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难民和移民中的癌症筛查:全球视角

Cancer Screening in Refugees and Immigrants: A Global Perspective.

作者信息

Walker Patricia F, Settgast Ann, DeSilva Malini B

机构信息

HealthPartners Institute, Bloomington, Minnesota.

Department of Medicine, University of Minnesota, Minneapolis, Minnesota.

出版信息

Am J Trop Med Hyg. 2022 May 9;106(6):1593-600. doi: 10.4269/ajtmh.21-0692.

Abstract

Clinicians in the United States are trained to screen for cancer based on patient age, gender, family history, and environmental risk factors such as smoking. These cancers generally include, breast, cervical, colon, lung, and prostate cancers. We know that refugees and other immigrants to the United States experience dramatic disparities in cancer screening. Additionally, many immigrants experience elevated risks from infection-attributable cancers due to their country or region of origin. U.S.- based clinicians may not routinely consider these unique risk factors. Although this article focuses on refugees, it is also intended to guide clinicians caring for other foreign-born immigrant groups living in the United States (hereafter referred to as "immigrants"). The document contains two sections: 1) special considerations for U.S. Preventive Services Task Force guidelines cancer screening recommendations in immigrants and 2) cancer risks and screening recommendation unique to certain immigrant groups. Disparities in cancer screening and prevalence are often greater for specific immigrant groups than for broader racial or ethnic groups (e.g., Black, Asian, Hispanic) into which they may fit. Disaggregation of data by language or country of origin is useful to identify such disparities and to design intervention opportunities within specific communities that are culturally distinct and/or who have different environmental exposures. Unique cancer risks and disparities in screening support a nuanced approach to cancer screening for immigrant and refugee populations, which is the focus of this narrative review.

摘要

美国的临床医生接受过培训,会根据患者的年龄、性别、家族病史以及吸烟等环境风险因素来筛查癌症。这些癌症通常包括乳腺癌、宫颈癌、结肠癌、肺癌和前列腺癌。我们知道,美国的难民和其他移民在癌症筛查方面存在巨大差异。此外,许多移民由于其原籍国或地区的原因,感染所致癌症的风险较高。美国的临床医生可能不会常规考虑这些独特的风险因素。尽管本文重点关注难民,但它也旨在指导照顾居住在美国的其他外国出生移民群体(以下简称“移民”)的临床医生。该文件包含两个部分:1)美国预防服务工作组指南中针对移民癌症筛查建议的特殊考虑因素;2)某些移民群体特有的癌症风险和筛查建议。特定移民群体在癌症筛查和患病率方面的差异往往比他们可能所属的更广泛种族或族裔群体(如黑人、亚裔、西班牙裔)更大。按语言或原籍国对数据进行分类,有助于识别此类差异,并在文化独特和/或环境暴露不同的特定社区内设计干预机会。独特的癌症风险和筛查差异支持对移民和难民人群采取细致入微的癌症筛查方法,这是本叙述性综述的重点。

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