title: Spanish as a primary language and its effect on breast cancer presentation.
abstract: OBJECTIVE
  It is well documented that patients without health insurance tend to present at more advanced cancer stages than those with insurance. What has not been well documented is the effect that primary language has on cancer stage presentation. Given the significant number uninsured patients and patients not fluent in English who are treated at our institution, we sought to identify how these parameters affect cancer staging at presentation using breast cancer as a model.
  
  
  METHODS
  We conducted a retrospective chart review over a 36-month period at an urban community hospital. Patients who received their initial surgical treatment at this facility were included. One hundred seventy patients were identified. Definitive breast cancer surgery, breast cancer stage, and type were recorded for all subjects. We analyzed patient demographics including ethnicity, primary language spoken, and insurance status.
  
  
  RESULTS
  All patients were female. Patient populations were evenly distributed among three major ethnicities: 39% were African American, 36% were white, 23% were Hispanic, and 2% were listed as "other." Seventy percent of Hispanic patients noted that English was not their primary language. Ten percent of the white population presented at stage III or greater compared with 16% of African Americans and 22% of Hispanics. Twenty-seven percent of non-English-speaking Hispanics presented with advanced-stage disease.
  
  
  CONCLUSIONS
  Non-English-speaking Hispanic patients presented at more advanced stages than their English-speaking counterparts. Health care reform must address the non-English-speaking Hispanic to effectively improve the health of all groups in the United States.
authors: Methodist Dallas Medical Center, Dallas, TX.
authors: Kristin
authors: K
authors: Oliveira
authors: Steven
authors: S
authors: Clark
authors: Ernest
authors: E
authors: Dunn
authors: Alicia
authors: A
authors: Mangram