About one-quarter of Germany’s population have a migration background in the 1st and 2nd generation. Data on cancer incidence and prevalence are incomplete, and there are still obstacles in the provision of care that need to overcome gaps in both aspects.
People with a migration background and tumor diseases show a few differences compared to people without a migration background. These differences must be taken into account in daily practice and clinical settings in order to provide a proper level of information and medical support to all stakeholders.
First and foremost, cultural and linguistic differences probably come to mind when it comes to people with a migration background. Both are also immensely important for therapy adherence, for physician-patient relationships, and for the level of health literacy.
In addition, there are significant differences in tumor treatment, and especially in the field of psycho-oncology. In some cultures or religions, certain measures are not desired or allowed and are therefore rejected. This is often an obstacle in education about tumor disease or the necessary consequent therapy.
Last but not least, people from other countries of origin often bring along clinically relevant comorbidities that we local physicians are not aware of in their day to day work. In the case of European physicians, they may face cases of hepatitis C (present mainly in the Middle East and North Africa), tuberculosis (e.g. in South Africa, Eastern Europe, and Southeast Asia) or sickle cell anemia (mainly in Africa). In addition, people from Africa, Southeast Asia, or Russia, may have a higher incidence of HIV.
These examples show how important it is to detect such previous illnesses in tumor patients based on their migration background, at an early stage, as they can impair therapy or unnecessarily worsen prognosis. For example, sickle cell anemia or thalassemia can lead to anemic conditions that are relevant for treatment even before the initiation of chemotherapy. In the worst case, these then intensify the anemia as a result of chemotherapy, which can quickly become life-threatening.
According to the WHO (2018), the incidence of certain cancers worldwide does not usually differ from the figures found in the German context. For example, lung and prostate carcinomas also occupy the top positions among men with a history of migration. In women, breast cancer is prevalent. However, there are also special cases, such as cervical carcinoma in women from Africa or Kaposi's sarcoma as a very rare skin tumor, especially in people from Mozambique.
Source: "Care of cancer patients with a migration background"; DKK 2020, Berlin, 21.02.2020