Lower participation among immigrants in colorectal cancer screening in Norway

Abstract

IntroductionOrganized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups.MethodsBetween 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors.ResultsIn total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04–1.23) and 1.82 (1.69–1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21–1.48) and 2.83 (2.55–3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia.ConclusionParticipation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries.

Access to colorectal cancer screening for Pakistani immigrants in Norway – a qualitative study

“…All participants had a positive attitude towards colonoscopy when the risk of illness was concrete, for instance when blood is already detected in the stool, even though it is a more invasive procedure. However, a recent study showed that non-Western immigrants had lower participation than non-immigrants in colonoscopy after a positive FIT [ 10 ].…”

“…In many countries, cancer screening uptake is lower in socio-economically deprived groups and in immigrants [ 6 , 7 ]. Studies from Norway have shown a substantially lower participation rate among immigrants compared to non-immigrants in mammographic and cervical cancer screening, and in the pilot for CRC screening [ 8 – 10 ]. Prior to startup of ColorectalScreen Norway, a pilot was conducted in two counties in the period 2012–2023 [ 11 ].…”

“…Prior to startup of ColorectalScreen Norway, a pilot was conducted in two counties in the period 2012–2023 [ 11 ]. The participation rate was 28% among immigrants born in Pakistan in the first round of FIT screening in the pilot project, as compared to 60% among non-immigrants [ 10 ]. Despite the intention for equal access [ 12 ], participation disparities suggest otherwise.…”

“…Over 41,000 inhabitants in Norway have Pakistani origin (immigrants from Pakistan and their descendants), which accounts for 3.8% of the population with a foreign background in Norway [ 14 ]. Immigrants from Pakistan are shown to have low participation rate in breast, cervical and colorectal cancer screening, and are thus potentially at risk for unfavorable outcome due to more advanced disease [ 8 – 10 ]. It is thus important to explore what immigrants from Pakistan know about CRC and how they perceive CRC screening.…”