| Hepatocellular carcinoma (HCC) | - Screen all refugees and immigrants born in countries with greater than 2% hepatitis B virus (HBV) prevalence, if not completed overseas before US arrival.
- Perform hepatitis C virus screening for all individuals 18-79 years of age, and those with known risk factors.
- All HBV and HCV infected individuals should be evaluated by a hepatologist and should undergo HCC screening in accordance with national guidelines, which includes initiation of HCC surveillance at age 20 years for African-born patients with chronic HBV.
- HCC screening includes laboratory testing and ultrasound or other imaging modalities every 6 months.
- Although not part of the America Association for the Study of Liver Disease guidelines, given increasing HCC rates in Asian immigrants, <30 years, clinicians may consider initiation of HCC screening for Asian patients with chronic HBV infection at age 20 years.
- Automated best practice alerts that trigger based on country of birth can improve screening for HBV; linkage to a primary care provider, implementation of a chronic disease registry for HBV, and use of culturally tailored educational materials also improves adherence to screening recommendations.
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| Gastric cancer | - Gastric cancer incidence varies dramatically worldwide, and many immigrants come from high-incidence countries.
- No US guidelines exist regarding screening for gastric cancer in high-risk immigrant populations, despite implementation of successful screening programs in some high-risk countries.
- Identify patients at high-risk for gastric cancer based on ethnicity, country of origin, family history of gastric cancer, or Helicobacter pylori infection.
- Consider screening patients at high risk for gastric cancer with endoscopy, and treat symptomatic, infected patients to eradicate H. pylori.
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| Bladder cancer | - No screening recommendations exist for patients with Schistosoma hematobium, a known risk factor for bladder cancer.
- Immigrant patients from endemic areas who present with urinary symptoms (eg, dysuria, gross hematuria, pelvic pain) should be screened for hematuria with urinalysis, and, if present, evaluate further with urine cytology, urine ova, and parasite testing (between 12 and 3 pm), serology for schistosomiasis and cystoscopy.
- Patients from S. hematobium-endemic areas with unexplained hematuria should be referred for cystoscopy and considered for empiric treatment with praziquantel due to potential benefits versus risk of treatment, and low sensitivity of testing.
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| Cholangiocarcinoma | - Identify high risk groups for biliary tract cancers due to liver fluke infection based on region of origin (Southeast Asia, including northern Thailand, northern Vietnam and Laos, Manchuria, east Russia and northern Siberia, South Korea, mainland China except the northwest, and Taiwan), and exposure history (eating raw or fermented freshwater fish).
- Evaluate for liver fluke infection with complete blood count with differential and three stools for ova and parasite testing in patients from endemic areas with a history of biliary tract stones or dilated intrahepatic bile ducts without obstruction.
- Consider empiric treatment with praziquantel for patients from endemic areas with a history of biliary stones or dilated intrahepatic bile ducts due to potential benefits versus risk of treatment, and low sensitivity of stool testing for ova and parasites.
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| Nasopharyngeal cancer | - Consider screening high-risk persons with serology, clinical examination, and nasopharyngoscopy—those from southern China (including Hong Kong), Singapore, Malaysia, Philippines, and Vietnam, non-US born Hmong individuals, and those with a family history of nasopharyngeal cancer.
- Patients at high-risk for nasopharyngeal cancer presenting with persistent nasal obstructive symptoms, discharge, epistaxis, tinnitus, or hearing loss should undergo careful physical examination for adenopathy and early referral to an otorhinolaryngology specialist rather than empiric treatment of symptoms.
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| Oral and esophageal cancer | - Screen for use of betel nut and areca nut in addition to tobacco products and perform a thorough oral examination on an annual basis.
- Early referral to otorhinolaryngology for evaluation of suspicious findings, including leukoplakia, erythroplakia, or oral submucous fibrosis.
- Counsel on cessation of use of betel nut and areca quid, as well as other tobacco products.
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