercise among Caucasians. Caucasian participants had higher scores for nutrition and medical screening compared with Chinese and Korean immigrants. These findings indicate that fatalism is more prevalent among Chinese immigrants; however, there is no evidence of a detrimental effect of fatalism on exercise, nutrition or medical screening among the Asian immigrants. Caucasians with higher fatalism may be at greater risk of future illnesses, given the association between fatalism and sedentary behavior in this group. Differences between cultural groups in the adoption of health behavior justify the development and assessment of targeted interventions to optimize health promoting behaviors.

Comparison of influenza vaccination coverage between immigrant and Australian-born adults

Australia has a large immigrant population but there are few data regarding whether influenza vaccine coverage in adults varies according to country of birth. We quantified and compared self-reported influenza vaccination coverage between Australian-born and immigrant residents aged ⩾49years enrolled in a large cohort (the 45 and Up Study), surveyed in 2012 and 2013. Estimated vaccine coverage was adjusted for age, sex and other factors known to be associated with vaccine uptake. Among 76,040 participants included in the analyses (mean age 66.2years), 21.6% were immigrants. In Australian-born adults aged 49-64 and 65+ years the age- and sex-adjusted estimates for influenza vaccination within the year prior to survey was 39.5% (95% CI 38.9-40.0) and 70.9% (70.4-71.5) respectively. The corresponding estimates in immigrants were significantly lower at 34.8% (33.7-35.8) and 64.4% (63.4-65.4) respectively. Among immigrants, coverage varied by region of birth, and was slightly lower among those who spoke a language other than English at home compared to those who only spoke English. Among immigrants there was no significant difference in coverage comparing those who migrated when they were children to those who migrated as adults and coverage did not differ significantly according to years lived in Australia. Programs to increase adult vaccination coverage should consider the needs of immigrants.

Participation in cancer screening among female migrants and non-migrants in Germany: A cross-sectional study on the role of demographic and socioeconomic factors

In many European countries, migrants utilize cancer screening less often than non-migrants. In Germany, in contrast, higher rates of utilization among migrants as compared with non-migrants have been reported. The role of demographic and socioeconomic factors potentially confounding the association between migration status and participation in screening, however, could not be studied. The present study aims to investigate the utilization of cancer screening among migrant and nonmigrant women residing in Germany, adjusting for potential confounders.We used self-reported information from women surveyed on whether they have ever participated in screening for cancer (n = 11,709). The data was collected as part of a cross-sectional representative telephone survey conducted by the Robert Koch-Institute in 2010. We distinguished between three groups of women: (1) respondents of non-German nationality, those who had immigrated to Germany after their birth or those who have two foreign-born parents ("migrants with two-sided migration background"), (2) respondents who only have one foreign-born parent ("migrant with one-sided migration background"), and (3) all others ("non-migrants").To account for confounders, logistic regression analysis was performed. Only individuals proficient in German were included in the survey, allowing to control for a bias arising from poor language proficiency.84.9% of nonmigrant women, 82.1% of women with a one-sided, and 70.5% of women with a two-sided migration background had utilized screening for cancer at least once in their lifetime before the survey. The adjusted odds ratios (OR) as compared with nonmigrant women were 0.99 (95% confidence interval [95% CI]: 0.77-1.27) and 0.55 (95% CI: 0.47-0.64), respectively.The study shows that migrant women with a two-sided migration background residing in Germany utilize screening for cancer less often than nonmigrant women-independently of demographic and socioeconomic factors. This is in line with findings from other countries. Likely, barriers that migrant women encounter limit them from taking informed choices. These barriers need to be identified and appropriate measures aiming to enhance informed decision making must be implemented.

Cancer screening education: can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia?

Issue addressed: Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland.Methods: Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening.Results: There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146).Conclusion: These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening.So what?: It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes.

Improving the identification of priority populations to increase hepatitis B testing rates, 2012

Background

It is estimated that over 40 % of the 218,000 people with chronic hepatitis B (CHB) in Australia in 2011 are undiagnosed. A disproportionate number of those with undiagnosed infection were born in the Asia-Pacific region. Undiagnosed CHB can lead to ongoing transmission and late diagnosis limits opportunities to prevent progression to hepatocellular carcinoma (HCC) and cirrhosis.

Strategies are needed to increase testing for hepatitis B virus (HBV) (including culturally and linguistically diverse communities, Aboriginal and/or Torres Strait Islander (Indigenous) people and people who inject drugs). General practitioners (GPs) have a vital role in increasing HBV testing and the timely diagnosis CHB. This paper describes the impact of a GP-based screening intervention to improve CHB diagnosis among priority populations in Melbourne, Australia.

Methods

A non-randomised, pre-post intervention study was conducted between 2012 and 2013 with three general practices in Melbourne, Australia. Using clinic electronic health records three priority populations known to be at increased CHB risk in Australia (1: Asian-born patients or patients of Asian ethnicity living in Australia; 2: Indigenous people; or 3): people with a history of injecting drugs were identified and their HBV status recorded. A random sample were then invited to attend their GP for HBV testing and/or vaccination. Baseline and follow-up electronic data collection identified patients that subsequently had a consultation and HBV screening test and/or vaccination.

Results

From a total of 33,297 active patients, 2674 (8 %) were identified as a priority population at baseline; 2275 (85.1 %) of these patients had unknown HBV status from which 338 (14.0 %) were randomly sampled. One-fifth (n = 73, 21.6 %) of sampled patients subsequently had a GP consultation during the study period; only four people (5.5 %) were subsequently tested for HBV (CHB detected in n = 1) and none were vaccinated against HBV.

Conclusion

CHB infection is an important long-term health issue in Australia and strategies to increase appropriate and timely testing are required. The study was effective at identifying whether Asian-born patients and patients of Asian had been tested or vaccinated for HBV; however the intervention was not effective at increasing HBV testing.

Quantifying disparities in cancer incidence and mortality of Australian residents of New South Wales (NSW) by place of birth: an ecological study

Background

In 2013, about 32 % of the Australian population over 15 years of age was born overseas. Previous cancer-related immigrant health studies identified differences in mortality and incidence between immigrants and Australian-born people. To identify groups that may require targeted interventions, we describe by region of birth: 1. the highest cancer incidence and mortality rates for NSW residents, Australia’s most populous state; and 2. mortality to incidence ratios (MIR) for all cancers.

Methods

Cancer incidence and mortality data were obtained from NSW residents for 2004–2008 (averaged) by sex, region of birth and 10 year age groups. Age standardised incidence and mortality rates were calculated with 95 % confidence intervals (per 100,000), using the world standard population. In the place of 5-year survival rates, we used age standardised MIRs (=M/I) as a simple proxy indicator of cancer survival.

Results

All-cancer incidence only exceeded Australian born people (308.5) for New Zealand born (322). The highest reported incidence rates for cancers from all regions were prostate and breast cancers. All-cancer mortality exceeded Australian-born (105.3) in people born in Western Europe (110.9), Oceania (108.2) and UK and Ireland (106.4). For Australian-born residents, the MIR was 34 cancer deaths per 100 cases compared to residents from Central Europe at 38 deaths per 100 cases and lowest at 28 deaths per 100 cases for residents from Central and Southern Asia.

Conclusion

Some disparities between Australian-born NSW residents and immigrants were identified in prostate, breast and lung cancer mortality rates. While on average most immigrant groups have similar cancer characteristics for the top cancers, areas for improvement to inform strategies to alleviate cancer disparities are required. This analysis suggests that NSW residents could benefit from specific prevention programmes on healthy eating and smoking cessation, especially people from Central Europe, UK and Ireland and Western Europe. Rising immigration rates encourage us to continue to address the areas indicated for improvement.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2141-3) contains supplementary material, which is available to authorized users.

Recruiting migrants for health research through social network sites: an online survey among chinese migrants in australia

BACKGROUND

Traditionally, postal surveys or face to face interviews are the main approaches for health researchers to obtain essential research data. However, with the prevalence of information technology and Internet, Web-based surveys are gaining popularity in health research.

OBJECTIVE

This study aims to report the process and outcomes of recruiting Chinese migrants through social network sites in Australia and to examine the sample characteristics of online recruitment by comparing the sample which was recruited by an online survey to a sample of Australian Chinese migrants collected by a postal survey.

METHODS

Descriptive analyses were performed to describe and compare the process and outcomes of online recruitment with postal survey questionnaires. Chi square tests and t tests were performed to assess the differences between the two samples for categorical and continuous variables respectively.

RESULTS

In total, 473 Chinese migrants completed the online health survey from July to October 2013. Out of 426 participants recruited through the three Chinese social network sites in Australia, over 86.6% (369/426) were recruited within six weeks. Participants of the Web-based survey were younger, with a higher education level or had resided in Australia for less time compared to those recruited via a postal survey. However, there was no significant difference in gender, marital status, and professional occupation.

CONCLUSIONS

The recruitment of Chinese migrants through social network sites in our online survey was feasible. Compared to a postal survey of Chinese migrants, the online survey attracted different group of Chinese migrants who may have diverse health needs and concerns. Our findings provided insightful information for researchers who are considering employing a Web-based approach to recruit migrants and ethnic minority participants.

Cardiovascular disease risk factor profiles of 263,356 older Australians according to region of birth and acculturation, with a focus on migrants born in Asia

Risk factors for cardiovascular disease (CVD), such as obesity, diabetes, hypertension and physical inactivity, are common in Australia, but the prevalence varies according to cultural background. We examined the relationship between region of birth, measures of acculturation, and CVD risk profiles in immigrant, compared to Australian-born, older Australians. Cross-sectional data from 263,356 participants aged 45 and over joining the population-based 45 and Up Study cohort from 2006–2008 were used. Prevalence ratios for CVD risk factors in Australian- versus overseas-born participants were calculated using modified Poisson regression, adjusting for age, sex and socioeconomic factors and focusing on Asian migrants. The association between time resident in Australia and age at migration and CVD risk factors in Asian migrants was also examined. Migrants from Northeast (n = 3,213) and Southeast Asia (n = 3,942) had lower levels of overweight/obesity, physical activity and female smoking than Australian-born participants (n = 199,356), although differences in prevalence of overweight/obesity were sensitive to body-mass-index cut-offs used. Compared to Australian-born participants, migrants from Northeast Asia were 20–30% less likely, and from Southeast Asia 10–20% more likely, to report being treated for hypertension and/or hypercholesterolaemia; Southeast Asian migrants were 40–60% more likely to report diabetes. Northeast Asian-born individuals were less likely than Australian-born to have 3 or more CVD risk factors. Diabetes, treated hypertension and hypercholesterolaemia occurred at relatively low average body-mass-index in Southeast Asian migrants. The CVD risk factor profiles of migrants tended to approximate those of Australian-born with increasing acculturation, in both favourable (e.g., increased physical activity) and unfavourable directions (e.g., increased female smoking). Minimizing CVD risk in migrant populations may be achieved through efforts to retain the healthy facets of the traditional lifestyle, such as a normal body mass index and low prevalence of smoking in women, in addition to adopting healthy aspects of the host country lifestyle, such as increased physical activity.

Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study

Over 25% of the Australian population are immigrants, and are less active participants in cancer screening programmes. Most immigrants live in urban areas of Australia, but a significant proportion (~20%), live in regional areas. This study explored differences in cancer screening participation by place of birth and residence. Self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests was obtained from 48,642 immigrants and 141,275 Australian-born participants aged 50 years or older in the 45 and Up Study (New South Wales, Australia 2006-2010). Poisson regression was used to estimate relative risks of test use, adjusting for key socio-demographic characteristics. Overall, immigrants from Asia and Europe were less likely to have had any of the tests in the previous two years than Australian-born participants. Regional Australian-born participants were more likely to have had any of the tests than those living in urban areas. Regional immigrant participants were more likely to have had an FOBT or PSA test than those living in urban areas, but there were no differences in mammograms. This report identifies key immigrant groups in urban and regional areas that policymakers and healthcare providers should target with culturally appropriate information to promote cancer screening.

Building knowledge about health services utilization by refugees

The objective of this study was to compare the utilization of outpatient physician, emergency department and hospital services between refugees and the general population in Calgary, Alberta. Data was collected on 2,280 refugees from a refugee clinic in Calgary and matched with 9,120 non-refugees. Both groups were linked to Alberta Health and Wellness administrative data to assess health services utilization over 2 years. After adjusting for age, sex and medical conditions, refugees utilized general practitioners, emergency departments and hospitals more than non-refugees. A similar proportion in the two groups had seen a general practitioner within 1 week prior to their emergency department visit; however, refugees were more likely to have been triaged for urgent conditions and female refugees seen for pregnancy-related conditions than non-refugees. Refugees were more likely to have had infectious and parasitic diseases. Refugees utilized health services more than non-refugees with no evidence of underutilization.

A validation of the use of names to screen for risk of chronic hepatitis B in Victoria, Australia, 2001 to 2010

The burden of chronic hepatitis B (CHB) is increasing in Australia, particularly in those born in the Asia-Pacific region, and nearly half are undiagnosed. Primary care clinicians have a key role in diagnosing CHB, however identification of patients at risk is hindered by lack of awareness and limited information on country of birth in patient records. This study evaluates the potential of a validated list of names associated with Asian country of birth as a screening tool to predict risk of CHB, by comparing it with surveillance records for all people diagnosed with CHB or salmonellosis in Victoria from 2001 to 2010, and analysed using standard screening tools. Name list match was associated with CHB notification, with over 60% of cases having one name matching the list (sensitivity), and nearly one third matching both given name and surname; less than 15% and 2% of salmonellosis notifications matched for one name and both names, respectively (false positives). These results show that more than half of notified cases of CHB would have been identified by this name list, and that it could be used in support of initiatives to improve diagnosis of patients with diseases associated with country of birth when limited information is available.

A comparison of US and Australian men's values and preferences for PSA screening

Background

Patient preferences derived from an assessment of values can help inform the design of screening programs, but how best to do so, and whether such preferences differ cross-nationally, has not been well-examined. The objective of this study was to compare the values and preferences of Australian and US men for PSA (prostate specific antigen) screening.

Methods

We used an internet based survey of men aged 50–75 with no personal or family history of prostate cancer recruited from on-line panels of a survey research organization in the US and Australia. Participants viewed information on prostate cancer and prostate cancer screening with PSA testing then completed a values clarification task that included information on 4 key attributes: chance of 1) being diagnosed with prostate cancer, 2) dying from prostate cancer, 3) requiring a biopsy as a result of screening, and 4) developing impotence or incontinence as a result of screening. The outcome measures were self reported most important attribute, unlabelled screening test choice, and labelled screening intent, assessed on post-task questionnaires.

Results

We enrolled 911 participants (US:456; AU:455), mean age was 59.7; 88.0% were white; 36.4% had completed at least a Bachelors’ degree; 42.0% reported a PSA test in the past 12 months. Australian men were more likely to be white and to have had recent screening. For both US and Australian men, the most important attribute was the chance of dying from prostate cancer. Unlabelled post-task preference for the PSA screening-like option was greater for Australian (39.1%) compared to US (26.3%) participants (adjusted OR 1.68 (1.28-2.22)). Labelled intent for screening was high for both countries: US:73.7%, AUS:78.0% (p = 0.308).

Conclusions

There was high intent for PSA screening in both US and Australian men; fewer men in each country chose the PSA-like option on the unlabelled question. Australian men were somewhat more likely to prefer PSA screening. Men in both countries did not view the increased risk of diagnosis as a negative aspect, suggesting more work needs to be done on communicating the concept of overdiagnosis to men facing a PSA screening decision.

Trial registration

This trial was registered at ClinicalTrials.gov (NCT01558583).

Diverging breast and stomach cancer incidence and survival in migrants in The Netherlands, 1996-2009

BACKGROUND

Migrant populations usually experience a health transition with respect to their cancer risk as a result from environmental changes and acculturation processes. We investigated potentially contrasting experiences with breast and stomach cancer risk and survival in migrants to the Netherlands in a retrospective cohort study.

METHODS

Invasive breast (n = 96 126) and stomach cancer cases (n = 24 496) diagnosed 1996-2009 were selected from the population-based Netherlands Cancer Registry. Standardized Incidence Ratios (SIRs) were computed as the ratio of observed and expected cancers. Differences in survival were expressed as relative excess risk of mortality (RER).

RESULTS

Women from Morocco, Suriname and Turkey exhibited a significantly lower risk for breast cancer than native Dutch women (SIR range 0.5-0.9). Relative excess mortality was significantly increased in Surinamese (RER = 1.2, 95% CI 1.0-1.5) patients. The incidence of non-cardia stomach cancer was significantly elevated in all migrants, except in Indonesians, being highest in Turkish males (SIR = 2.2, 1.9-2.6). Cardia stomach cancer appeared to be less frequent in all migrants, being lowest in Surinamese males (SIR = 0.3, 0.2-0.5). Relative excess mortality was significantly lower in patients from the Antilles (RER = 0.7, 0.5-1.0), Suriname (0.8, 0.6-0.9) and Turkey (0.7, 0.6-0.9).

CONCLUSION

The lower incidence rates of breast and cardia stomach cancer in migrants as well as their higher non-cardia stomach cancer rates reflect most likely early life exposures including pregnancy and/or dietary patterns during life-course. While higher relative excess mortality from breast cancer in migrant women might point toward inadequate access and treatment in this group, lower excess mortality from (especially non-cardia) stomach cancer remains to be explained.

Breast cancer screening utilization among Eastern European immigrant women worldwide: a systematic literature review and a focus on psychosocial barriers

OBJECTIVE

Many countries host growing Eastern European immigrant communities whose breast cancer preventive behaviors are largely unknown. Thus, we aimed to synthesize current evidence regarding secondary prevention via breast cancer screening utilized by that population.

METHODS

All observational, general population studies on breast cancer screening with Eastern European immigrant women and without any country, language, or age restrictions were identified. Screening modalities included breast self-examination, clinical breast examination, and mammography.

RESULTS

The selected 30 studies were published between 1996 and 2013 and came from Australia, Canada, Denmark, Germany, Israel, the Netherlands, Spain, Switzerland, the UK, and the USA. The reported prevalence of monthly breast self-examination was 0-48%; for yearly clinical breast examination 27-54%; and for biennial mammography 0-71%. The substantial methodologic heterogeneity prevented a meta-analysis. Nonetheless, irrespective of host country, healthcare access, or educational level, the findings consistently indicated that Eastern European immigrant women underutilize breast cancer screening largely because of insufficient knowledge about early detection and an external locus of control regarding decision making in health matters.

CONCLUSIONS

This is a vulnerable population for whom the implementation of culturally tailored breast cancer screening programs is needed. As with other underscreened immigrant/minority groups, Eastern European women's inadequate engagement in prevention is troublesome as it points to susceptibility not only to cancer but also to other serious conditions for which personal action and responsibility are critical.

Reducing disparity in outcomes for immigrants with cancer: a qualitative assessment of the feasibility and acceptability of a culturally targeted telephone-based supportive care intervention

PURPOSE

Australia has one of the most culturally diverse populations in the world. Immigrant cancer patients' poorer outcomes compared to English-speaking patients confirm the need for culturally sensitive supportive care interventions. The aims of this study were (1) to identify cultural sensitivities that are important to the acceptability of a telephone-based supportive care intervention and (2) to identify cultural barriers and facilitators to intervention participation.

METHODS

Patients and carers attending Chinese or Arabic cancer support groups were recruited. Two focus groups comprising 12 patients and 4 carers, and two telephone interviews were conducted in the participants' own language. A semi-structured interview format was utilised to determine potential cultural sensitivities that may influence the intervention delivery format as well as patients' willingness to participate in telephone-based supportive care interventions. Content analysis confirmed similar themes across groups.

RESULTS

The intervention was viewed favourably as a means of providing information and support in the patient's language. Cultural considerations included assurances of confidentiality, as cancer is not openly discussed within communities. An initial face-to-face contact was highlighted as the most important factor facilitating participation. Participants also recommended the inclusion of patient-initiated calls as part of the intervention.

CONCLUSIONS

This study provides cultural insights relevant to the development of a culturally sensitive telephone-based supportive care intervention for Arabic- and Chinese-speaking cancer patients. Participants highlighted the need for face-to-face contact and inclusion of patient-initiated calls as important methodological considerations.

The burden of chronic hepatitis B virus infection in Australia, 2011

OBJECTIVE

The number of Australians living with chronic hepatitis B (CHB) is thought to be increasing, as are adverse outcomes including cirrhosis and liver cancer, however, robust, up-to-date estimates of this burden are limited. Contemporary estimates of the prevalence of CHB in Australia are essential to guide appropriate public health and clinical responses.

METHODS

This study used census-based methodology attributing risk of CHB by country of birth and Aboriginal and Torres Strait Islander status, augmented with priority risk-group based estimates. Deterministic mathematical modelling was used for comparison and for validation of census-derived estimates.

RESULTS

An estimated 218,000 Australians (plausible range 192,000-284,000) are living with CHB, a significant increase over previous estimates. The prevalence derived using mathematical modelling was similar, at 204,000. Notable differences were observed by geographic area in both prevalence and the populations predominantly affected. It is estimated that only 56% of people living with CHB in Australia have been diagnosed and notified.

CONCLUSIONS

The prevalence of CHB in Australia is increasing, with 1% of the population now estimated to be affected. The majority of the burden is experienced by people born overseas in endemic areas, with more than 95% of new cases of CHB entering the population through migration.

IMPLICATIONS

It is imperative that more attention and greater resources are devoted to addressing CHB in Australia; to increase the proportion of Australians affected who have been diagnosed and who are on treatment, in accordance with the First National Hepatitis B Strategy.

Knowledge, attitudes and usage of cancer screening among West African migrant women

AIMS AND OBJECTIVES

To explore West African migrant women's knowledge, attitude and usage of cancer screening in Australia.

BACKGROUND

Despite strong evidence that cancer screening saves lives through early detection and treatment, there is lack of empirical studies on West African migrant women's knowledge, attitude and usage of cancer screening in Australia.

DESIGN

Qualitative naturalistic inquiry.

METHODS

Twenty-one West African migrant women who consented to participate in the study were recruited through a snowballing technique. These women were engaged in face-to-face audiotaped in-depth interviews which lasted for about 90 minutes. Interviews were transcribed verbatim and thematically analysed.

RESULTS

The following three themes emerged from the data: knowledge of cancer screening, attitude towards cancer screening and usage of cancer screening Irrespective of the women's place of birth in Africa, twenty of the participants had no knowledge of cancer screening prior to migration, and most had a negative attitude towards screening. Women who had given birth after migrating to Australia were more likely to have had cervical cancer screening. Women who had passed their child-bearing years or had not presented to healthcare facilities for medical issues were more likely to be unaware of cancer screening.

CONCLUSIONS

Improved health promotion strategies that provide accessible information and education to West African migrant women regarding cancer screening are required to enhance the uptake of such screening in this migrant group.

RELEVANCE TO CLINICAL PRACTICE

Nurses who encounter West African migrant women in their day-to-day practice have the opportunity to provide this group with education related to the importance of cancer screening.

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women

Background

The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women.

Methods

This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies.

Results

The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting.

Conclusions

Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.

Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study

OBJECTIVES

To investigate key patient clinical and demographic characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer (CRC) patients. This will add to the little published research examining the pathway following CRC diagnosis and prior to surgery.

DESIGN

Retrospective cohort analysis of linked data.

SETTING

A population-based sample of people diagnosed August 2004 to December 2007 in New South Wales, Australia.

PARTICIPANTS

569 CRC patients, of whom 407 (72%, 95% CI 68% to 75%) had colonoscopy followed by surgery.

PRIMARY OUTCOME MEASURES

Time between colonoscopy and surgery, and whether the surgery took place in a specialist cancer centre.

RESULTS

Among the 407 eligible patients analysed, the median time from colonoscopy to surgery was 19 days (IQR 12-29 days). After adjusting for key demographic and clinical characteristics such as age and disease stage, the time was longer for rectal cancer patients and those reporting fair/poor health, although differences in medians were <5 days. 24% (95% CI 20% to 28%) had surgery in a specialist cancer centre, which was more common among people resident in metropolitan areas (37% vs 14% for others, adjusted p=0.001) and those without private health insurance (30% vs 21% for others, adjusted p=0.03).

CONCLUSIONS

There do not appear to be systemic issues affecting time from colonoscopy to surgery related to patients' socio-demographic characteristics. However, patients with private insurance and those living in rural areas may be less likely to receive optimal specialist treatment. A more systematic approach might be needed to ensure cancer patients are treated in specialist cancer centres, particularly patients requiring more specialised treatment.

East meets West: ethnic differences in prostate cancer epidemiology between East Asians and Caucasians

Prostate cancer is the most prevalent cancer in males in Western countries. The reported incidence in Asia is much lower than that in African Americans and European Caucasians. Although the lack of systematic prostate cancer screening system in Asian countries explains part of the difference, this alone cannot fully explain the lower incidence in Asian immigrants in the United States and west-European countries compared to the black and non-Hispanic white in those countries, nor the somewhat better prognosis in Asian immigrants with prostate cancer in the United States. Soy food consumption, more popular in Asian populations, is associated with a 25% to 30% reduced risk of prostate cancer. Prostate-specific antigen (PSA) is the only established and routinely implemented clinical biomarker for prostate cancer detection and disease status. Other biomarkers, such as urinary prostate cancer antigen 3 RNA, may increase accuracy of prostate cancer screening compared to PSA alone. Several susceptible loci have been identified in genetic linkage analyses in populations of countries in the West, and approximately 30 genetic polymorphisms have been reported to modestly increase the prostate cancer risk in genome-wide association studies. Most of the identified polymorphisms are reproducible regardless of ethnicity. Somatic mutations in the genomes of prostate tumors have been repeatedly reported to include deletion and gain of the 8p and 8q chromosomal regions, respectively; epigenetic gene silencing of glutathione S-transferase Pi (GSTP1); as well as mutations in androgen receptor gene. However, the molecular mechanisms underlying carcinogenesis, aggressiveness, and prognosis of prostate cancer remain largely unknown. Gene-gene and/or gene-environment interactions still need to be learned. In this review, the differences in PSA screening practice, reported incidence and prognosis of prostate cancer, and genetic factors between the populations in East and West factors are discussed.

Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia

Accurate estimates of HPV vaccination coverage are critical for determining the proportion of the target female population that is not protected by the vaccine, as well as for monitoring the performance of vaccine delivery programs. The implementation of an HPV vaccination register, either as part of an existing immunisation register or stand-alone, can add substantial benefits to an HPV vaccination program. In Australia, the National HPV Vaccination Program Register supports the HPV vaccination program by providing information to consumers and providers about incomplete courses as well as estimates of vaccination coverage by age and area. Future monitoring of vaccine effectiveness will be facilitated by cross-linking to Pap test registries.

Disparities in cancer care in australia and the pacific

Disparities in cancer care across populations become apparent only when there is a cancer registry to record the cancer incidence and mortality statistics and data capture is comprehensive. In Australia, one of the obvious disparities is geography, with mortality in some cancers being worse with increasing remoteness. The reasons are not just poorer access to screening and treatment but lifestyle and occupational factors which encompass increased cancer risk factors compared with urban counterparts. There are also higher proportions of lower socioeconomic groups and Aboriginal and Torres Strait Islanders, both of which in addition to remoteness have poorer cancer outcomes. Indigenous Australians have a higher exposure to risk factors of smoking and obesity, live remotely, and have lower participation rates in screening and treatment than non-Indigenous Australians. Immigrants to Australia from diverse backgrounds have a lower incidence of the common cancers and a lower overall mortality. They have a different spectrum of cancers such as more liver cancer because of their exposure to hepatitis B. The Māori in New Zealand are well studied and display disparities in cancer outcomes similar to Indigenous Australians. There is less known of the Pacific Islanders, but they often have worse outcomes than Europeans living in the same environment, a greater exposure to risk factors, and the added problem of often needing to travel from the Pacific Islands to New Zealand for treatment. Poorer socioeconomic status is the other major factor associated with poorer outcomes in cancer treatment. Often, low socioeconomic status groups have lifestyles with higher levels of smoking and obesity, do not participate in screening as readily, and may not be able to afford unsubsidized treatments such as high-cost drugs.

Australia's national bowel cancer screening program: does it work for indigenous Australians?

BACKGROUND

Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups.

METHODS

A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions.

RESULTS

The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening.

CONCLUSIONS

Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.

Evidence-based uncertainty: recent trial results on prostate-specific antigen testing and prostate cancer mortality

Large-scale randomised controlled trials in Europe and the United States are informing evidence-based clinical advice.