Medical News

CHICAGO, IL October 20 2003–Although the rate of breast cancer among Hispanic women in the United States is lower than among Caucasians or African Americans, breast cancer is the leading cause of cancer death in this patient population. This result is largely because Hispanic women often are diagnosed after breast cancer has advanced locally or has metastasized to the bone, according to Amelie Ramirez, Dr.PH, associate director for community research, San Antonio Cancer Institute and associate professor of medicine, Baylor College of Medicine.

Contributing to the increased mortality is lack of compliance with breast care, Dr. Ramirez explained at the 2003 Clinical Congress of the American College of Surgeons. According to a survey commissioned by the Susan G. Komen Breast Cancer Foundation, most Caucasians and a sizable proportion of African-American women undergo regular mammographic screening, but only 38 percent of Hispanic women over the age of 40 have yearly breast examinations, Dr. Ramirez observed. Even after they are diagnosed with the disease, Hispanic women tend to skip followup breast care appointments. Surgeons who treat women with breast cancer at the University of Texas Health Science Center may never see a Hispanic woman who has been referred for treatment after an abnormal mammogram, or they may see these women once or not for several months at a time, according to Alexander Miller, MD, director of surgical oncology and of the Cancer Prevention and Risk Assessment Clinic at the Cancer Treatment and Research Center, San Antonio, TX.

To begin to understand what keeps Hispanic women from participating in breast care, Drs. Miller and Ramirez conducted a pilot study focusing on the barriers to compliance with treatment recommendations. The study, which surveyed 117 Hispanic women with breast cancer and 78 of their family members, showed that fear was a principal factor. Ninety-one percent of women and 91 percent of their families reported that patients were afraid of the recommendations that surgeons would make for treatment.

Lack of health insurance was another critical element. Seventy-five percent of women and 80 percent of families said the high cost of health care was a major reason why patients did not follow breast cancer care recommendations. ?Hispanic women may have to choose between coming in for breast cancer care follow-up or putting food on the table,? Dr. Ramirez asserted. ?Hispanic women also tend to put themselves a little lower on the totem pole in terms of family needs,? she added. So rather than devote scarce household resources for their own health care, ?Hispanic women tend to procrastinate or avoid coming in for a followup visit,? she said.

Other reasons for not complying with breast cancer care identified in the study were the inability to understand the physician (reported by 81 percent of women and 77 percent of their families), a previous bad experience with a physician (reported by 79 percent of women and 78 percent of families), and inability to take off time from work (reported by 75 percent of women and 58 percent of families).

The findings from this study are leading Drs. Miller and Ramirez to explore ways of eliminating obstacles to breast cancer treatment among Hispanic women. One is by increasing awareness among physicians and surgeons about women?s fears. ?Physicians need to understand that these patients come in with a lot of trepidation, so they need to take extra time to explain the risks of the disease and of not seeking treatment, and help these women in making decisions about available treatment options,? Dr. Ramirez said.

Also important for physicians to understand is the importance of involving family mem-bers in treatment discussions. Dr. Ramirez pointed out that Hispanic women bond closely with their families and therefore may welcome having family members involved in discussions about treatment options. ?We recognize that the health care system can be very intimidating. We want to recruit family members to be supportive of Hispanic women because of the strong family structure and the availability of family members to serve as a translators or give patients a ride
to see their doctors and provide other help to get patients what they need,? Dr. Miller explained.

Because of the number of women and families in the study who reported having difficulty understanding investigators, Drs. Miller and Ramirez hope to provide more training in cultural competency, help physicians communicate more effectively with Hispanic patients, increase the number of bilingual health care providers, and hire more translators.

To increase the chances that Hispanic women will remain in the health care loop, the investigators involved in the study are considering strengthening ties between breast surgeons and other physicians who treat Hispanic women. ?Surgeons know that a patient is supposed
to be coming in because they have a referral. We could do a better job of connecting surgeons with the physicians who make the initial referral to be sure a woman is not lost to followup,? Dr. Ramirez maintained. A simple callback system?whereby the physician?s offices keep in contact with each other and the patient who has been referred for a surgical consult?is one possible method that could be explored, Dr. Ramirez suggested.

Additionally, physicians and community groups should be encouraging Hispanic women to participate in existing breast cancer screening programs, such as broad-based community efforts to offer mammograms regardless of a patient?s ability to pay, as well as public assistance programs and other sources of financial support provided for health care, explained Dr. Miller.

In addition to physician education, public education also needs to be tailored to Hispanic women, Dr. Ramirez added. ?The general health messages are not reaching the Latina community. We need to help these women take a more proactive role in their care by arming them with information and questions to ask the doctor. We also need to provide more information about positive outcomes of cancer treatment to reduce the fears that these women have,? she said.

?If we want to get to the point of providing a potential cure for breast cancer, we have to do something on the front end to get Hispanic women into the health care system sooner and make sure they stay in the system once they get there,? Dr. Miller concluded.

Also participating in the study were Fabiola Aparicio-Ting, MPH, Sandra San Miguel, MS, and Bradley Pollock, PhD.