Added to the bureaucratic problems are language barriers that hinder access to cancer prevention for immigrants, thus too many diagnoses occur at an advanced stage. 39% of immigrant women do not undergo mammography (compared to 27% of Italians), with the consequence that, in this population, breast cancer is diagnosed in an early stage (I-II) in approximately 80% of cases, compared to almost 90% in Italians. These are problems also felt by oncologists: 6 out of 10 believe that the management of non-EU patients is complex and 91% are worried about not being able to communicate adequately with these patients. In fact, only 4 out of 10 have the support of a cultural mediator during the first visit. For 81% the oncological prognosis in migrants is different (worse) compared to the results achieved in the resident population and for 86% this is due to inequalities in access to treatment in a timely manner. These are, in summary, the main results of the survey promoted by the Italian Association of Medical Oncology (Aiom) – we read in a note – to analyze the level of knowledge of specialists on the assistance of foreigners in our country, presented at the national conference ‘Oncology and immigration’, at the center of the ‘Ethics Days’, organized by the scientific society and the Aiom Foundation, which open today on the Island of San Servolo (Venice).
“Already in 2020, the then Aiom president, Giordano Beretta, decided to organize this event which, however, was postponed due to the pandemic – explains Francesco Perrone, Aiom president – The conference was strongly supported by the management and represents an activity necessary and natural. As highlighted by President Mattarella, the topic of oncological treatments for immigrants highlights the intense and indispensable connection between medicine, ethical profiles and social implications. We want to bring to light a phenomenon that concerns everyone, but finds us unprepared. In fact, 80% of oncologists believe they only partially have or are completely devoid of adequate tools for the management of immigrant patients affected by cancer. At the end of the ‘Ethics Days’ we will publish a document, a statement, with operational proposals to propose to the institutions”.
As Antonella Brunello, member of the national AIOM board, observes, “communication difficulties hinder access to treatments and prevention tools and have a significant impact on the management of the disease in foreigners. Just think that only 40% of oncologists, during the first oncological visit of a patient with a language barrier, have the possibility of having a cultural mediator: 27% in person and 13% on the telephone. The main obstacles in taking care of a non-EU patient – he adds – are the difficulty in understanding the oncological path and in communicating the diagnosis, the lack of a caregiver because they are often lonely people and problems in prescribing drugs”.
The resident population of foreign citizenship (as of 1 January 2024) is 5 million and 308 thousand units, an increase of 166 thousand individuals (+3.2%) on the previous year. The incidence on the total population reaches 9%. 58.6% of foreigners, equal to 3 million 109 thousand units, live in the North, for an incidence of 11.3%.
“In addition to their increasingly significant presence in society, they are also present in medical oncology departments – underlines Tiziana Latiano, member of the national AIOM board – We are faced with an ethical problem and we must not distinguish between regular and irregular immigrants. We often treat regular immigrants, who however do not speak Italian, so the language barrier remains insurmountable. In these cases, if it is not possible to communicate, the assistance becomes qualitatively different, even if we can offer the same therapies guaranteed to Italian patients. Without a cultural mediator, many phases of oncological disease cannot be managed in the same way as for patients without linguistic barriers.”
Immigrants “present, even temporarily, in our territory have the right to access health facilities – explains Filippo Pietrantonio, member of the national AIOM board – However, formal recognition does not always correspond to real taking charge of cultural, bureaucratic, administrative, information, which make it particularly difficult for immigrants to access care. These people too often reach the diagnosis when the cancer is already in an advanced stage, due to poor prevention and information. We must also consider the tragedy of irregular immigration, which is unable to access any type of preventive control”. At the ‘Ethics Days’ the results of a study on the incidence of tumors in the immigrant population in the region which involved around 4 million people aged 20 and over in the five-year period 2015-2019, of which 470 thousand from countries with strong migratory pressure such as Eastern Europe, Asia, Africa, Central and South America. Foreigners from these countries are much younger than Italians and have an average age of 40 (the over 60s are only 10%). The incidence of tumors in migrants was significantly lower (-26% in males and -20% in females) compared to what was observed in Italians. In particular, the risk of developing breast cancer is 37% lower and prostate cancer is 29%.
“Protective factors against breast cancer are much more widespread in immigrant women, such as the first pregnancy at a young age, a high number of children and breastfeeding – clarifies Alessandra Fabi, member of the national AIOM board – As regards prostate cancer, the greater incidence in Italian men derives from an excessive use of the Psa test, which leads to a significant number of overdiagnoses, i.e. the identification of very small tumors, indolent in perspective, which would not have shown signs of in the absence of diagnosis”.
Cervical cancer, which is becoming a rare tumor among Italians thanks to the spread of screening with the Pap test and the HPV test, has a double incidence among foreigners. In the last 3-5 years, 78% of Italian women have performed cervical screening (within organized programs or on personal initiative), this value stops at 67% in foreign women. “In migrants the rate of participation in screening is significantly lower – underlines President Perrone – We must not forget the resistance represented by the embarrassment, the lack of information, the prejudice of a large part of the immigrant population, who consider the exploration of the own body. The National Oncology Plan 2023-2027 recognizes the fragile status of migrants and identifies, among the strategic objectives, the increase in vaccination coverage and conscious adherence to screening campaigns. We need a Prevention Plan that considers the diversity of migrants.”
Adds Saverio Cinieri, president of the Aiom Foundation: “In 2023, Aiom built a research bridge with Peru and South America, sharing guidelines on the main big killers. The objective was to promote precision oncology in these countries too. In 2025, a Foundation delegation will go to Tanzania, to the Bugando Medical Center Hospital in Mwanza. Medical oncology in this city has been operational since 1999, thanks to an initiative by Professor Dino Amadori, past president of Aiom. In recent years our scientific society has played an important role in the cultural growth of professionals in Tanzania, through direct contact with Italian oncologists at the Bugando Medical Center and thanks to their periodic attendance at centers in our country. A collaboration that led, in 2022, to the inauguration of the Mwanza Cancer Center. We want to continue to support clinical activity and promote scientific research – he concludes – by intensifying relationships with Tanzanian professionals”.
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