Journal of Immigrant and Minority Health

, Volume 21, Issue 3, pp 473–482 | Cite as

Breast and Colorectal Cancer Screening Barriers Among Immigrants and Refugees: A Mixed-Methods Study at Three Community Health Centres in Toronto, Canada

  • A. M. Q. Wang
  • E. M. Yung
  • N. Nitti
  • Y. Shakya
  • A. K. M. Alamgir
  • A. K. LoftersEmail author
Original Paper


Mammography and fecal occult blood testing (FOBT) improve the detection, management, and prognosis of breast and colorectal cancer, respectively, but are underperformed in the recent immigrant and refugee population. We aimed to identify barriers to screening and potential solutions in this population. A mixed-methods study involving a retrospective chart review and focus group interviews was conducted, with data analyzed using univariate logistic regression and thematic analysis, respectively. Mammography completion was associated with greater time in Canada (p = 0.01) and region of origin (p = 0.04), while FOBT completion was associated with region of origin (p = 0.03). Barriers included time constraints, language and cultural differences, and poor interprofessional communication. This study of recent immigrants and refugees identifies barriers to screening and supports potential solutions including culturally-congruent peer workers, targeted screening workshops, and visual screening aids. Further work is needed to address the unique healthcare needs of this diverse and growing population.


Breast cancer Colorectal cancer Cancer screening Immigrants Refugees Community health centre Health promotion 



The authors would like to thank My Dang, Dr. Heather Sampson, and Christopher Meaney for their invaluable help in the conduct and analysis of this study. There are no relevant external funding sources to report and the authors declare they have no relevant conflicts of interest to report. Dr. Aisha Lofters is supported as a Clinician Scientist by the Department of Family and Community Medicine at the University of Toronto and at St. Michael’s Hospital, and by the Canadian Institutes of Health Research as a New Investigator.

Author Contributions

All authors have made substantive intellectual contribution to the development of this article and have reviewed and agree with the content of the article.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • A. M. Q. Wang
    • 1
  • E. M. Yung
    • 1
  • N. Nitti
    • 2
  • Y. Shakya
    • 2
  • A. K. M. Alamgir
    • 2
  • A. K. Lofters
    • 3
    • 4
    Email author
  1. 1.Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Access Alliance Multicultural Health and Community ServicesTorontoCanada
  3. 3.Department of Family and Community MedicineUniversity of TorontoTorontoCanada
  4. 4.St. Michael’s Hospital Family Practice Unit, Centre for Urban Health SolutionsSt. Michael’s HospitalTorontoCanada

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