ImmigrantScreen

This project aims to measure the effect of invitations and information on breast and colorectal cancer screening based on the assumed mother tongue. Additionally, it seeks to investigate the reasons why immigrants either participate or do not participate in organized screening programs for breast and colorectal cancer.
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Background and purpose

In Norway, all women between the ages of 50 and 69 are invited every other year to BreastScreen Norway, which is a population-based screening program for breast cancer in Norway. A national screening program for colorectal cancer - ColorectalScreen Norway - will be rolled out in 2022/2023. Here, all women and men will be invited to participate during the year they turn 55.

Breast and colorectal cancer screening aims to detect cancer or precursors to cancer before the disease has spread to other organs. This allows for less aggressive treatment, better treatment success, and a reduction in mortality from the disease. Studies from Norway and other countries have shown that immigrants are less likely to participate in cancer screening than non-immigrants. The reasons are likely complex and may be related to socio-economic factors, communication challenges, and various pre- and post-migratory factors.

The Cancer Registry has therefore initiated the ImmigrantScreen project. The purpose is to investigate whether informing and inviting immigrants to breast and colorectal cancer screening in their assumed mother tongue, in addition to Norwegian, can affect attendance. The project will also examine factors that may influence immigrants' decisions to participate in cancer screening programs. A doctoral thesis on immigrants and the BreastScreen Norway program has already been completed.

Sub-studies and status

Study 1: A randomized controlled study will investigate whether receiving invitations in one's own mother tongue, in addition to Norwegian, can affect participation in the breast screen program among immigrant women. The analysis will compare attendance among those who received letters in both their assumed mother tongue and Norwegian with attendance among those who only received letters in Norwegian.

Status: Recruitment is completed. The study will be published in the fall of 2023.

 

Study 2: A qualitative study will assess factors that may affect participation in colorectal screening among immigrants born in Poland and Pakistan.

Status: Ongoing. The study on immigrants born in Poland has been published: Link to publication. The study on immigrants born in Pakistan is ongoing.

 

Study 3: A randomized controlled study will investigate whether oral information about colorectal screening in one's assumed mother tongue will increase participation in the Colorectal Screening Program.

Status: Not started. Necessary approvals have been obtained.

Data

Study 1: The study used information from the Cancer Registry's databases, in accordance with cancer registry regulations. Information about the country of birth and about invitations and attendance for the Mammography Program was used. The study population consisted of women aged 50-69 who were invited to participate in the Mammography Program and were registered as being born in Algeria, Egypt, the Philippines, Iraq, Lebanon, Morocco, Pakistan, Palestine, Poland, Somalia, Sudan, Syria, or Tunisia.

The project only uses data from women who have not objected to the storage of information from their screening examinations in the Cancer Registry. It will be impossible to identify individuals in published results.

 

Study 2: Thematic analysis is performed on qualitative interviews with immigrants aged 50 to 60 born in Poland and Pakistan. Interviews are semi-structured and conducted in Polish, Urdu, or Norwegian.

 

Study 3: Information about the data source in Study 3 will be provided closer to the start of the study.

Organization

The Cancer Registry is responsible for data management in the project and is the research responsible institution. They are responsible for obtaining the necessary approvals, collecting data, analyzing the data, and publishing results.

 

Thy JE, Bhargava S, Larsen M, Akslen LA, Hofvind S. Early screening outcomes among non-immigrants and immigrants targeted by BreastScreen Norway, 2010-2019. Scand J Public Health. 2023 May;51(3):403-411. doi: 10.1177/14034948221078701. Epub 2022 Mar 31. PMID: 35361004; PMCID: PMC10251461.

Bhargava S, Czapka E, Hofvind S, Kristiansen M, Diaz E, Berstad P. Polish immigrants' access to colorectal cancer screening in Norway - a qualitative study. BMC Health Serv Res. 2022 Nov 10;22(1):1332. doi: 10.1186/s12913-022-08719-3. PMID: 36352442; PMCID: PMC9646271.

Hofvind S, Iqbal N, Thy JE, Mangerud G, Bhargava S, Zackrisson S, Berstad P. Effect of invitation letter in language of origin on screening attendance: randomised controlled trial in BreastScreen Norway. (in press).