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Spanish-Speakers Experience Barriers When Receiving Dense Breast Notifications

Spanish-speaking women encounter unique challenges when receiving notifications regarding their mammogram results and breast density. The findings, which appear in the Journal of General Internal Medicine, are an example of the unintended consequences some new health policies can have on specific populations.

Providing health information to those with limited English proficiency has challenged the health system for decades. Previous research has shown an association between language barriers and misconceptions about disease, poor understanding of recommendations, and worse health outcomes. Additionally, there is a trend toward engaging patients in decision-making. State legislation requires that women receive written notification if mammograms indicate they have dense breast tissue, with the goal of empowering women to be active in decisions about additional breast cancer screening and prevention.

In order to learn about the effects of state policy on individual patient experiences, researchers from Boston University School of Medicine (BUSM) interviewed 19 Spanish-speaking women who had a mammogram and were sent a letter stating that they had dense breasts. They talked to women on the phone about what they recalled the letter said, how it made them feel, and what actions they decided to take about their dense breasts.

They found that approximately one-half of the women did not receive letters in their native language. The majority of participants did not have prior knowledge regarding breast density, which added to confusion about what the notification meant for them and led to misinterpretation of key messages. The women sought out diverse sources of information—internet, friends and family, physicians—to help them understand what dense breasts were. They also held unrealized expectations for follow up, including the desire for timely and in-person health communication.

"I hope this study highlights the challenges of implementing laws that require very specific medical communications, especially for groups that may be more vulnerable to systems designed for majority populations," says corresponding author Christine Gunn, PhD, a research assistant professor of medicine at BUSM.

While the study focused on non-English speaking women, Gunn says it highlights important concepts for all women receiving mammograms. Specifically, dense breasts are a normal finding and many women have them.

"Patients should be aware that there are state laws that require doctors to give them this information," Gunn says. "They should ask their doctors about what it means for them and their chances of developing breast cancer."