Addressing Cancer Control Needs of African-born Immigrants in the US

October 28, 2015

Compared to non-Hispanic Whites, African immigrants have worse cancer outcomes. However, there is little research about cancer behaviors and/or interventions in this growing population as they are generally grouped with populations from America or the Caribbean. This systematic review examines cancer-related studies that included African-born participants. We searched PsychINFO, Ovid Medline, Pubmed, CINHAL, and Web of Science for articles focusing on any type of cancer that included African-born immigrant participants. Twenty articles met study inclusion criteria; only two were interventions. Most articles focused on one type of cancer (n=11) (e.g., breast cancer) and were conducted in disease-free populations (n=15). Studies included African participants mostly from Nigeria (n=8) and Somalia (n=6). However, many papers (n=7) did not specify nationality or had small percentages (<5%) of African immigrants (n=5). Studies found lower screening rates in African immigrants compared to other subpopulations (e.g. US born). Awareness of screening practices was limited. Higher acculturation levels were associated with higher screening rates. Barriers to screening included access (e.g. insurance), pragmatic (e.g. transportation), and psychosocial barriers (e.g. shame). Interventions to improve cancer outcomes in African immigrants are needed. Research that includes larger samples with diverse African subgroups including cancer survivors are necessary to inform future directions.

African born immigrants are one of the fastest growing immigrant groups in the US; increasing from 881,300 in 2000 to 1,606,914 by 2010. The majority of African immigrants come from Western (35.71%) and Eastern Africa (29.612%). Specific top countries of origin include Nigeria (13.65%), Ghana (7.76%), Ethiopia (10.80%), and Kenya (5.51%). More than half of the African immigrants arrived recently to the US. Thus, there has been limited research on African immigrant health, and it has mostly focused on infectious diseases (e.g. tuberculosis, HIV) while chronic diseases, such as cancer, have been understudied.Previous research has shown disparities among US and immigrant populations in cancer information, screening rates,early diagnosis, quality of care, receipt of recommended treatment, and survival outcomes. Identified barriers to access health services include access to care factors (e.g. insurance, citizenship status), pragmatic factors (e.g. language difficulties), and psychosocial factors (e.g. limited knowledge, embarrassment and fear of screening procedures, cultural beliefs). Having a usual source of care, provider recommendation, and acculturation, are some of the identified protective factors that increase the odds of screening in this population.

However, African immigrants are underrepresented in this research. The scarce research that includes African immigrants has shown cancer-related disparities across the cancer control continuum. However, African-born immigrants tend to constitute small percentages of the samples and/or they tend to be lumped with African Americans or Caribbean, or categorized as “African” or “Black foreign-born” without specifying country of origin. The goal of this paper is to offer a systematic literature review of cancer studies that include African-born populations to suggest venues for further research and interventions that can be implemented in the US.  


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