# Non–English Language Preference and Breast Cancer Outcomes

## TL;DR

This study found that non-English language preference in breast cancer patients is linked to treatment delays but not to differences in survival outcomes.

## Contribution

The study provides new evidence that language barriers are associated with surgical delays but not survival differences in breast cancer patients.

## Key findings

- Non-English language preference was associated with a significant delay in surgical management.
- Disease-specific, disease-free, and overall survival rates did not differ significantly between non-English and English language preference groups.
- Language-related disparities highlight the need for support systems to improve care for non-English speaking patients.

## Abstract

Is non–English language preference (NELP) associated with breast cancer outcomes?

This cohort study of 2261 patients with breast cancer treated at an academic medical center found that NELP was not associated with differences in the primary outcome of disease-specific survival or other survival outcomes. However, NELP was associated with a significant delay in surgical management.

These findings suggest that, while NELP may not be directly associated with survival outcomes in a resource-rich setting, targeted interventions are needed to address treatment delays and socioeconomic disparities for patients with NELP.

Non–English language preference (NELP) poses a challenge in health care delivery and may contribute to disparate outcomes. Understanding the impact of NELP can provide insight for health care professionals, policymakers, and advocates aiming to enhance care quality for diverse populations.

To investigate the association of NELP with breast cancer–related outcomes.

This single-center cohort study of patients with breast cancer treated with curative intent was performed at a tertiary academic medical center from January 1, 2000, to December 31, 2020. A total of 22 355 patients were included in the initial cohort acquired through electronic medical record data; 2261 had complete data when cross-referenced with the institutional cancer registry. Data were analyzed from January 8 to December 11, 2024.

Language preference.

The primary end point was disease-specific survival (DSS) rates for patients with NELP compared with patients with English language preference (ELP), with adjustment for baseline clinical and demographic characteristics and treatments. Secondary end points included disease-free survival (DFS) and overall survival (OS). Time from diagnosis to definitive surgery was also analyzed. Kaplan-Meier analyses and log-rank tests were used to compare survival in the NELP and ELP groups.

The 2261 patients included in the analysis consisted of 2023 with ELP and 238 with NELP (2240 female [99.1%]; mean [SD] age, 59.6 [12.3] years). Clinical and treatment data were well balanced between the NELP and ELP groups. Median follow-up was 60.0 (IQR, 40.0-76.6) months. Median time between biopsy and definitive surgery was significantly longer for the NELP group compared with the ELP group (49 [IQR, 29-75] vs 38 [IQR, 24-57] days; P < .001). Stratified by insurance, only those with Medicare had significant delays between biopsy and surgery (median, 54 [IQR, 29-96] vs 36 [IQR, 25-53] days; P < .001). Five-year DSS rates for the NELP and ELP groups were 98.5% (95% CI, 93.8%-99.6%) and 99.0% (95% CI, 98.3%-99.4%), respectively (log-rank P = .39). DFS was 93.9% (95% CI, 89.4%-96.5%) for the NELP group and 95.6% (95% CI, 94.4%-96.5%) for the ELP group (log-rank P = .96). OS was 94.4% (95% CI, 89.3%-97.1%) for the NELP group and 96.7% (95% CI, 95.7%-97.5%) for the ELP group (log-rank P = .26).

In this cohort study examining the association of NELP with breast cancer outcomes, patients with NELP had significant delays in definitive surgical management compared with patients with ELP, but DSS, DFS, and OS did not differ significantly between groups. This suggests the importance of having robust support systems to mitigate language-related disparities and preserve breast cancer outcomes in this vulnerable population.

This cohort study investigates whether non–English language preference is independently associated with survival among patients with breast cancer.