Women who have limited English proficiency have significantly lower rates of undergoing this exam.
Only speaking Spanish puts women at greater risk for not getting the screening mammograms they need.
“Spanish-only speakers appear to have a 27-percent less likelihood of having a screening mammogram than English speakers,” said lead study investigator Jose L. Cataneo, M.D., a general surgery resident at the University of Illinois at Chicago (UIC/Metropolitan Group Hospitals.
Cataneo and his colleagues presented their findings, based on women ages 40 and above living in the United States, during the American College of Surgeons (ACS) Clinical Congress 2020.
The existing recommendation from the American Cancer Society is that women should begin screening mammography at age 45 with an option of starting at age 40. For women ages 50-to-74, the U.S. Preventive Services Task Force suggests biannual screening. Women in their 40s can also choose to follow this recommendation. It is well known that mammography reduces the rates of advanced and fatal breast cancers by detecting them early when they are still easily treatable. This is particularly important because breast cancer is the No.1 cause of cancer-related deaths among Hispanic women.
But, communication struggles can make getting access to these services much more difficult.
“The impact of language barriers on screening mammography was previously unknown from a national database,” Cataneo said. “It is important because approximately 67 million people in the United States speak a language other than English, and 41 million of those speak Spanish.”
The Effect of Limited English Proficiency
To determine the impact of the language barrier, Cataneo’s team looked at screening mammography rates for women who had limited English proficiency (LEP) – those who spoke only or mostly a language other than English. Using 2015 data from the National Health Interview Survey – an annual survey of U.S. civilians, non-institutionalized residents – the team focused on women ages 40 to 75. They identified 1,040 women – from 9,653 included in the study – who had LEP, and 756 spoke only Spanish.
The women answered questions in the language they usually speak.
According to their analysis, for the 936 women with LEP who were given mammogram information, the overall rate of getting a screening mammogram was 12 percent less than for women who spoke English proficiently – 78 percent to 90 percent, respectively.
In addition, 209 women with LEP reported never having undergone a screening mammogram. Using statistical software, the team extrapolated that number for the U.S. female population between ages 40 and 75 as a whole, and they determined their results equaled as estimated 450,000 women nationwide who are eligible for – but have never had – a screening mammogram.
Cataneo’s team also broke down the screening mammography rate by age group within their total study population – 40-to-50, 45-to-75, and 50-to-75. They determined the impact of LEP was consistent.
“In all three groups, we found that those with limited English proficiency had less frequency of getting a screening mammogram,” he said.
The team took their research a step further and standardized the women with LEP and those who spoke English proficiently by statistically matching them by age, race-ethnicity, insurance status, family income, and other factors. Based on those results, they discovered that only speaking Spanish was associated with a significantly lower probability of getting a screening mammogram – the odds ratio was 0.73, they said.
What Can Be Done
The reasons behind why women with LEP do not get screening mammograms are myriad, said Celeste Cruz, M.D., the study’s senior investigator and breast surgeon at Advocate Illinois Masonic Medical Center in Chicago. Low income levels and a lack of health insurance can play significant roles, as can fears around the exam itself. Consequently, it is important for providers to be proactive in helping to dispel any myths while conveying the importance of the test.
In addition, many women – regardless of ethnicity or language proficiency – erroneously believe that having no family history of breast cancer means they are not at risk for developing the disease themselves, Cruz said. But, according to existing research, only 5 percent-to-10 percent of breast cancers are hereditary.
To specifically address these language-based disparities, she said her facility has taken steps to improve screening mammography rates. They have created Spanish-language seminars that include education on breast health, the importance of screening, and breast cancer treatment advances. In addition, Cruz, herself, provides lectures via community organizations for healthcare providers and employers who also want to promote breast health and screening.
These resources are now being offered virtually during the COVID-19 pandemic, and she said the institution is actively working to make online mammography scheduling services available in languages other than English.
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