What is Cancer?
Almost 40 percent of all Americans will develop cancer at one point in their lives. Underserved populations have a greater risk of developing certain cancers than the overall population. Additionally, their diagnoses often come later, which can affect survival outcomes. Many factors influence the development of cancer in migrant and other underserved populations, including genetics, local environmental risk factors, cultural perspectives and practices, occupational exposure, access to health services, and other social determinants of health. As with many other health concerns, a wide lens to capture the full range of risk factors, including sociocultural and socioeconomic components, is essential for clinicians to best determine a migrant patient’s cancer risk. What is Cancer? Tumors Types of Tumors Benign Benign tumors do not grow in other parts of the body other than where they began Frequently they can be removed through surgery and in the majority of cases they will not return Most importantly benign tumors rarely cause death Malignant Malignant tumors are cancer The cells of cancerous tumors are abnormal and divide without control or order Cancerous cells invade and destroy the surrounding tissue Cancerous cells can metastasis or grow into other parts of the body via the blood and lymphatic systems Metastasis is the expansion of cancer through the lymphatic system Types of Cancer Most Common Types of Cancer Symptoms Signs to Watch Out For Pain Inflammation Swelling Fatigue Screening Screening and Diagnosis Mammogram
A mammogram is an x-ray image of the tissues inside the breast. Generally mammograms can detect a growth in the breast before it is large enough to be felt. Mammograms can also show a group of small calcifications, called microcalificiations which often indicate precancerous growths. If these are found it is necessary to further examine them to see if there are abnormal growths.
Patient education on mammograms
Mammograms are important because they diagnose early cancer in the breast before there are any symptoms. Women over the age of 40 should get a mammogram every year or every 2 years. Women under the age of 40 who have risk factors for cancer should talk to their doctor to see if they should get a regular mammogram.
Other types of screening or diagnosis Treatment Most Common Types of Treatment for Cancer Surgery Chemotherapy Radiology Migrants’ Exposure to Chemicals that Cause Cancer
Migrants, similar to the general population, are exposed to numerous cancer-causing chemicals throughout the day, at home, at work, at school, in our food and water, and in the environment. The cumulative effect of regular exposures varies from person to person, but the evidence is clear that these exposures promote the development of cancer over time. As with many other health complications, there are significant cancer health disparities that negatively impact migrants. Migrants often live in economically depressed communities that are medically underserved and have higher rates of exposure to chemicals due to proximity to agriculture and industry. Other risk factors for cancer, like smoking and heavy drinking, vary among immigrant groups and ethnicities, but may be a cause for concern. Obesity is another serious risk factor for cancer, and children of immigrants, in particular,
have a higher rate of obesity than children of non-immigrants. All of these risks require the attention of clinicians in determining a patient’s cancer risk. Occupational Exposure
Migrants may be at a higher risk of exposure to cancer-causing chemicals than the general population because of their occupations, as migrants often work in industries that rely heavily on chemicals that are known or probable carcinogens.
Migrant agricultural workers are exposed to pesticides used in the fields throughout the course of their day: when they pick produce that has been treated, or walk behind a tractor that is kicking up dirt that was recently sprayed, or experience pesticide drift from a neighboring field. Pesticide applicators, of course, also face a serious risk of exposure. Agricultural workers may inadvertently expose their families to the same chemicals, by bringing home pesticide residue on their clothing and shoes. Agricultural communities overall have a higher risk of cancer-causing chemical exposure from chemical residues in the soil, in the air, in the food, and in well water. Please visit MCN’s Pesticides page to access resources on pesticide exposure and pesticide reporting. Carcinogenic chemicals are used in a variety of professions. Migrants with jobs as janitors, house cleaners, window washers, car washers, and others using cleaning agents absorb chemicals through skin exposure or inhalation of chemical fumes. In US cities, 63 percent of nail salon workers are minorities, many of whom are migrants. Nail salon workers use carcinogenic nail paints, polishes, adhesives, paint removers, and other chemicals all day, often without sufficient ventilation. Chemicals are not the only cancer-causing substance that migrants may be exposed to at work. Silica, wood, and asbestos dust, found in a wide range of workplaces including construction and demolition sites, contribute to lung cancer. Coal dust for miners, diesel exhaust for transportation and shipping workers, prolonged sun exposure for outdoor workers, and secondhand smoke for waiters are further examples of carcinogens that workers encounter on the job. Migrants work in a variety of industries and in a wide range of settings. Clinicians are encouraged to obtain a detailed personal history to best assess if a migrant patient has had concerning exposure to cancer-causing chemicals.
Barriers for Migrants
Migrants are at a higher risk for poor outcomes from cancer. Due to their mobility and the many barriers to care, migrant patients often delay their health needs, which may lead to a late diagnosis. As with other health concerns, migrants lack familiarity with the health system, may not be able to communicate easily with their clinician, may have transportation barriers, and may have fear of accessing care due to immigration status, among other barriers. As they continue to move, migrant patients experience the barriers again and again at every new location. Consequently, cancer patients may end treatment before completion. In a 2015 study of Australian migrants, researchers found that migrants with cancer had “clinically significantly worse health-related quality of life” in addition to higher rates of depression and anxiety than non-migrants with cancer.1 They pinpointed “understanding the health system” and “difficulty communicating with the doctor” as key barriers. Importantly, the researchers found that “migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes.”
Additionally, migrants may lack important education on cancer and/or may bring a cultural perspective that is resistant to education or screening. A 2015 focus group with Somali Muslim women living in Seattle found that, in addition to reported barriers to breast cancer screening like fear of pain, difficulty with transport, and lack of knowledge, “participants explained that Somali women tended not to discuss breast cancer or breast cancer screening.” The researchers also found that “religion played a central role in their care and treatment decisions and coping mechanisms.” The authors concluded that, “if such barriers are addressed, fewer women may present with late-stage breast cancer, resulting in greater chances for long-term breast cancer survival.” 2 Finally, immigrant women who move from countries with a low-risk of cancer to an industrialized country like the US very soon acquire the higher risk of the new country. Patients may underestimate the risk of cancer based on experiences and education in their home country. (The disparity between cancer rates in developed and developing countries is attributable to diet and lifestyle changes as well as environmental factors -- read more in “Risk Factors.”) Clinicians are encouraged to focus on the individual patient’s risk factors, as determined by their medical history and migration experience. Additionally, culturally sensitive cancer prevention programs can greatly benefit this population. Finally, in order to assist mobile patients in continuing cancer treatment while on the move, clinicians are encouraged to enroll their mobile cancer patients in Health Network. Resources
References Sze M, Butow P, Bell M, et al. Migrant health in cancer: outcome disparities and the determinant role of migrant-specific variables. Oncologist. 2015;20(5):523-31. Al-amoudi S, Cañas J, Hohl SD, Distelhorst SR, Thompson B. Breaking the silence: breast cancer knowledge and beliefs among Somali Muslim women in Seattle, Washington. Health Care Women Int. 2015;36(5):608-16.