BALTIMORE – Diagnosed with stage 3 cancer at age 32, Karol Contreras was already scared and unsettled.
The thought of discussing her condition and treatment with doctors only added to her anxiety. Contreras grew up in Honduras; her English is limited.
An acquaintance connected her with Nueva VIDA, a nonprofit that provided a bilingual mentor to accompany her to appointments at the University of Maryland St. Joseph Medical Center in Towson. Nueva Vida – Spanish for New Life – provides “culturally sensitive” cancer support services for Latino families in the Baltimore, Washington and Richmond, Virginia, areas.
“She made me feel more comfortable,” Contreras said through an interpreter. Two years after her diagnosis, Contreras is now cancer-free. Other Hispanic women are not as fortunate.
Breast cancer is the leading cause of death among Hispanic women, in part because many are not knowledgeable about the U.S. healthcare system or fluent in English. While they are less likely to get breast cancer than other ethnic groups, Hispanic women who are diagnosed are 20 percent more likely than white women to die from the disease. They are more likely to learn they have breast cancer at later stages of the disease, when tumors are larger.
The disparity persists, even as hospitals and nonprofits have pumped more resources into programs targeting Hispanic women.
Carol DeSantis, director of breast and gynecological cancer surveillance at the American Cancer Society, said one problem “might be that they don’t think it affects them. But they should be getting screened, because it does affect Hispanic women. They want to catch it as soon as possible in order to improve their chances of survival.”
Doctors, nurses and advocates for patients blame the disparity on factors both medical – higher rates of diabetes – and sociological: cultural differences, language barriers and a desire to stay under the radar as anti-immigrant sentiment in the United States increases. All these factors have created obstacles that prevent women from getting screened, diagnosed and treated.
“Sometimes they have different ideas about breast cancer and screening and treatment,” said Kim Schmulowitz, a spokeswoman for Susan G. Komen Maryland. “A lot of times it is about educating them about when to get screened and dispelling some of the myths they might have about breast cancer.”
Komen, which has set a goal of reducing breast cancer death rates in the United States by 50 percent by 2026, funds Nueva VIDA and other programs that target Hispanics. The group believes it can reduce death rates by a third by addressing disparities among vulnerable populations, such as Hispanics and African-Americans.
Komen and other groups have found that doing educational outreach to Hispanic communities, and hiring bilingual workers to help with doctor appointments and paperwork, have helped reduce gaps in screening, diagnosis and treatment.
Health advocates say that some Hispanic women, whether or not they are in the United States legally, have avoided seeing doctors or showing identification to medical workers as the Trump administration has increased enforcement against undocumented immigrants.
Avonne Connor, an assistant professor of epidemiology and oncology at the Johns Hopkins Bloomberg School of Public Health, said more research needs to be done into how biological factors and lifestyle affect breast cancer in Hispanic women. Even as more Hispanic women are screened for breast cancer, she said, the numbers of those dying have not improved proportionately – which leads her to believe there might be other reasons for the disparities.