Screening Shortfalls Leave Refugee and Immigrant Patients Behind in Cancer Detection

A quiet but consequential gap in preventive medicine has come into sharp focus in upstate New York. A team of researchers at SUNY Upstate Medical University in Syracuse conducted a retrospective review of 1,083 patient charts at an academic adult medicine clinic, examining whether refugees and immigrants receiving primary care there were up to date on cancer screenings aligned with nationally accepted guidelines. The results, published in Discover Social Science and Health, reveal a patchwork of performance: some screening rates approach levels seen in the general U.S. population, while others fall dramatically short, leaving patients vulnerable to cancers that are often detectable and treatable when caught early.

The study’s methodology reflects a careful attempt to identify a population that is frequently invisible in electronic health record data. Because many medical records do not reliably capture country of birth, the researchers used preferred language as a proxy for foreign-born status, then confirmed immigrant status through a complete review of the electronic medical record carried out by a trained clinical team. This two-step verification matters, because language barriers themselves are a known driver of health care underuse, and conflating language with birthplace without verification could have distorted the findings. The chart review covered the period from June to December 2021 and assessed screening status for five cancer types: cervical, breast, colon, lung, and hepatocellular cancer.

The headline numbers tell a story of uneven protection. Among eligible women, 63.0 percent were up to date on cervical cancer screening and 71.4 percent on breast cancer screening. Colon cancer screening fared worse, with only 52.4 percent of eligible patients current. The steepest shortfalls appeared in the screening programs that depend on specific risk profiles: just 23.1 percent of patients eligible for lung cancer screening and 25.0 percent of those eligible for hepatocellular cancer screening were up to date with recommended guidelines. For lung cancer, eligibility typically hinges on age and a documented smoking history, while hepatocellular surveillance is generally reserved for patients with cirrhosis or chronic hepatitis B infection, making accurate risk documentation a prerequisite for any screening at all.

Why do these particular screens lag so far behind? The technical requirements of risk-based screening offer one explanation. Unlike population-wide tests such as mammography or colonoscopy, lung and liver cancer screening depend on clinicians first identifying who qualifies. That identification step can fail at multiple points for patients who arrived as refugees or immigrants: smoking histories may never be documented in a patient’s preferred language, hepatitis B status acquired in endemic regions may go untested, and conversations about eligibility may never happen if interpretation services are inconsistent. A screening program that begins with an unasked question effectively ends before it starts, and the Syracuse data suggest exactly that pattern.

The broader context makes these numbers more alarming. Cancer screening rates in refugee and immigrant populations across the United States are consistently lower than those of the U.S.-born population, a disparity rooted in a tangle of barriers: limited English proficiency, unfamiliarity with the preventive care model, competing settlement priorities, insurance gaps, transportation challenges, cultural attitudes toward cancer and its disclosure, and prior negative experiences with health systems both abroad and in the United States. Refugees often arrive after years of displacement and may have missed screening opportunities entirely during the intervals when guidelines would have applied. The Syracuse study provides baseline data from a non-English-speaking refugee and immigrant primary care population at an academic medical institution, a measurement step the authors describe as essential before interventions can be designed.

Baseline data of this kind serve a specific technical purpose in health equity research. Without knowing where screening rates stand, clinics cannot set targets, allocate resources, or evaluate whether an intervention works. The Syracuse team frames its findings as an opportunity: identifying the gaps in cancer screening provides a chance to design meaningful clinic-based and community-based interventions for providers and health systems to improve health equity. In practice, such interventions might include reminder systems in patients’ preferred languages, dedicated navigation staff who shepherd patients from eligibility determination to completed screening, integrated interpretation services, and community partnerships that build trust and health literacy around cancer prevention.

The study also illustrates the value of academic primary care clinics as windows into underserved populations. SUNY Upstate’s adult medicine clinic serves a substantial refugee and immigrant patient base, reflecting Syracuse’s long history as a resettlement city. Chart review of this kind, approved by the institution’s Institutional Review Board with consent waived, allows researchers to measure real-world care delivery rather than relying on self-reported screening, which is known to be imprecise. The trade-off is that a single-clinic, single-city sample cannot be generalized wholesale to other settings, but it offers something national datasets often cannot: a granular, verified picture of one clinic’s performance against national guidelines for a specific, identifiable population.

The five cancer types examined span the major evidence-based screening programs in American medicine. Cervical cancer screening via cytology and HPV testing, breast cancer screening via mammography, and colorectal cancer screening via stool-based tests or colonoscopy are recommended for broad age-eligible populations. Lung cancer screening with low-dose computed tomography is targeted at high-risk current and former smokers, and hepatocellular surveillance with ultrasound, with or without alpha-fetoprotein testing, targets patients with cirrhosis or chronic hepatitis B. The divergence in the Syracuse data between the broad-population screens and the risk-stratified screens points to a structural insight: disparities are not uniform across preventive services but concentrate where screening depends on upstream risk assessment and patient-clinician communication.

Timing also deserves attention. The chart review window of June to December 2021 fell during the COVID-19 pandemic, when routine preventive care was disrupted nationwide as clinics suspended non-urgent services and patients deferred visits. Screening rates measured in that period may reflect pandemic-era backlogs that have since partially recovered, a caveat that underscores why the authors position this as baseline data rather than a definitive portrait. Still, the scale of the shortfalls in lung and liver cancer screening, at roughly one in four or fewer patients current, exceeds what pandemic disruption alone would plausibly explain, and aligns with the persistent disparities documented in refugee and immigrant health research.

What happens next will determine whether this study becomes a turning point or another data point. The authors’ stated purpose, to present baseline data that enables the design of clinic and community interventions, implies a research-to-practice pipeline: targeted outreach, risk documentation improvements, language-concordant education, and system-level tracking of screening completion. For the patients behind the 1,083 charts, the stakes are concrete. Cancers detected through screening are typically found earlier and carry better prognoses than symptomatic cancers, and every percentage point of screening completion represents lives potentially extended. The Syracuse findings transform an abstract inequity into a measurable, addressable checklist, and in doing so they offer health systems elsewhere a template for asking the same question of their own records: who among our most vulnerable patients is being missed, and by which screens?

Subject of Research: Cancer screening disparities among refugee and immigrant primary care patients in Syracuse, New York

Article Title: Cancer screening gaps among refugees and immigrants in Syracuse New York

Article References: Thompson, C. A., Sous, W., Ahmed, A., Rogner, J., Chee, S., Arafa, F., Searles, M., Purdy, A., & Shaw, A. V. (2026). Cancer screening gaps among refugees and immigrants in Syracuse New York. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00466-8

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00466-8

Keywords: cancer screening, refugees, immigrants, health equity, primary care, SUNY Upstate, Syracuse, lung cancer, hepatocellular carcinoma, cervical cancer, chart review, health disparities