Preventing Colorectal Cancer Among Immigrants

Beyond genetic and biological factors, social and cultural factors can also play an important role in reducing the screening for and thereby incidence of colorectal cancer (CRC). The influence of ethnicity and migration on CRC screening is not a new idea but a growing number of recent studies have found racial and ethnic inequities in CRC screening, with foreign-born populations often less likely to be screened. However, the topic has been understudied, especially in Israel where there is a diversity of immigrant groups, making up about a third of the population.

This study sought to understand colorectal cancer screening rates among immigrants to Israel as well as to analyze how CRC screening varies by key demographic groups, including immigrant characteristics, as well as variations by screening type.

The medical records of 300,000 patients aged 40-75 of a leading Israeli HMO were analyzed, of which 100,000 were born in another country, using data from 2011-2021. Descriptive and multivariate analyses were performed. We analyzed screening according to three dimensions of immigration which, according to the literature, can be related to screening: country or region of birth, years since migration, and age of migration.

We found differences according to country/region of birth, migration year, age at migration and type of screening. Immigrants from the Former Soviet Union, Europe and North America in particular performed fewer screening tests. The reasons for the lack of testing found in this study include both personal factors (eg health behaviors and lifestyle) and systemic factors (eg health system utilization and provider behaviors).

We conclude that it is necessary to increase screening rates for CRC among certain immigrant groups in Israel. Barriers can potentially be addressed through interventions such as increased education, facilitation of health system utilization, innovative solutions such as community health workers, and general prevention initiatives.