Journal of General Internal Medicine

, Volume 34, Issue 2, pp 198–205 | Cite as

A Qualitative Study of Spanish-Speakers’ Experience with Dense Breast Notifications in a Massachusetts Safety-Net Hospital

  • Christine M. GunnEmail author
  • Amy Fitzpatrick
  • Sarah Waugh
  • Michelle Carrera
  • Nancy R. Kressin
  • Michael K. Paasche-Orlow
  • Tracy A. Battaglia
Original Research



Legislation requiring mammography facilities to notify women if they have dense breast tissue found on mammography has been enacted in 34 US states. The impact of dense breast notifications (DBNs) on women with limited English proficiency (LEP) is unknown.


This study sought to understand Spanish-speaking women’s experience receiving DBNs in a Massachusetts safety-net hospital.


Eligible women completed one audio-recorded, semi-structured interview via telephone with a native Spanish-speaking research assistant trained in qualitative methods. Interviews were professionally transcribed verbatim and translated. The translation was verified by a third reviewer to ensure fidelity with audio recordings.


Nineteen Spanish-speaking women ages 40–74 who received mammography with a normal result and recalled receiving a DBN.


Using the verified English transcripts, we conducted a content analysis to identify women’s perceptions and actions related to receiving the notification. A structured codebook was developed. Transcripts were independently coded and assessed for agreement with a modification of Cohen’s kappa. Content codes were grouped to build themes related to women’s perceptions and actions after receiving a DBN.

Key Results

Nineteen Spanish-speaking women completed interviews. Nine reported not receiving the notification in their native language. Four key themes emerged: (1) The novelty of breast density contributed to notification-induced confusion; (2) women misinterpreted key messages in the notification; (3) varied actions were taken to seek further information; and (4) women held unrealized expectations and preferences for follow-up.


Not having previous knowledge of breast density and receiving notifications in English contributed to confusion about its meaning and inaccurate interpretations of key messages by Spanish speakers. Tools that promote understanding should be leveraged in seeking equity in risk-based breast cancer screening for women with dense breasts.


limited English proficiency breast cancer screening health policy risk perception informed decision-making 



This work was supported by the Boston University Clinical and Translational Science Institute under Grant 1UL1TR001430. The authors would like to thank Marisol Amaya and La Alianza Hispania for their contributions to the Science Cafe and feedback on preliminary themes.

Compliance with Ethical Standards

Study activities were approved by the Boston University Medical Center Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Christine M. Gunn
    • 1
    • 2
    Email author
  • Amy Fitzpatrick
    • 1
  • Sarah Waugh
    • 1
  • Michelle Carrera
    • 1
  • Nancy R. Kressin
    • 3
    • 4
  • Michael K. Paasche-Orlow
    • 4
  • Tracy A. Battaglia
    • 1
  1. 1.Women’s Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine Boston UniversityBostonUSA
  2. 2.Department of Health Law, Policy, and Management, School of Public HealthBoston UniversityBostonUSA
  3. 3.Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonUSA
  4. 4.Section of General Internal Medicine, Evans Department of Medicine, School of MedicineBoston UniversityBostonUSA

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