breast cancer, early stage breast cancer, surgery, language barrier, immigrant, health care, breast conserving therapy, prophylactic mastectomy, disparities


Health and Medical Administration | Oncology | Plastic Surgery | Social Work | Surgery


Background: Arriving at and implementing an appropriate patient centered treatment plan for early stage breast cancer requires significant dialogue between healthcare providers and patients. How language barriers affect this process has not been thoroughly explored in the literature. The aim of this paper is to examine the effect of language barrier on variation and receipt of early stage breast cancer treatment.

Methods: Rates of lumpectomy, mastectomy, and contralateral prophylactic mastectomy (CPM) with or without reconstruction were compared between English speaking and Low English Proficiency (LEP) cohorts. Patients with recurrent or bilateral breast cancer, male patients, and/or known genetic mutations were excluded. Receipt of recommended treatments including chemotherapy, hormonal therapy and radiation were compared between the two groups, as well as patient refusal and loss of follow-up. Regression analysis for all-cause mortality within this time period was tabulated for each group.

Results: There were no significant differences between receipt of recommended treatments, patient refusal or loss of follow up between the cohorts. LEP patients had a greater proportion of lumpectomies (79.7 versus 70.7%) while 9.2% of English-speaking patients had CPM or CPM with reconstruction compared to none of the LEP patients. These trends, however, did not rise to statistical significance within our small population sample. Age, insurance type, and LEP were associated with significant difference in all-cause mortality, however only age and insurance remained significant in adjusted analysis.

Conclusion: Our results indicate a non-statistically significant trend towards less variation of surgical treatment variation for early stage breast cancer in the LEP population, including a greater frequency of lumpectomy and less utilization of CPM. Larger, multicenter studies would be needed to affirm and further investigate these trends.