{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T23:19:30Z","timestamp":1788909570697,"version":"build-2803163510"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with breast cancer and limited English proficiency (LEP) experience barriers to care that may result in greater disease burden. We aim to evaluate breast cancer presentation and pathologic characteristics of patients with LEP compared with patients with English proficiency (EP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We performed an institutional review board (IRB)-approved, retrospective review of prospectively collected patient-reported data among a multilingual population evaluated within a New York City safety-net health system between 2018 and 2025. Comparative analysis and logistic regression were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A cohort of 299 patients were included with a total of 304 breast tumors. Patients with LEP comprised 36.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009108) of the cohort and were significantly more likely, compared with EP, to be living in an impoverished neighborhood (37.6% versus 25.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), underinsured\/uninsured (51.3% versus 31.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004), and reporting health literacy barriers (79.8% versus 44.6%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001). LEP was significantly associated with axillary nodal metastasis (pN\n                      <jats:sup>+<\/jats:sup>\n                      ) compared with EP (31.2% versus 18.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) and was significantly associated with completion axillary lymph node dissection compared with EP (12.8% versus 3.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0041). Patients with LEP had significantly longer time-to-therapy intervals from biopsy to first therapy compared with EP (52 versus 49 days;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041). On multivariate analysis, both LEP and delays to first therapy were significantly associated with axillary nodal metastasis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with breast cancer and LEP were significantly more likely to have axillary nodal metastasis compared with patients with EP. Increased axillary nodal metastasis in this population may, in part, be due to lack of screening and delays to breast cancer treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20422-9","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:50:55Z","timestamp":1787597455000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Increased Axillary Nodal Metastasis in Patients with Breast Cancer and Limited English Proficiency"],"prefix":"10.1245","author":[{"given":"Thomas","family":"Amburn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Louie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Schwartz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"McFarlane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ravenell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathie-Ann","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"2","key":"20422_CR1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.pec.2010.07.009","volume":"84","author":"LS Karliner","year":"2011","unstructured":"Karliner LS, Hwang ES, Nickleach D, Kaplan CP. Language barriers and patient-centered breast cancer care. Patient Educ Couns. 2011;84(2):223\u20138. https:\/\/doi.org\/10.1016\/j.pec.2010.07.009.","journal-title":"Patient Educ Couns."},{"key":"20422_CR2","unstructured":"U.S. Census Bureau. Language Spoken at Home. American Community Survey \u201cWhy we ask each question.\u201d Census.gov. Updated 2024. https:\/\/www.census.gov\/acs\/www\/about\/why-we-ask-each-question\/language\/. Accessed 25 February 2025."},{"issue":"10","key":"20422_CR3","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1002\/pon.4176","volume":"25","author":"GK Perez","year":"2016","unstructured":"Perez GK, Mutchler J, Yang MS, et al. Promoting quality care in patients with cancer with limited English proficiency: perspectives of medical interpreters. Psychooncology. 2016;25(10):1241\u20135. https:\/\/doi.org\/10.1002\/pon.4176.","journal-title":"Psychooncology."},{"issue":"4","key":"20422_CR4","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.surg.2024.06.025","volume":"176","author":"A Hernandez Alvarez","year":"2024","unstructured":"Hernandez Alvarez A, Escobar-Domingo MJ, Lee D, et al. Beyond the language barrier: assessing health literacy of Spanish breast cancer surgery resources. Surgery. 2024;176(4):1029\u201335. https:\/\/doi.org\/10.1016\/j.surg.2024.06.025.","journal-title":"Surgery."},{"issue":"12","key":"20422_CR5","doi-asserted-by":"publisher","first-page":"e31338","DOI":"10.1002\/pbc.31338","volume":"71","author":"JM Robles","year":"2024","unstructured":"Robles JM, Ruiz J, Correa R, Dinescu-Munoz N, Patel C, Noyd D, Alvarez M, Frost E, Ledbetter L, LeBlanc TW. The impact of language discordance on pediatric cancer care outcomes: a systematic review. Pediatr Blood Cancer. 2024;71(12):e31338. https:\/\/doi.org\/10.1002\/pbc.31338.","journal-title":"Pediatr Blood Cancer."},{"issue":"9","key":"20422_CR6","doi-asserted-by":"publisher","first-page":"951","DOI":"10.6004\/jnccn.2023.7037","volume":"21","author":"DW Chen","year":"2023","unstructured":"Chen DW, Banerjee M, He X, et al. Hidden disparities: how language influences patients\u2019 access to cancer care. J Natl Compr Canc Netw. 2023;21(9):951-959.e1. https:\/\/doi.org\/10.6004\/jnccn.2023.7037.","journal-title":"J Natl Compr Canc Netw."},{"issue":"2","key":"20422_CR7","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.clbc.2022.11.008","volume":"23","author":"JL Cataneo","year":"2023","unstructured":"Cataneo JL, Meidl H, Ore AS, et al. The impact of limited language proficiency in screening for breast cancer. Clin Breast Cancer. 2023;23(2):181\u20138. https:\/\/doi.org\/10.1016\/j.clbc.2022.11.008.","journal-title":"Clin Breast Cancer."},{"issue":"6","key":"20422_CR8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.14036","volume":"8","author":"DY Spiegel","year":"2025","unstructured":"Spiegel DY, Levey J, Modest A, et al. Non-English language preference and breast cancer outcomes. JAMA Netw Open. 2025;8(6):e2514036. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.14036.","journal-title":"JAMA Netw Open."},{"issue":"8","key":"20422_CR9","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2020.7797","volume":"19","author":"KE Balazy","year":"2021","unstructured":"Balazy KE, Benitez CM, Gutkin PM, Jacobson CE, von Eyben R, Horst KC. Delays in care associated with non-English-speaking patients with breast cancer. J Natl Compr Canc Netw. 2021;19(8):e20467. https:\/\/doi.org\/10.6004\/jnccn.2020.7797.","journal-title":"J Natl Compr Canc Netw."},{"issue":"2","key":"20422_CR10","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1200\/OP.23.00446","volume":"20","author":"MV Ragavan","year":"2024","unstructured":"Ragavan MV, Swartz S, Clark M, et al. Access to financial assistance programs and their impact on overall spending on oral anticancer medications at an integrated specialty pharmacy. JCO Oncol Pract. 2024;20(2):291\u20139. https:\/\/doi.org\/10.1200\/OP.23.00446.","journal-title":"JCO Oncol Pract."},{"key":"20422_CR11","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.annepidem.2020.09.005","volume":"54","author":"EL Herbach","year":"2021","unstructured":"Herbach EL, Weeks KS, O\u2019Rorke M, et al. Disparities in breast cancer stage at diagnosis between immigrant and native-born women: a meta-analysis. Ann Epidemiol. 2021;54:64-72.e7. https:\/\/doi.org\/10.1016\/j.annepidem.2020.09.005.","journal-title":"Ann Epidemiol."},{"issue":"8","key":"20422_CR12","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.2105\/AJPH.2004.041418","volume":"95","author":"EA Jacobs","year":"2005","unstructured":"Jacobs EA, Karavolos K, Rathouz PJ, et al. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95(8):1410\u20136. https:\/\/doi.org\/10.2105\/AJPH.2004.041418.","journal-title":"Am J Public Health."},{"issue":"12","key":"20422_CR13","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1002\/cncr.32027","volume":"125","author":"KE Balazy","year":"2019","unstructured":"Balazy KE, Benitez CM, Gutkin PM, et al. Association between primary language, a lack of mammographic screening, and later stage breast cancer presentation. Cancer. 2019;125(12):2057\u201365. https:\/\/doi.org\/10.1002\/cncr.32027.","journal-title":"Cancer."},{"key":"20422_CR14","unstructured":"US Department of Agriculture, Economic Research Service. Poverty area measures: background and uses. Updated 30 September 2025. https:\/\/www.ers.usda.gov\/data-products\/poverty-area-measures\/background-and-uses. Accessed 23 March 2026.\u00a0"},{"issue":"4","key":"20422_CR15","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1007\/s12282-023-01456-3","volume":"30","author":"R Pathak","year":"2023","unstructured":"Pathak R, Leslie M, Dondapati P, et al. Increased breast cancer mortality due to treatment delay and needle biopsy type: a retrospective analysis of SEER-Medicare. Breast Cancer. 2023;30(4):627\u201336. https:\/\/doi.org\/10.1007\/s12282-023-01456-3.","journal-title":"Breast Cancer."},{"issue":"20","key":"20422_CR16","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.1200\/JCO.19.02896","volume":"38","author":"SA McLaughlin","year":"2020","unstructured":"McLaughlin SA, Brunelle CL, Taghian A. Breast cancer-related lymphedema: risk factors, screening, management, and the impact of locoregional treatment. J Clin Oncol. 2020;38(20):2341\u201350. https:\/\/doi.org\/10.1200\/JCO.19.02896.","journal-title":"J Clin Oncol."},{"issue":"1","key":"20422_CR17","doi-asserted-by":"publisher","first-page":"12091","DOI":"10.1038\/s41598-023-39259-3","volume":"13","author":"S Zhu","year":"2023","unstructured":"Zhu S, Li S, Huang J, et al. Time interval between breast cancer diagnosis and surgery is associated with disease outcome. Sci Rep. 2023;13(1):12091. https:\/\/doi.org\/10.1038\/s41598-023-39259-3.","journal-title":"Sci Rep."},{"key":"20422_CR18","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2025.101526","volume":"61","author":"LEM Duijm","year":"2025","unstructured":"Duijm LEM, van der Veer EL, van Beek HC, et al. Frequency and survival of delayed breast cancer diagnosis in women participating in screening mammography in the Netherlands: a population-based study. Lancet Reg Health Eur. 2025;61:101526. https:\/\/doi.org\/10.1016\/j.lanepe.2025.101526.","journal-title":"Lancet Reg Health Eur."},{"issue":"4","key":"20422_CR19","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.5322","volume":"8","author":"S Huang","year":"2025","unstructured":"Huang S, Westvold SJ, Soulos PR, et al. Screening history, stage at diagnosis, and mortality in screen-detected breast cancer. JAMA Netw Open. 2025;8(4):e255322. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.5322.","journal-title":"JAMA Netw Open."},{"issue":"3","key":"20422_CR20","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1093\/jbi\/wbad109","volume":"6","author":"YZ Feliciano-Rivera","year":"2024","unstructured":"Feliciano-Rivera YZ, Yepes MM, Sanchez P, et al. Appropriate use of medical interpreters in the breast imaging clinic. J Breast Imaging. 2024;6(3):296\u2013303. https:\/\/doi.org\/10.1093\/jbi\/wbad109.","journal-title":"J Breast Imaging."},{"key":"20422_CR21","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006707","author":"BM Dacier","year":"2025","unstructured":"Dacier BM, Jones AN, Allar BG, et al. Language serving hospitals and their impact on readmission for surgical patients with a non-english primary language: a retrospective cohort study. Ann Surg. 2025. https:\/\/doi.org\/10.1097\/SLA.0000000000006707.","journal-title":"Ann Surg."},{"issue":"4","key":"20422_CR22","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1097\/SLA.0000000000006828","volume":"282","author":"CP Miller","year":"2025","unstructured":"Miller CP, Le T, Amburn T, et al. Living in a disadvantaged NYC neighborhood is associated with poorly differentiated breast cancer and shorter breast cancer-specific survival. Ann Surg. 2025;282(4):570\u20139. https:\/\/doi.org\/10.1097\/SLA.0000000000006828.","journal-title":"Ann Surg."},{"issue":"16","key":"20422_CR23","doi-asserted-by":"publisher","first-page":"3125","DOI":"10.1002\/cncr.30722","volume":"123","author":"CD Hsu","year":"2017","unstructured":"Hsu CD, Wang X, Habif DV Jr, Ma CX, Johnson KJ. Breast cancer stage variation and survival in association with insurance status and sociodemographic factors in US women 18 to 64 years old. Cancer. 2017;123(16):3125\u201331. https:\/\/doi.org\/10.1002\/cncr.30722.","journal-title":"Cancer."},{"issue":"1","key":"20422_CR24","first-page":"3061","volume":"6","author":"SS Coughlin","year":"2020","unstructured":"Coughlin SS, Vernon M, Hatzigeorgiou C, et al. Health literacy, social determinants of health, and disease prevention and control. J Environ Health Sci. 2020;6(1):3061 (PMID:33604453).","journal-title":"J Environ Health Sci."},{"issue":"2","key":"20422_CR25","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","volume":"155","author":"ND Berkman","year":"2011","unstructured":"Berkman ND, Sheridan SL, Donahue KE, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97\u2013107. https:\/\/doi.org\/10.7326\/0003-4819-155-2-201107190-00005.","journal-title":"Ann Intern Med."},{"key":"20422_CR26","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1471-2458-12-80","volume":"12","author":"K S\u00f8rensen","year":"2012","unstructured":"S\u00f8rensen K, Van den Broucke S, Fullam J, et al. HLS-EU Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. https:\/\/doi.org\/10.1186\/1471-2458-12-80.","journal-title":"BMC Public Health."},{"issue":"3","key":"20422_CR27","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1007\/s10549-019-05340-7","volume":"177","author":"S Steven","year":"2019","unstructured":"Steven S, Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat. 2019;177(3):537\u201348. https:\/\/doi.org\/10.1007\/s10549-019-05340-7.","journal-title":"Breast Cancer Res Treat."},{"key":"20422_CR28","doi-asserted-by":"publisher","first-page":"1188783","DOI":"10.3389\/fpsyg.2023.1188783","volume":"14","author":"JJ Shi","year":"2023","unstructured":"Shi JJ, McGinnis GJ, Peterson SK, et al. Pilot study of a Spanish language measure of financial toxicity in underserved Hispanic cancer patients with low English proficiency. Front Psychol. 2023;14:1188783. https:\/\/doi.org\/10.3389\/fpsyg.2023.1188783.","journal-title":"Front Psychol."},{"issue":"1","key":"20422_CR29","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1177\/08404704241265675","volume":"38","author":"ML Wiedmeyer","year":"2025","unstructured":"Wiedmeyer ML, Machado S, Tayyar E, et al. How immigration shapes health disadvantages and what healthcare organizations can do to deliver more equitable care. Healthc Manage Forum. 2025;38(1):16\u201322. https:\/\/doi.org\/10.1177\/08404704241265675.","journal-title":"Healthc Manage Forum."},{"key":"20422_CR30","doi-asserted-by":"publisher","first-page":"9","DOI":"10.21037\/jphe-22-72","volume":"7","author":"EA Alsrayheen","year":"2023","unstructured":"Alsrayheen EA, Aldiabat K, Aquino-Russell C. Impact of social determinants of health on immigrant women\u2019s cancer prevalence, outcomes, and survival experiences: narrative review. J Public Health Emerg. 2023;7:9. https:\/\/doi.org\/10.21037\/jphe-22-72.","journal-title":"J Public Health Emerg."},{"key":"20422_CR31","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1186\/1471-2407-10-603","volume":"10","author":"TH Keegan","year":"2010","unstructured":"Keegan TH, Quach T, Shema S, et al. The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women. BMC Cancer. 2010;10:603. https:\/\/doi.org\/10.1186\/1471-2407-10-603.","journal-title":"BMC Cancer."},{"issue":"7","key":"20422_CR32","doi-asserted-by":"publisher","first-page":"440","DOI":"10.4236\/jct.2022.137039","volume":"13","author":"A Hernandez","year":"2022","unstructured":"Hernandez A, Reyes CL, Garcia I, Palacios RL. I felt defeated. I felt helpless\u201d: social determinants of health influencing the cancer survivorship of a young Latina mother. J Cancer Ther. 2022;13(7):440\u20139. https:\/\/doi.org\/10.4236\/jct.2022.137039.","journal-title":"J Cancer Ther."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-20422-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-20422-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-20422-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:50:57Z","timestamp":1787597457000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-20422-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":32,"alternative-id":["20422"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-20422-9","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"assertion":[{"value":"26 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflict of interest.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}}]}}