Cancer risk diversity in non-Western migrants to Europe: An overview of the literature

1. This project is funded under the framework of Public Health Programme 2003-2008 of the European Commission (contract number 2005122) EUPHA 2009 Lodz, 26.-28. Nov Cancer risk diversity in non-Western migrants to Europe: An overview of the literature Arnold M1, Coebergh JWW2, Razum O1 1 Department of Epidemiology and International Public Health, Bielefeld University, Germany 2 Department of Public Health, Erasmus Medical Center Rotterdam, The Netherlands

2. Background • Europe: 44.1 millionmigrants in 2005 (9.5% of the entire European population) • US: 38.3 millionmigrants in 2005 (12.9% of the entire US population) • Heterogeneous motives and origins • Diverse exposures to risk factors Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

3. Cancer in migrants • Cancer risks vary geographically and between ethnic groups • Assessing the relevance of • environmental (“nurture”) components • genetic (“nature”) components  Allowing progress in etiology research  Allowing migrant-specific prevention means Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

4. Underlying hypotheses 1. Cancer risk patterns of migrants with non-Western roots differ from those of the native population of their host country 2. Migrants are more prone to certain cancers 3. Cancer risks of migrants alter over time and across generations Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

5. Methods • Inclusion criteria: • Studies on cancer incidence and mortality in adult migrants from non-Western countries, residing in the European Union, published in English between 1990 and March 2009 • comparison between the migrant population and the native population of the country of the study • Migrant origins were pooled • Tendencies were using to indicate differences Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

6. Findings • 31 studies from 7 countries were included • Lower all-cancer mortality and morbidity in all non-Western migrant groups • Exceptions: Males from West-Africa; Migrants from Eastern Europe Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

7. Findings • Greater likelihood to develop cancers with a relation to infectious diseases • Oral cavity, nasopharynx, stomach, liver, gallbladder, cervix uteri, lymphoma • Decreased risk for cancers associated with a ‚Western‘ lifestyle • Colorectum, pancreas, lung, breast, ovary, kidney, stomach, bladder Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

8. Findings Source: Globocan database, IARC 2002 Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

9. Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

10. Discussion 1. Lower all-cancer risk coincide in most studies irrespective of exact migrant origin  health/epidemiologic transition 2. Susceptibility to certain cancers  life-course perspective can help to identify decisive exposures during life 3. Cancer risks in migrants converge over time  to be investigated Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

11. Conclusion • Challenges • Heterogeneity of migrant groups and origins • Heterogeneity of applied definitions and measures of association • Research Prospects • Transnational study (closer networking) • Comparison of cancer occurence in home and host country of migrants Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe

12. Thank you very much for your attention! Melina Arnold Bielefeld University Department of Epidemiology and International Public Health melina.arnold@uni-bielefeld.de

13. References • Marmot M. Changing places changing risks: the study of migrants. Public Health Rev. 1993;21(3-4):185-95. • Rogerson PA, Han D. The effects of migration on the detection of geographic differences in disease risk. Soc Sci Med. 2002 Nov;55(10):1817-28. • Parkin DM, Khlat M. Studies of cancer in migrants: rationale and methodology. Eur J Cancer. 1996 May;32A(5):761-71. • Zeeb H, Spallek J, Razum O. [Epidemiological perspectives of migration research: the example of cancer]. Psychother Psychosom Med Psychol. 2008 Mar-Apr;58(3-4):130-5. • Spallek J, Razum O. Erklärungsmodelle für die gesundheitliche Situation von Migrantinnen und Migranten. In: Bauer U, Bittlingmayer UH, Richter M, editors. Health Inequalities: Determinanten und Mechanismen gesundheitlicher Ungleichheit Wiesbaden: Vs Verlag; 2008. p. 271-88. • Stirbu I, Kunst AE, Vlems FA, Visser O, Bos V, Deville W, et al. Cancer mortality rates among first and second generation migrants in the Netherlands: Convergence toward the rates of the native Dutch population. Int J Cancer. 2006 Dec 1;119(11):2665-72. • Zeeb H, Razum O, Blettner M, Stegmaier C. Transition in cancer patterns among Turks residing in Germany. Eur J Cancer. 2002 Mar;38(5):705-11. • Spallek J, Arnold M, Hentschel S, Razum O. Cancer incidence rate ratios of Turkish immigrants in Hamburg, Germany: A registry based study. Cancer Epidemiol. 2009 Nov 7. Arnold M, Coebergh JWW, Razum O: Cancer risk diversity in non-Western migrants to Europe