Previniendo el Cáncer de las Mamas: Addressing Breast Cancer Screening Disparities in Spanish-Preferred Populations Increasing BC Compliance in Spanish Population
Abstract
Background: Breast cancer is the leading cause of death among Hispanic/Latina women. Screening mammograms reduces morbidity and mortality, although Spanish-preferred patients face linguistic barriers, with 61% of patients in an Internal Medicine (IM) clinic being up to date on screenings. The study aimed to increase breast screening rates among Spanish-preferred IM patients by 12% within six weeks using culturally tailored Spanish-language educational materials.
Methods: Spanish-preferred patients were identified by language preference, age, and breast cancer screening status. Thirty-six women IM patients (intervention) and twenty-six Family Medicine (FM) patients (control) were selected. The IM patients received a link to a Spanish screening education video via an electronic portal message or mailed letter. If no screening was completed, patients were then called by a native Spanish speaker. FM patients received no intervention. Screening rates were compared to evaluate the efficacy of the video in increasing screening.
Results: Nine IM patients were excluded due to relocation or receiving care elsewhere. Post-intervention, screening adherence improved in both groups; the IM group improved by 25.9% (7 patients, P = 0.007) and 15.4% in the FM group (4 patients, P = 0.04). The change was significantly higher in the intervention group, P < 0.001.
Conclusion: Providing screening education in Spanish significantly improved adherence. Incorporating culturally tailored education in clinical practice mitigates language-related health disparities and improves screening rates. Further research is needed on a larger scale with education in other languages to determine the effects on screening rates when patients have education in their preferred language.
Full text article
References
Society AC. Breast cancer facts and figures. Accessed January 30, 2024. Available from: http://www.cancer.org/downloads/STT/CAFF2005BrF.pdf.
Hendrick RE, Monticciolo DL, Biggs KW, Malak SF. Age distributions of breast cancer diagnosis and mortality by race and ethnicity in US women. Cancer. Dec 1 2021;127(23):4384-4392. doi:10.1002/cncr.33846.
Talham CJ, Montiel Ishino FA, O'Brien KM, Sandler DP, Williams F. Breast cancer screening among Hispanic and non-Hispanic White women by birthplace in the Sister Study. Cancer Med. Apr 2022;11(8):1913-1922. doi:10.1002/cam4.4563.
Stapleton SM, Oseni TO, Bababekov YJ, Hung YC, Chang DC. Race/Ethnicity and Age Distribution of Breast Cancer Diagnosis in the United States. JAMA Surg. Jun 1 2018;153(6):594-595. doi:10.1001/jamasurg.2018.0035.
Cataneo JL, Meidl H, Ore AS, Raicu A, Schwarzova K, Cruz CG. The Impact of Limited Language Proficiency in Screening for Breast Cancer. Clin Breast Cancer. Feb 2023;23(2):181-188. doi:10.1016/j.clbc.2022.11.008.
Moreno PI, Yanez B, Schuetz SJ, et al. Cancer fatalism and adherence to national cancer screening guidelines: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cancer Epidemiol. Jun 2019;60:39-45. doi:10.1016/j.canep.2019.03.003.
Villa Camacho JC, Pena MA, Flores EJ, et al. Addressing Linguistic Barriers to Care: Evaluation of Breast Cancer Online Patient Educational Materials for Spanish-Speaking Patients. J Am Coll Radiol. Jul 2021;18(7):919-926. doi:10.1016/j.jacr.2021.02.001.
Institude MP. Frequently Requested Statistics on Immigrants and Immigration in the United States. Migration Policy Institude. Accessed January 30, 2024. http://www.migrationpolicy.ord/article/frequently-requested-statistics-immigrants-and-immigration-united-states#:~:text=Of%2062.5%20million%20people,42.6%20million)%20were%20native%20born.
Li Y, Carlson E, Hernandez DA, et al. Patient Perception and Cost-Effectiveness of a Patient Navigation Program to Improve Breast Cancer Screening for Hispanic Women. Health Equity. 2019;3(1):280-286. doi:10.1089/heq.2018.0089.
Schnitman G, Wang T, Kundu S, et al. The role of digital patient education in maternal health: A systematic review. Patient Educ Couns. Mar 2022;105(3):586-593. doi:10.1016/j.pec.2021.06.019.
Lamb LR, Baird GL, Roy IT, Choi PHS, Lehman CD, Miles RC. Are English-language online patient education materials related to breast cancer risk assessment understandable, readable, and actionable? Breast. Feb 2022;61:29-34. doi:10.1016/j.breast.2021.11.012.
Monteiro Grilo A, Ferreira AC, Pedro Ramos M, Carolino E, Filipa Pires A, Vieira L. Effectiveness of educational videos on patient's preparation for diagnostic procedures: Systematic review and Meta-Analysis. Prev Med Rep. Aug 2022;28:101895. doi:10.1016/j.pmedr.2022.101895.
Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. May 2006;61(2):173-90. doi:10.1016/j.pec.2005.05.004.
Goolsby RS, Mark. A Theoretical Approach to Improving Patient Education through Written Materials. Annals of Behavioral Science and Medical Education. 2013;19:14-18. doi:10.1007/BF03355232.
Aponte J, Tejada K, Figueroa K. Readability Level of Spanish Language Online Health Information: A Systematic Review. Hisp Health Care Int. Oct 3 2024:15404153241286720. doi:10.1177/15404153241286720.
Hernandez Alvarez A, Escobar-Domingo MJ, Lee D, et al. Beyond the language barrier: Assessing health literacy of Spanish breast cancer surgery resources. Surgery. Oct 2024;176(4):1029-1035. doi:10.1016/j.surg.2024.06.025
Gu JZ, Baird GL, Escamilla Guevara A, et al. A systematic review and meta-analysis of English language online patient education materials in breast cancer: Is readability the only story? Breast. Jun 2024;75:103722. doi:10.1016/j.breast.2024.103722
Measurement MC. Minnesota Health Care Quality Report: Part 2: Clinical Quality Measures Reported by Payers. 2023. https://mncmsecure.org/website/Reports/Community%20Reports/Health%20Care%20Quality%20Report/2022%20MY%20HCQR%20Chartbook%20Pt%202%20-%20FINAL.pdf.
Taskforce USPS. Breast Cancer: Screening. Accessed April 30, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
Siedlecki SL. Quasi-Experimental Research Designs. Clin Nurse Spec. Sep/Oct 2020;34(5):198-202. doi:10.1097/NUR.0000000000000540.
Bonett DG. Point-biserial correlation: Interval estimation, hypothesis testing, meta-analysis, and sample size determination. Br J Math Stat Psychol. Nov 2020;73 Suppl 1:113-144. doi:10.1111/bmsp.12189.
McHugh ML. The chi-square test of independence. Biochem Med (Zagreb). 2013;23(2):143-9. doi:10.11613/bm.2013.018.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Routledge; 1988.
Ko NY, Hong S, Winn RA, Calip GS. Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer. JAMA Oncol. Mar 1 2020;6(3):385-392. doi:10.1001/jamaoncol.2019.5672.
Ferreira CS, Rodrigues J, Moreira S, Ribeiro F, Longatto-Filho A. Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: A systematic review. Mol Clin Oncol. Jul 2021;15(1):139. doi:10.3892/mco.2021.2301.
Gathirua-Mwangi W, Cohee A, Tarver WL, et al. Factors Associated with Adherence to Mammography Screening Among Insured Women Differ by Income Levels. Womens Health Issues. Sep-Oct 2018;28(5):462-469. doi:10.1016/j.whi.2018.06.001.
Zafar N, Wolf AB, Kepniss JL, Teal AC, Brem RF. Effectiveness of Community Education for Breast Cancer Screening. J Breast Imaging. Apr 1 2024;6(2):166-174. doi:10.1093/jbi/wbae002.
Bayard S, Fasano G, Tamimi RM, Oh PS. Leveraging Electronic Health Records to Address Breast Cancer Disparities. Curr Breast Cancer Rep. 2022;14(4):199-204. doi:10.1007/s12609-022-00457-z.
Lurie N, Margolis KL, McGovern PG, Mink PJ, Slater JS. Why do patients of female physicians have higher rates of breast and cervical cancer screening? J Gen Intern Med. Jan 1997;12(1):34-43. doi:10.1046/j.1525-1497.1997.12102.x.
Mendoza-Grey S, Ramos-Muniz J, Armbrister AN, Abraido-Lanza AF. Mammography Screening Among Latinas: Does Gender and Ethnic Patient-Physician Concordance Matter? J Immigr Minor Health. Oct 2021;23(5):986-992. doi:10.1007/s10903-021-01170-2.
Authors
Copyright (c) 2025 Archives of Breast Cancer

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.