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Spanish-only speaking women in the US get fewer mammograms

A new study finds that women in the United States who speak only Spanish are less likely to undergo screening for breast cancer.

Breast cancer does not always cause symptoms. For this reason, the American Cancer Society (ACS) recommend that women undergo screening mammograms.

When a doctor is able to detect breast cancer early, the chance of successfully treating it is higher.

A new study that researchers presented at the American College of Surgeons Clinical Congress 2020 finds that Spanish-only speaking women in the U.S. are less likely to undergo what can be lifesaving screenings.

“Spanish-only speakers appear to have a 27% less likelihood of having a screening mammogram than English speakers,” says lead study author Jose L. Cataneo.

Researchers have not previously reported on this language barrier to early detection, says Cataneo, who is a general surgery resident at the University of Illinois at Chicago. For the women this language barrier affects, however, the consequences can be life threatening.

According to senior study investigator Celeste Cruz, who is a breast surgeon at Advocate Illinois Masonic Medical Center in Chicago:

“Mammography screening overall really reduces the rate of advanced and fatal breast cancers by finding cancers when they are at earlier stages and highly treatable.”

According to Cataneo, U.S. Census Bureau estimates reveal why the shortfall in screenings for women with limited English proficiency (LEP) is a serious national problem.

“It is important,” he says, “because approximately 67 million people in the [U.S.] speak a language other than English, and 41 million of those speak Spanish.”

To arrive at their conclusions, the researchers analyzed 2015 data from the National Health Survey. This is an annual, nationally representative survey of civilian, non-institutionalized U.S. residents.

The authors of the study focused on women aged 40–75 years. This is the age group in which several organizations recommend undergoing yearly screening mammograms.

Among the pieces of information the survey respondents supplied was their primary language. Of the 9,653 women included in the study, 756 spoke only Spanish. Overall, 1,040 individuals described themselves as speaking only or mostly a language other than English, which the researchers used to define as having LEP.

The study found that 90% of proficient English speakers had received mammograms but that only 78% of the LEP group members had. Of the 936 LEP group members who reported mammogram information, 209 reported never having undergone a mammogram.

The study authors extrapolated this finding to the entire female population of the U.S. They estimate that in the age range of 40–75 years, 450,000 U.S. women eligible for mammograms have not undergone one — much less the recommended yearly screenings.

Further validating the study’s findings, the researchers analyzed the survey data taking into account age, insurance status, race/ethnicity, and family income, among other factors.

Spanish-only speaking women had a lower probability of undergoing a mammogram. For each 100 proficient English-speaking women who undergo mammograms, only 73 Spanish-only speaking women do.

Both the ACS and the U.S. Preventive Services Task Force (USPSTF) recommend undergoing regular screenings.

For women at average risk, the ACS suggest that women can choose to start screening at 40 years old, but they actively recommend annual screenings for women aged 45–54 years. They also say that women can choose to change to every 2 years from age 55 years.

For those at higher risk, screenings can begin at 30 years old.

The USPSTF recommend undergoing a mammogram every 2 years for women aged 50–74 years, with individuals making a personal choice about whether to start screenings from age 40 years based on their weighing up of potential harms and benefits.

Mammography rates vary by age, so the researchers analyzed the frequency of screenings in three different age groups to see if the effect of LEP persisted among them. Those age groups were:

  • 40–50 years
  • 45–75 years
  • 50–75 years

“In all three groups,” says Cataneo, “we found that those with [LEP] had less frequency of getting a screening mammogram.”

The study authors suggest a few factors that may explain this problem.

First, their analysis found that women with LEP were more likely to have a lower income and lack health insurance than other women — that said, the result was still significant when they took these factors into account.

There is also a fear among many women, say the researchers, about the safety of mammography.

It may also be that Spanish-only speaking women consider themselves at low risk.

Although breast cancer affects fewer Hispanic women than non-Hispanic white women, it is nonetheless the leading cause of cancer death among Hispanic women, according to the ACS.

In addition, although many consider their chance of developing breast cancer to be low because they have no family history of the condition, this is not statistically the case, says Cruz. Only 5–10% of breast cancers are hereditary.

The hospital in which Cruz works is stepping up its outreach to Spanish-only speaking women. So far, it has increased Spanish language educational programs that communicate the benefits of mammography screenings. Its teams are also presenting seminars in Spanish.

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