Foreign-Trained Physicians Less Likely to Screen for Cancer, Especially Among Immigrant Populations

Rosemary Frei, MSc

March 2015, Vol 6, No 2 - Quality Care

Screening for cancer is suboptimal among some immigrant populations, especially those whose primary care physicians are trained in foreign countries, according to results of a new study of primary care practices in Canada; specifically, women from South Asia whose family physicians were trained in South Asia were less likely to be screened for cervical cancer than nonimmigrant women whose physicians were not immigrants (Lofters AK, et al. Cancer Med. 2015;4:212-223.

Overall, South Asian patients are less likely to be screened for cervical, breast, or colorectal cancer than immigrants from other countries, regardless of their doctors’ country of origin.

Although the study was conducted in Canada, the results likely apply to ethnic populations in the United States, both primary care physicians and their physicians, suggested lead investigator Aisha K. Lofters, MD, PhD, a family physician at St. Michael’s Hospital and Adjunct Scientist, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

“Our findings may reflect differences in what’s emphasized in medical school curriculums around the world,” Dr Lofters said. “These findings also suggest that there’s a particular gap with South Asian–trained doctors being less likely to perform Pap tests on South Asian women.”

Study Details

Using 2008-2010 data from several Canadian administrative databases, Dr Lofters and her team analyzed information on 6303 doctors in urban centers serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical cancer screening, and 2,260,569 men and women eligible for colorectal cancer screening.

Overall, physicians trained in Canada were the most likely to screen their patients for cancer. A multivariable analysis revealed that family doctors who studied medicine in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen patients for cancer than those who studied medicine in Canada.

Furthermore, physicians who were trained in South Asia were the least likely to screen for cervical cancer. The odds ratio of physicians trained in South Asia screening South Asain women for cervical cancer was 0.56 compared with physicians trained in the United States, Australia, or New Zealand screening women from these countries for cervical cancer.

People from the Caribbean/Latin America were the only ethnic group that did not have lower probabilities versus nonimmigrants of being screened for cervical, breast, or colorectal cancer.

Overall, ethnic patients with higher income and those who had a female physician were more likely to be screened for cancer than other groups.

“The study highlights certain physician characteristics that are associated with cancer screening for eligible patients, including immigrant patients, and that should be considered when designing physician-targeted interventions. We have also highlighted an ethnic community, South Asians, which requires particular attention, both among its patients and its primary care providers,” Dr Lofters and colleagues wrote.

New Screening Programs

These findings add urgency to programs aimed at boosting cancer screening in other subpopulations, Dr Lofters told Value-Based Cancer Care.

She said that she was launching a pilot project that uses the “Plan-Do-Study-Act” approach for improving cancer screening among South Asian patients.

“The main tools are patient education, patient reminders, and small media—brochures and pamphlets. And the way the doctors will deliver them will be adapted based on how well it’s working,” said Dr Lofters.

She was also involved in the design of the Screening Saves Lives program. In that program, South Asian community leaders are educated about the importance of cancer screening, and they, in turn, educate their peers about this.

Dr Lofters suggested that these types of programs could also be helpful in the United States.