Addressing language disparities in breast cancer screening

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• Patients who prefer a non-English language often face barriers to accessing care due to poor communication, unmet information needs & discrimination.
• The links between language barriers & health disparities are well recognized, but little research exists on how they influence the use of breast cancer screenings.
• Research by CORE explores barriers & facilitators to mammography in a non-English language population, & steps to address language-related disparities.

Health systems are frequently unequipped to meet the needs of patients who prefer communicating in a language other than English. As a result, individuals with a non-English language preference (NELP) face significant barriers to accessing care. Poor communication can lead to unmet informational needs, and factors like discrimination and a lack of cultural competency contribute to lower satisfaction and quality of care. Together, these issues create major disparities in health and healthcare.

While these disparities are well recognized, less is known about the specific impacts on the use of breast cancer screenings (mammography). This gap in evidence is particularly concerning for women and their healthcare providers, because breast cancer is a leading cause of cancer death among women, and early detection through mammography is vital to improving cancer outcomes.

A research project by the Providence Center for Outcomes Research and Education (CORE) is working to fill the gap by studying the factors that impact the use of mammography among a population of patients whose preferred language is Spanish.

A community-informed research approach

With input from the Coalition of Communities of Color and funding from the Kuni Foundation, CORE contacted patients in five languages in Oregon and Washington using digital and paper surveys. To help shape a community-informed research approach, we also held online focus groups in English and Spanish and gained insight from Promotores, traditional healthcare workers serving the Latinx population, who support breast cancer screening in their communities.

Survey questions explored key areas related to breast cancer screenings, including screening history, perceptions, and communication. Respondents were also asked why they may have missed or skipped a mammogram and about the services or supports that would help them get a mammogram. The survey received 7,473 responses (37.3% response rate), and of those respondents, 420 reported that they preferred a language other than English.

Provider-patient communication & cultural responsiveness are key

CORE’s research findings suggest that while significant barriers to care exist for individuals with NELP, provider-patient communication, culturally-responsive health promotion materials, and language services are all crucial in supporting and encouraging preventive mammography.

Survey responses highlighted a persistent unmet need for interpretation and translation support in Spanish. When asked, “what would help you get a mammogram?”, responses included:

• “Interpretation during appointments”
• “Attention in Spanish”
• “Translation and interpretation for transportation and for appointments”
• “Bilingual staff”

Other takeaways include:

• Misconceptions about the need for mammography can act as a barrier to care for individuals with NELP.
• Patient-provider communication can serve as a facilitator to mammography for NELP patients.
• Few respondents received written or verbal information in their preferred language, highlighting the need for health promotion materials and provider communication tailored to the patient's culture and language.
• More research is needed to better understand the specific cultural beliefs and practices that may impact mammography screening rates.
• CORE’s research also describes the importance of addressing financial and logistical barriers to mammograms for individuals with NELP.

This research highlights the essential role of provider communication in supporting mammography. Improved provider communication could also help overcome misconceptions about mammography that serve as a barrier to care. The bottom line is that healthcare providers should take measures across all forms of communication to ensure appropriate language services, cultural competency, and support for patients who prefer a non-English language

Related resources

• Blog post: studying disparities in breast cancer screening
• Learn more about the Coalition of Communities of Color