摘要：Objective. We examined breast cancer treatment experiences of and outcomes for Latinas in Los Angeles County. Methods. We conducted a population-based survey of women who were diagnosed with breast cancer between December 2001 and November 2002 (n=910) to evaluate the types of treatments received, communication with clinicians, and satisfaction. Results. About two thirds were non-Latina White, 18.8% were African American, and 18.9% were Latina (with 11.0% preferring English and 7.9% preferring Spanish). The rest indicated other ethnic groups. Latinas who preferred Spanish were more likely to experience a delay of 3 months or more from diagnosis to surgical treatment (36.4% vs 9.1% for non-Latina Whites, 18.6% for African Americans, and 12.7%, for other Latinas, P <.001). African Americans and Latinas who preferred Spanish had very low rates of reconstruction (13.8% and 9.2%, respectively, compared with 42.1% for Whites and 34.5% for Latinas who preferred English, P =.009). Latinas who preferred Spanish had the highest odds ratio for low satisfaction. Conclusion. Latinas who preferred Spanish received different treatments and perceived a different treatment experience than did other cultural groups. Breast cancer is the most common cause of cancer and cancer-related mortality among Latinas in the United States. In 2003, about 11000 new cases of breast cancer were diagnosed in Latinas—a higher incidence than for the next 4 cancer sites combined. 1 Population-based studies have shown that Latinas present with more advanced disease and with more adverse prognostic indicators than do non-Latina White women. 2 , 3 A recent analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program showed that Latinas had a higher risk of mortality after a breast cancer diagnosis than did non-Latina White women. 4 Further, Latinas were more likely to receive a first course of treatment that did not meet 2000 National Comprehensive Cancer Network standards. 4 Ethnic differences in breast cancer morbidity and mortality are likely the result of a complex interplay between clinical, cultural, and socioeconomic factors. 5 , 6 First, Latina women present with later-stage disease that may limit treatment options. 3 , 7 , 8 In addition, powerful cultural factors shape the health care treatment experiences of many Latinas, who have diverse levels of acculturation as expressed by language, family origin, immigration experience, and social class. Patients with low acculturation are more likely to prefer to communicate in Spanish. Studies have shown that language and literacy are major barriers to cancer screening and treatment opportunities. 9 Communication between patients and clinicians may also be influenced by a number of other cultural factors that are relevant to the Hispanic community and may affect patient preferences with regard to providers or their perceptions of quality of care. 10 , 11 Finally, financial and nonfinancial dimensions of access are highly correlated with acculturation and strongly limit opportunities to obtain quality treatment. 12 Although there is a growing literature on African American versus White differences in breast cancer treatment, there is very little information to date on Latinas’ experiences with such treatment, especially from population-based studies. 13 To explore Latinas’ experiences with and perspectives on breast cancer treatment and communication, we conducted a population-based study to examine the following questions: (1) Were there differences in the distribution of specific therapies (mastectomy vs breast-conserving surgery [BCS], breast reconstruction, and radiation post-BCS) across ethnic groups? (2) What patient–surgeon communication factors were associated with ethnic differences in receipt of therapies? (3) Were ethnic differences in treatment associated with socioeconomic and access factors? (4) Were there ethnic differences in satisfaction with the decision-making process regarding surgery?
