This large epidemiological study was designed to investigate whether stage at breast cancer diagnosis and treatment received vary by ethnicity and birthplace among U.S.-born Hispanic, foreign-born Hispanic, and white women. Previous studies have found that Hispanic women in the U.S. are diagnosed with breast cancer at more advanced stages of the disease and start treatment later than non-Hispanic white women. The study included 31,012 Hispanic women and 372,313 white women diagnosed between 1988 and 2005.

Cancer stage at diagnosis was found to differ significantly by ethnicity and birthplace: foreign-born Hispanics had lower rates of stage I tumors at diagnosis (35.4%) compared to U.S.-born Hispanics (40.6%), Hispanics with unknown birthplace (42.3%), and whites (47.4%). Primary treatment also varied: foreign-born and birthplace-unknown Hispanics had lower rates of breast conserving therapy with radiation (34.9%, 30.7%) than U.S.-born Hispanics and whites (41.5%, 38.8%). The authors conclude that among Hispanic and white women, foreign-born Hispanic women are the least likely to be diagnosed at an early stage of breast cancer. Furthermore, if such women are diagnosed with early-stage disease, they are less likely to be treated with lumpectomy plus radiation than U.S.-born Hispanics and whites.

Findings highlight need for further action

Although rates are lower overall for Latinas than Caucasian women, breast cancer is still the most common malignancy among U.S. Latinas. The study confirms the result of previous reports that Latinas are far more likely than Caucasians to be diagnosed at an advanced stage of the disease, when it is likely to be less treatable. Latinas are also more liable than Caucasians to be diagnosed with hormone receptor negative (ER-/PR-) breast cancer, which makes early diagnosis even more urgent since this type has a less favorable prognosis than hormone receptor positive tumors. One positive finding of the study is that, when diagnosed with early-stage breast cancer, U.S.-born Latinas have rates of lumpectomy plus radiation comparable to Caucasians (i.e., compared to mastectomy).

Efforts to improve the stage of diagnosis and optimize the treatment for Latinas have been undertaken by groups such as Latinas Contra Cancer. Centers such as the UCLA Kaiser Permanente Center for Health Equity are also making contributions in addressing disparities between diagnosis, treatment and survival. The study brings up the predicament of foreign-born Latinas, on whom we will focus in our comments.

Strategies that Latina immigrants use to improve their health

Low-income immigrant Latinas are hampered by lack of access to health care and communication barriers with most mainstream health care providers. Some may not have a regular doctor or get regular checkups of any kind. However immigrant Latinas are known to use strategies such as diet, exercise, prayer and other expressions of spirituality, as well as a sense of humor, to maximize their wellbeing and cope with any problems. Thus they actively participate in enhancing their health.

In fact, the diets of many in Latin America are more healthy overall than the typical U.S. diet. The level of physical activity also tends to be higher. Partly as a result, the rates of cancer are lower for those new to this country than those in the second and third generations. While immigrant Latinas urgently require better access to timely breast cancer diagnosis and treatment, the cancer-protective features of their traditions and lifestyles should be valued, encouraged and preserved. Health outreach programs should recognize and build on the positive aspects of the diets and lifestyles of the country of origin while at the same time discouraging the few foods and habits that can increase risk of cancer.