Journal of Immigrant and Minority Health

Rates of Cervical Cancer Screening and Dysplasia Among Refugees in a Health Care Safety Net System

Refugees may be at higher risk of cervical dysplasia. The prevalence of screening, pathology, risk factors, and management of patients in our Refugee Women's Health Clinic (RWHC) was assessed. A retrospective review of RWHC patient records between 2009 and 2015 assessed demographic factors, medical history, initial chief complaint, prevalence of screening, HPV status, and loss to follow-up. We reviewed 696 charts; 84.2% (n = 586) were successfully screened. Prevalence of dysplasia was 6.8% (n = 40). Among those, 5% (n = 2) had high-grade dysplasia, equivalent to 0.34% of the screened population. Only 43.6% received indicated colposcopy. FGM/C was associated with non-statistically significant higher rate of dysplasia, at 11.3%. HIV was associated with a statistically significant higher rate of dysplasia at 36.8% (p < 0.001). The rate of high-grade cervical dysplasia among refugees in RWHC is similar to their home countries. RWHC patients were screened at a higher rate than the general Arizona population.

Cervical, Breast, and Colorectal Cancer Screening Outcomes Among Refugees in Philadelphia, Pennsylvania

Abstract Cancer screening can detect cancer at an early stage and decrease cancer morbidity and mortality. Refugee populations may have had limited access to cancer screening before arrival in the United States. A cross-sectional analysis of cervical, breast, and colorectal cancer screening was conducted among refugees with primary care visits between 2018 and 2022 at a refugee health clinic in Philadelphia, Pennsylvania. Cancer screening outcomes included the number and type of screenings; the number of normal, inconclusive, and abnormal screening results; completion of follow-up tests for inconclusive and abnormal results; and the number of cancer diagnoses. Among 149 refugee women aged 21–65, 80.5% were screened for cervical cancer at least once. Among 181 cervical cancer screenings, 89.0% were normal, 3.9% were unsatisfactory, and 7.2% were abnormal. Among 38 refugee women aged 50–74, 92.1% were screened for breast cancer at least once. Among 111 breast cancer screenings, 81.1% were normal, 11.7% were incomplete, and 7.2% were abnormal. Among 107 refugees aged 50–75, 80.4% were screened for colorectal cancer at least once. Among 189 colorectal cancer screenings, 76.2% were normal, 11.1% were inconclusive, and 12.7% were abnormal. There were 0 cancer diagnoses. Longitudinal outcomes beyond the domestic medical exam are valuable to provide insight into cervical, breast, and colorectal cancer screening among refugees in the United States. This could serve as a foundation for future quality improvement interventions to increase cancer screening.

Understanding the Pap Testing Behaviors of African Immigrant Women in Developed Countries: A Systematic Review

African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population. To review studies on the prevalence and determinants of Pap testing among AI women living in developed countries. PubMed, CINAHL, Embase, and Scopus were searched for relevant articles that included African-born immigrant participants; were published in English; addressed the prevalence of Pap testing; conducted in a developed country; and identified correlates of Pap testing behavior. The Andersen Behavioral Model guided synthesis of the key findings. Sixteen studies met the inclusion criteria. The prevalence of Pap testing ranged from 4.6% to 73.0%. Having a female provider and access to primary care facilitated Pap testing. Barriers to Pap testing included low income, male healthcare providers, and no history of gynecological exam. Healthcare providers and social determinants-particularly income and healthcare access, play an important role in improving Pap testing among AI women. Larger qualitative and mixed methods studies are needed to explore other important determinants of Pap testing such as disease knowledge, self-efficacy, health literacy to reduce the burden of cervical cancer among AI women.

The Hidden Burden: Unveiling the Cervical Cancer Burden Among Recent Afghan Women Immigrants in the United States

Cervical cancer is a significant global health issue, ranking as the second most prevalent cancer among women of reproductive age. While prevention strategies like HPV vaccination and screening have made it highly preventable, these benefits are mostly seen in high-HDI nations. In contrast, LMICs lag behind, with Afghanistan facing a growing crisis due to war, poverty, and lack of awareness. The recent influx of Afghan evacuees to the U.S. poses a risk of introducing undiagnosed cases. Addressing this requires collaborative efforts to raise awareness, promote screening, and vaccination among Afghan women, leveraging culturally sensitive approaches and community partnerships to improve health outcomes.

Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening

Somali American women have low rates of breast and cervical screening. This research aimed to test the feasibility and impact of religiously tailored workshops involving Somali American Muslim women and male imams to improve intention to undergo breast or cervical cancer screening. Religiously tailored workshops addressing cancer screening (each approximately 3 h in length) were conducted with 30 Somali American women and 11 imams. Pre- and post-test surveys measured attitudes toward screening, screening intention, and workshop experience. The workshops were feasible, and both the women and the imams found the workshops enjoyable as well as informative. The discussions of religiously tailored messages had a positive impact on attitudes toward cancer screening, and, for the women, a positive impact on intention to screen. Religiously tailored messages can be an important community asset for engaging Somali American Muslim women around the value of breast and cervical cancer screening.

Pap Smear and Mammogram Screening Rates in a Refugee and General OB/GYN Clinic: A Retrospective Review

Although multiple studies have shown that resettled refugee women are less likely to receive preventative cancer screenings like pap smears and mammograms, a small number have demonstrated the opposite. This retrospective chart review, conducted between January 2017 and October 2018, compares pap smear and mammogram rates of patients seen in a refugee-specific OB/GYN clinic with patients from the general OB/GYN clinic at the same institution. Data from 298 patients (149 refugee and 149 general clinic patients matched by age and date-of-visit) were analyzed. Pap smear screening rates were 90.60% in the refugee group and 73.83% in the general group [p < 0.009, aOR 3.46 (1.36-8.81)], while mammogram screening rates were 36.84% and 38.60%, respectively (p = 0.46). The provision of holistic services meeting refugee women's unique needs can effectively increase pap smear screening rates.

Nativity Differences in Awareness and Knowledge About HPV Infection and Vaccination Among U.S. Adults: Findings from a National Population-Based Sample

Foreign-born populations in the United States suffer multiple disparities related to human papillomavirus, including higher cervical cancer mortality and lower HPV vaccination. No nationally based studies have examined the relationship between nativity with HPV and HPV vaccination awareness and knowledge, especially examining acculturation, an immigration-specific process affecting health-related behaviors. We assessed nativity differences in HPV awareness and knowledge, and awareness of HPV vaccination using data from a population-based sample of adults in the U.S. (n = 2415). Among foreign-born respondents, we also assessed the association of acculturation with outcomes. Awareness of HPV and HPV vaccination were lower among foreign-born respondents compared to U.S.-born respondents. Knowledge of HPV was similar between populations. Acculturation was not associated with any of the assessed outcomes. Findings suggest HPV-related awareness deficits among foreign-born U.S. residents, highlighting a need for culturally-appropriate HPV prevention efforts.

Cervical Cancer Screening Behaviors Among Asian Indians in the United States: A Systematic Review

While Asian Indians (AIs) are the third fastest-growing Asian minority population in the United States, they fall short of the Healthy People cervical cancer screening target goals, with rates averaging 70% compared to 83% among non-Hispanic Whites. The purpose of this systematic review is to examine factors influencing cervical cancer screening behaviors among AIs in the US. Medline, CINAHL, PubMed, PsychINFO, and ProQuest databases were searched for qualitative and quantitative studies conducted between 1990 and 2017 that focused on cervical cancer screening behaviors among AIs in the US. The seven selected quantitative cross-sectional descriptive studies show that acculturation, length of stay in the US, age, education level, employment, cultural beliefs, and language influence cervical cancer screening behaviors among AIs in the US. Results from this systematic review inform development of culturally sensitive interventions to raise awareness and engagement in cervical cancer screening among AIs.

Associations between Fatalistic Cancer Beliefs and Cancer-Screening Behaviors in Chinese American Immigrant Women

Chinese Americans have among the lowest rates of up-to-date cancer screening in the United States. Fatalistic health beliefs are also common in this population and can lead to decreased healthcare utilization. We sought to understand how these fatalistic beliefs are associated with cancer screening behaviors in this underserved population. A cross-sectional survey was conducted with 732 Chinese women from the greater Chinatown area of Chicago, Illinois. Surveyed questions included sociodemographic information, self-reported healthcare utilization and cancer screening behaviors. The majority of respondents were older than 50, spoke Chinese, had less than a college education, public or no medical insurance, and an annual income  < $20,000. Approximately 20% had never received Papanicolaou or mammogram screening. Fatalistic beliefs were common and associated with increased health-seeking behaviors and appropriate Pap and mammogram screening. In this cohort of Chinese American immigrant women in an urban Chinatown community, fatalistic cancer beliefs were prevalent and associated with increased health-seeking and positive cancer screening behaviors. This previously unreported relationship could be leveraged in improving health outcomes of an underserved population.

Beyond Knowledge: Trust and the Engagement of Newly Arrived Refugee Women in Cervical Cancer Prevention

Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. Emerging research suggests that trust in healthcare systems and providers plays a pivotal role in shaping engagement with these services, yet little is known about how trust is built or broken in the early resettlement period. This study explores how trust and medical mistrust shape cervical cancer prevention behaviors among newly arrived refugee women in the United States, with attention to the multilevel relational and contextual factors that influence screening and vaccination. We conducted in-depth, semi-structured interviews with 17 refugee women resettled within the past two years in a Mid-western City, recruited through a community-based organization. Interviews were conducted in participants' preferred languages and lasted approximately 60 min. Data were thematically analyzed using Braun and Clarke's six-step framework, supported by Dedoose software. A codebook was developed through double coding and refined via consensus meetings. Themes were reviewed collaboratively and verified through member checking to enhance analytical rigor. Participants (n = 17) ranged in age from 21 to 56 and represented five countries, with the majority from Rwanda and Congo. Most had less than a high school education, and nearly all reported limited or no prior knowledge of cervical cancer, Pap smears, or HPV vaccination. Some confused HPV with other illnesses, while others attributed cervical cancer to unrelated factors such as stress or diet. Four themes emerged: trust as a precondition for engagement; provider trust shaped by cultural concordance, communication, and respect; systemic mistrust shaped by health literacy, practical/access issues and social influences; and the importance of community-based relationships in rebuilding trust and supporting preventive care engagement. Refugee women's engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.

Barriers to Breast, Cervical, and Colorectal Cancer Screenings Faced by Refugees Resettled in the United States: A Rapid Review

Abstract Millions of refugees fleeing countries with political unrest and war have been resettled in the United States (U.S.). Although refugees resettled in the U.S. are granted access to health insurance, there are large disparities in the use of preventive health services like cancer screenings between refugees and the native-born population. The U.S. Preventative Services Task Force (USPSTF) recommends screening for breast, cervical, and colorectal cancers, which are highly preventable if detected early. Previous research has investigated barriers to screening for breast, cervical, and colorectal cancers that may underlie screening disparities. However, current reviews assessing these barriers do not distinguish between immigrant and refugee populations and primarily cover breast and cervical cancer screenings. This rapid review aimed to identify barriers to breast, cervical, and colorectal cancer screenings experienced by refugee-specific communities resettled in the U.S. Of the 945 articles retrieved from the database searches, 12 articles were selected for analysis. Data extracted from the selected studies included screening barriers, screening rates, and sample demographics. Six key barrier themes were identified: (1) language and health system navigation, (2) cost, transportation, and time, (3) health knowledge and exposure, (4) fear of cancer screening and diagnosis, (5) cultural and religious beliefs, and (6) refugee experience or status. We noted variations in the screening barriers experienced by different refugee ethnic groups and noted the impact of refugee experiences and trauma in shaping refugee perspectives on screening. The findings of this review suggest the need for interventions aimed at increasing screening rates to consider the nuances in perceived barriers by different refugee ethnic groups and the role of trauma associated with refugee experiences in shaping these barriers.

A Narrative Review of Cervical Cancer Screening Utilization Among Haitian Immigrant Women in the U.S.: Health Beliefs, Perceptions, and Societal Barriers and Facilitators

Haitian immigrant women living in the U.S. have a higher rate of cervical cancer mortality than any other ethnic group, primarily due to lower rates of screening test utilization. Therefore, it is important to understand the issues affecting their pap smear screening behaviors. We conducted a narrative review of articles from PubMed, SCOPUS, Embase, CINAHL/Nursing, and Psych Info. Inclusion criteria: U.S. Haitian immigrant, screening, cervical cancer, health beliefs/perceptions. Exclusion criteria: HPV-vaccine. Primary barriers: (1) lack of knowledge of cervical cancer, HPV, and pap smears; (2) lack of culturally appropriate dissemination of information; and (3) difficulty obtaining the test. Primary facilitators: (1) provider recommendations, (2) Haitian media to disseminate health information, and (3) having health insurance. This review highlights the points for intervention by health professionals and policy makers to address this group's low pap smear utilization.

A Scoping Review of Cancer Interventions with Arab Americans

This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed.

Cervical Cancer Screening Among Immigrant and Refugee Women: Scoping-Review and Directions for Future Research

The purpose of this study is to explore existing research on determinants of cervical cancer screening among immigrants and refugees in the U.S. A scoping review was conducted on 77 studies targeting immigrant and/or refugee women in the U.S., investigating factors related to cervical cancer screening. Sixty-three percent of studies were conducted in the past ten years, and included 122,345 women. Studies predominately explored knowledge, beliefs and barriers related to cervical cancer and screening. Common beliefs included fear of cancer, treatment and death. Participants perceived pap smears to be associated with embarrassment, pain and fear. Barriers to screening were reported in three categories: psychosocial (shame and embarrassment), communication (inability to speak in English), and barriers related to access (lack of insurance or primary care provider). Study findings indicate research focused at the individual-level and future research should focus on exploring multilevel influences on cancer screening uptake.

High Prevalence of Cervical High-Risk Human Papillomavirus Harboring Atypical Genotypes in Human Immunodeficiency Virus -Infected and -Uninfected First-Generation Adult Immigrant Women Originating from Sub-Saharan Africa and Living in France

AbstractHuman papillomavirus (HPV)-related cervical lesions in first-generation immigrant African women in France should reflect the epidemiology of high-risk (HR)-human papillomavirus (HPV) infection in sub-Saharan Africa. First-generation immigrant African women attending the Centre Hospitalier Régional of Orléans, France, were prospectively subjected to endocervical swabs for HPV DNA PCR and Pap smear. Fifty women (mean age, 41.7 years) living in France (mean stay, 10.7 years) were enrolled, including 26.0% of HIV-negative women from general population and 74.0% of women with known HIV infection. Cervical HPV prevalence was 68.0%, with 56.0% of HR-HPV. HR-HPV -68 and -58 were the predominant genotypes (20.0% and 14.0%, respectively). HR-HPV-16 and HR-HPV-18 were infrequently detected. HIV-infected women showed a trend to be more frequently infected by HPV than HIV-negative women (70.3% versus 61.5%). Most women (84.0%) showed normal cytology, while the remaining (16.0%) exhibited cervical abnormalities and were frequently HIV-infected (87.5%). These observations highlight the unsuspected high burden of cervical HR-HPV infections mostly associated with atypical genotypes, HIV infection and cervical abnormalities in first-generation immigrant African women living in France.

Cervical Cancer Screening by Refugee Category in a Refugee Health Primary Care Clinic in Calgary, Canada, 2011–2016

AbstractNewly arrived refugees and refugee claimants experience low cervical cancer screening (CCS) rates in Canada. We investigated CCS at a dedicated refugee clinic. We completed a retrospective cohort study among patients at the Mosaic Refugee Health Clinic in Calgary, Canada, between 2011 and 2016. We investigated CCS offers and completion by refugee category. We then used multivariable logistic regression to estimate the association of CCS screening and refugee category, accounting for sociodemographic and clinical factors. We included 812 refugees. Most were married (71%) and had limited English proficiency (57%). Overall, 88% and 77% of patients were offered and completed screening, respectively. Compared to government assisted refugees, privately sponsored refugees completed CCS more often (OR 1.60, 95% CI [1.02–2.49]). A dedicated refugee clinic may provide effective CCS to newly arrived refugees irrespective of refugee category, insurance status or other barriers.