Breast Cancer Research and Treatment

, Volume 141, Issue 2, pp 261–268

Ductal carcinoma in situ: knowledge of associated risks and prognosis among Latina and non-Latina white women

  • Aparna R. Parikh
  • Celia Patricia Kaplan
  • Nancy J. Burke
  • Jennifer Livaudais-Toman
  • E. Shelley Hwang
  • Leah S. Karliner
Epidemiology

DOI: 10.1007/s10549-013-2676-x

Cite this article as:
Parikh, A.R., Kaplan, C.P., Burke, N.J. et al. Breast Cancer Res Treat (2013) 141: 261. doi:10.1007/s10549-013-2676-x
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Abstract

While not itself life-threatening, ductal carcinoma in situ (DCIS) can progress to invasive disease if untreated, and confers an increased risk of future breast cancer. We investigated knowledge of DCIS among a cohort of English- and Spanish-speaking Latina and English-speaking non-Latina white women previously treated for DCIS. We examined knowledge of DCIS with four true/false statements about risk of invasive disease, breast cancer recurrence, and prognosis. For each knowledge statement, we modeled the odds of a correct answer by language–ethnicity (English-speaking Latinas, Spanish-speaking Latinas, and English-speaking whites) adjusting for demographics, health history, and treatment factors. Of 710 participants, 52 % were English-speaking whites, 21 % English-speaking Latinas, and 27 % Spanish-speaking Latinas. Less than half (41 %) of participants were aware that DCIS is not life-threatening and only 32 % knew that surgical treatment choice does not impact mortality; whereas two-thirds (67 %) understood that DCIS confers increased risk of future breast cancer, and almost all (92 %) knew that DCIS, if untreated, could become invasive. Only three Spanish-speakers used professional interpreters during discussions with their physicians. In adjusted analyses, compared to English-speaking whites, both English- and Spanish-speaking Latinas had significantly lower odds of knowing that DCIS was not life-threatening (OR, 95 % CI 0.6, 0.4–0.9 and 0.5, 0.3–0.9, respectively). In contrast, Spanish-speaking Latinas had a twofold higher odds of knowing that DCIS increases risk of future breast cancer (OR, 95 % CI 2.6, 1.6–4.4), but English-speaking Latinas were no different from English-speaking whites. Our data suggest that physicians are more successful at conveying the risks conferred by DCIS than the nuances of DCIS as a non-life-threatening diagnosis. This uneven communication is most marked for Spanish-speaking Latinas. In addition to the use of professional interpreters, efforts to create culturally and linguistically standardized information could improve knowledge and engagement in informed decision making for all DCIS patients.

Keywords

Ductal carcinoma in situLatino/HispanicBreast cancerLanguage barriersHealthcare disparitiesPatient–physician communication

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Aparna R. Parikh
    • 1
    • 2
  • Celia Patricia Kaplan
    • 2
    • 3
    • 4
  • Nancy J. Burke
    • 2
    • 6
  • Jennifer Livaudais-Toman
    • 3
    • 4
  • E. Shelley Hwang
    • 5
  • Leah S. Karliner
    • 2
    • 3
    • 4
  1. 1.Division of Hematology and Oncology, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Helen Diller Family Comprehensive Cancer CenterUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Medical Effectiveness Research Center for Diverse PopulationsUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Division of General Internal Medicine, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  5. 5.Division of Surgical Oncology, Department of SurgeryDuke UniversityDurhamUSA
  6. 6.Department of Anthropology, History and Social MedicineUniversity of California San FranciscoSan FranciscoUSA