Understanding of breast cancer concepts in an undereducated county hospital population.
Authors: Bouton MP , Green A , Komenaka IK 
Published: December 2010

Abstract
Abstract #2102
Objectives: The purpose of this study was to determine whether patients at a county institution are sufficiently knowledgeable about breast cancer concepts to make informed decisions about their care.&#x2028; Methods: An 11 question multiple choice examination was devised at a Flesch-Kincaid grade level of 5.8. This was administered to patients prior to undergoing their definitive cancer operation to which they had previously consented. The completed test was reviewed with the patient prior to surgery, and all incorrect answers were thoroughly discussed.&#x2028; Results: Forty-one of 42 consecutive women agreed to participate in the study. Seventy-eight percent self identified as Latin American, 15% Caucasian, and 7% African American. Fifty-nine percent of respondents chose to receive their test in Spanish and 41% chose the English version. The educational backgrounds of participants were: 64% less than high school, 12% finished high school, 24% had some college education.&#x2028; These undereducated patients demonstrated some understanding of their operative procedure. For the question “Which surgery gives me a better chance to live?” 51% said mastectomy and lumpectomy are equal, 33% thought mastectomy was superior, and 16% felt lumpectomy was superior. Of those who felt mastectomy was better, 38% still chose to undergo a lumpectomy. In response to the question which we expected to be most difficult, “What is a sentinel lymph node?” 63% selected the correct answer.&#x2028; There was a significant correlation between highest level of education with test score (p = 0.001) and between employment status with test score (p = 0.001). Age, insurance status, household income, and ethnicity did not correlate with test score. The average score for those with less than a high school education was significantly lower than those who at least completed high school (mean 5.5 vs. 8.3, p = 0.002). The patients who chose the exam in Spanish scored lower than those who chose the exam in English (mean 6 vs. 7.8, p = 0.04).&#x2028; Of interest, 88% of respondents understood that mammograms are important because “they find cancers when they are small and save lives.” Sixty-two percent of the patients, however, did not get screening mammograms. The most common reasons patients reported for lack of compliance with screening recommendations was the cost of mammograms (33%), they had no family history (24%), and they had “no problem” with their breasts (19%).&#x2028; Conclusion: Although patients felt subjectively that they had enough information to sign an informed consent prior to their operation, this examination revealed deficits in the understanding of this undereducated population. Higher level of education and employment status did correlate with improved score on the test. Despite their low level of education, the patients recognize the importance of mammography. Their reasons for not undergoing mammograms, however, indicate that they may not understand the concept of screening nor how to access this important tool.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2102.