Cancer risk among individuals of migrant origin in Belgium during the 2000s – Evidence of migration as a ‘cancer risk transition’?

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Highlights

  • Cancer incidence among migrants changes with duration of stay in Belgium

  • How incidence evolves post-migration depends on the cancer and migrant origin group

  • Changes in cancer incidence affirm migration as an epidemiologic transition for men

  • For women, no clear pattern of cancer risk transition can be established

  • Italians have a specific pattern of cancer incidence change after migration

Abstract

Recent research has shown a generally lower cancer risk and mortality among migrants from less-industrialised country origin. However, while rates are usually lower for ‘lifestyle-related’ cancers (e.g. breast, prostate, lung, colorectal), they are typically elevated for ‘infection-related’ ones such as liver and stomach cancer. Although these observations appear in line with the theory of ‘migration as a rapid epidemiological transition’, changes in cancer risk after migration have yet to be investigated, effectively testing if migration also entails a ‘rapid cancer risk transition’. This study therefore examines cancer risk among migrants in Belgium, focusing on colorectal cancer as a typically lifestyle-related cancer on the one hand, and infection-related cancers on the other hand. We subdivide migrant groups of more and less industrialised country origin according to duration of stay, and calculate absolute and relative incidence rates between 2004 and 2013. Our findings corroborate the transition assumptions for men from Turkey and Morocco, but cannot support them for women. Italian male immigrants have an in-between position: their colorectal cancer risk does not differ from that of Belgian men, but infection-related and non-cardia stomach cancer risks are higher and remain so with longer duration of stay. The fact that rates for migrants from the Netherlands and France generally do not differ from those of Belgians further strengthens support for a cancer transition among male migrants. Further examinations should focus on changes in health-related behaviour that can explain persistently low colorectal cancer risks among Turkish and Moroccan migrants and can inform preventive strategies for other population subgroups. Knowledge about the higher non-cardia stomach cancer risk among Turkish, Moroccan, and Italian men can support early detection strategies by primary care providers when patients present with gastric symptoms, especially because this cancer tends to have unfavourable prognosis.

Section snippets

Author statement

Wanda M J Van Hemelrijck, Conceptualization, Data curation, Formal analysis, Writing – original draft, Michael Rosskamp, Data curation, Writing – review & editing, Freija Verdoodt, Writing – review & editing, Harlinde De Schutter, Writing – review & editing, Katrien Vanthomme, Conceptualization, Data curation, Writing – original draft

Data and study population

We used data from the 2001 population census that were individually linked to the Crossroads Bank for Social Security (CBSS) and the standard cancer registration database for incidence years 2004–2013 from the Belgian Cancer Registry (BCR). Census data contained socio-economic and demographic information about the study population on October 1st, 2001, whereas CBSS data pertained to vital status and emigration until December 31st, 2013. Nationwide information on cancer diagnoses came from the

Description of the study population

Women represent the majority of most Western-European groups (Belgian, Dutch and French origin) aged between 50 and 74 years, in contrast to the Italian, Turkish and Moroccan groups that were predominantly male (except for the more recent Moroccan immigrant group) (Table 2). The immigrant groups that had been residing in Belgium for more than 30 years had an average duration of stay between the range of 34 and 39 years whereas those arriving more recently had a duration of stay averaging

Discussion

This study aimed to test the notion of a ‘rapid cancer transition’ on colorectal, grouped infection-related, and non-cardia stomach cancer incidence for migrants of Turkish and Moroccan origin in Belgium while including Italians as a mixed group of labour migrants, and Dutch and French as a control group. Our findings are largely in line with the transition theory for men but are inconclusive for women. The Italian risk pattern furthermore did not follow that of any other origin group yet shows

Acknowledgements

The authors would like to acknowledge the support for this work from Vrije Universiteit Brussel grant OZR2818 and Fonds Wetenschappelijk Onderzoek grant G043517N; and the support Kom op Tegen Kanker lends the Belgian Cancer Registry which facilitated the data linkage for this study.

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