Language barrier puts Latina breast cancer patients at risk

SEATTLE -- The language barrier between Latina women and their healthcare providers could be putting lives at risk when it comes to breast cancer.

Researchers have found there are not enough Spanish-language resources available for Latina patients, which means it can take too long to diagnose breast cancer following a mammogram. As a result, Latina women in the United States are being diagnosed at a later stage with less chance of survival.

While Latina women in the United States are less likely than white women to be diagnosed with breast cancer, their survival rate upon being diagnosed is 5 percent worse, according to the American Cancer Society.

In fact, cancer recently passed heart disease as the leading cause of death among Latino people, and breast cancer is the most frequently diagnosed cancer among Latina women, reports the organization.

A concerning trend

Historically, Latina women have been less likely than white women to have mammograms performed. But even when they are screened researchers have found they take longer to be diagnosed.

A recently published study led by University of Texas researchers found that in six cities across the United States Latina women took an average of 60 days to be diagnosed with breast cancer after an abnormal mammogram - more than twice as long as white women.

While this study did not include any Washington cities, researchers at the Fred Hutchinson Cancer Research Center are currently working on a similar study and finding the same trend in our state.

Dr. Beti Thompson, leader on the Fred Hutch study, has been comparing how Latina women and white women in Washington respond to an abnormal breast cancer screenings. While the study is incomplete, Thompson said she is seeing a delay of diagnosis among Latina women.

Communication challenges

Thompson said the language difference between Latina women and their physicians is the greatest challenge this population faces fighting breast cancer.

When Latina women try to interpret the results of a breast cancer screening, Thompson said they do not always understand if there is a problem or if they need to follow up with their doctor. In other cases, Thompson said the patient may think an abnormal screening means they definitely have cancer, even if they have not been diagnosed yet.

Blanca del Sol of Seattle was diagnosed with breast cancer at just 35 years old in 2005. She had just moved to the United States from Mexico and struggled to communicate with her doctor.

"There was not a lot of help in Spanish," del Sol said. "It is especially hard to understand some of the medical words doctors use."

Silvia Kennedy came to Seattle from Guadalajara 11 years ago and now works for the Puget Sound affiliate of the Susan G. Komen Foundation. She helps local Latina women get screened for breast cancer and receive appropriate treatment. Kennedy has found that many Latina women struggle to understand the process of a breast cancer screening. She said they sometimes don't know why they are asked to share personal information like their social security number.

Kennedy worries specifically about women who cannot read or write. In response, she is working with Thompson's research team to create image-based materials that any woman would be able to understand.

Kennedy is also working with Thompson's team on a strategy to communicate with Latina women through their children - who often are more confident speaking English - and has created a Puget Sound Komen Facebook page in Spanish to educate women on breast cancer screenings.

Emotional impacts

In her research, Thompson has found Latina women experience greater distress after receiving abnormal screening results compared to white women. This anxiety can last up to six months and impact a woman's ability or willingness to comply with her doctor's directions.

She said this reaction may be caused by a Latino cultural belief that anyone diagnosed with cancer will die from the disease.

"The idea that there are no good treatments can keep women from coming in for follow ups," Thompson said.

Kennedy said Latina women sometimes don't want to know if they have breast cancer and only seek medical help if they become symptomatic.

"I think most Latina women don't understand they can survive breast cancer," Kennedy said. "We try to encourage them that if they are diagnosed early they will survive."

Kennedy said some women are also afraid to provide their personal contact information during a mammogram because they fear deportation. Often, she has seen women provide their doctors with fake phone numbers or addresses. If the screening comes back abnormal, the doctors have no way to contact them.

Cost concerns

Financial stress can also delay a woman's diagnosis. When del Sol found was diagnosed with cancer she said she was most concerned about how she would cover the medical expenses of treatment.

"I didn't know about all the groups that can help," del Sol said. "A lot of Latinos get scared. They think 'If it's positive I don't have any money [for treatment].'"

Now that she is cancer free, del Sol volunteers with Susan G. Komen to educate local Latina women on free mammogram services and programs that will offer them financial support if they are diagnosed.

Offering guidance

Kennedy said Spanish-speaking patient navigators can be extremely effective in getting Latina women diagnosed and treated for breast cancer more quickly. In some cases, she said these are respected members of the Latino community who will take women to their screenings and explain the process to them.

Unfortunately, Kennedy said she only knows of two part-time navigators working in King County. She said programs like the YMCA and Fred Hutch desperately need more funding to provide such services.

In the meantime, Kennedy said Susan G. Komen is reaching out to local Latina women through community health fairs at local churches.

"These women are not going to walk into a hospital and just ask for help," Kennedy said. "We need to create a relationship with them so they trust us. You need to engage with them by going somewhere they feel comfortable and safe."

Despite the challenges Latina women face fighting cancer, Kennedy is grateful for new research that is publicizing the issue.

"It is sad that people were not paying attention until now but I'm glad that at least more women may get help."