Health Services Research
PV QA 3 - Poster Viewing Q&A 3
Materials/Methods:Patients with breast cancer who underwent radiation treatment from 2016-2017 were identified (n=413 patients). Patients were categorized as English (n=342) vs Non-English Speakers (NES) (n=71), based on patients’ self-identified primary language. Stage at presentation (0/DCIS, I, II, III, and IV), age, and race/ethnicity (Hispanic, Asian, Non-Hispanic White, and Other) were recorded. A preliminary analysis was run comparing stage at presentation for all English vs NES patients. Additional analysis using Fisher’s Exact test controlled for age <50 (n=102) and ≥50 (n=316), to differentiate between pre-menopausal and post-menopausal patients who might have undergone screening. Finally, conditional odds ratios were calculated while adjusting for age and race/ethnicity using a log linear model.
Results:There was a significant difference in stage at presentation between English and NES patients who underwent breast radiation treatment (p=0.0053). More NES patients presented at Stage III (21.1%) compared to English speakers (7.2%). Fewer NES presented with Stage I disease (32.2% vs 47.2% of English speakers). When controlling for age <50 and ≥50, there was a significant difference in stage at presentation in the cohort ≥50 (p=0.0169), with NES more likely to present at Stage III than English speakers (14.7% vs 7.9%), and less likely to present at Stage I (33.3% vs 48.4%). There was no significant difference for those <50 (p=0.5676). Finally, the difference in stage at presentation persisted when controlling for race/ethnicity as well as age, with NES having lower odds of presenting with Stage I disease and higher odds of Stage III disease. With Stage I as a reference, NES have estimated odds of presenting at Stage III that are 4.28 times that of English speakers.
Conclusion:Non-English speaking patients with breast cancer present with more advanced disease when compared to English-speaking patients. Non-English speakers have lower odds of presenting with Stage I disease and higher odds of presenting with Stage III disease, even while controlling for age and race/ethnicity. This may indicate NES patients have a harder time gaining access to the healthcare system, thus delaying their work-up and diagnosis. This may then lead to more extensive treatment, including chemotherapy and regional nodal irradiation. Additionally, NES patients ≥50 present at more advanced stage, which may in part be due to undergoing less screening; this remains to be explored. Separate from race/ethnicity, language appears to be an independent predictor of advanced stage disease presentation.
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