Background on Cancer Disparities
One million newcomers arrive in the U.S. every year. The total U.S. population includes 32.5 million foreign-born individuals, representing 11.5 percent of the population and an increase of over 10 million from 1990 (U.S. Census Bureau, 2003). The top four metropolitan areas, or "classic" immigrant magnets, are home to 18 percent of our immigrants, yet contain only 6 percent of the U.S. population.
New York City is a "classic" immigrant magnet, and home to the largest foreign-born population in the U.S. More than one-third (approximately 2.9 million) of New York City's eight million residents is foreign-born. From 2000 to 2002 alone, more than 250,000 foreign-born persons immigrated to the City (New York City Department of Planning, 2003).
Minorities face considerable barriers in accessing appropriate cancer care and information, as highlighted by the Institute of Medicine, the Presidents' Cancer Panel, and the National Academy of Sciences. These include systems barriers, financial barriers, physical barriers, barriers related to information or education, under-representation in cancer research activities, and barriers related to cultural differences and biases in cancer care. Immigrant minorities may be subject to all of these barriers, plus the additional barriers of language skills and immigration status.
Cancer disparities, including dissimilar cancer incidence, mortality, or survival rates, and decreased access to treatment, end-of-life care, and survivorship services, are rife among immigrant minorities. Despite an observed decrease in overall cancer death rates in the U.S., immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates for many cancers. Later stage at diagnosis is partially responsible for the higher mortality rates.
Additional risk factors include environmental factors, inadequate nutrition and exercise, and differential rates of infection with cancer-causing pathogens. For example, Latino and Asian immigrants who recently came to the U.S. have a high incidence of gastric cancer, which is partly due to the high prevalence of Helicobacter pylori infection in their countries of origin. Similarly, high rates of liver cancer reflect the chronic hepatitis B infection among these immigrants.