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This content is from the “Advancing the Science of Cancer in Latinos: 2024 Conference Proceedings.”
Structural Determinants of Health Impacting Latino Cancer Health Disparities: Genetic Cancer Risk Assessment
Dr. Alejandra Hurtado de Mendoza is an Assistant Professor at the Cancer Prevention and Control Program at Georgetown Lombardi Comprehensive Cancer Center.
Disparities across the continuum

Dr. Hurtado de Mendoza’s presentation focused on disparities in genetic cancer risk assessment, multi-level barriers that Latinos face across the genetic cancer risk assessment continuum, and an example of a multilevel intervention to decrease disparities. The presentation began by discussing how disparities in the genetic cancer risk assessment continuum begin with awareness. Only 23% of Latino individuals were aware of cancer genetic testing in 2020, compared with 26% of Black/African American individuals and 42% of Non-Hispanic White individuals. Further evaluation showed that awareness of genetic testing was associated with higher household income and level of education.
Beyond awareness, screening and referrals are the next steps in the genetic cancer risk assessment continuum. One recent systematic literature review characterized strategies to identify at-risk individuals outside specialty settings and described the extent to which these strategies have extended the reach of genetic services to underserved target populations. In this nascent area of research, the review found that most interventions used brief screening tools plus institutional support. Although the findings were promising in terms of expanding the reach of cancer genetic services, there is limited research on the barriers to and facilitators for implementation. In addition, little is known about the scaling of these strategies.
Disparities in genetic counseling and testing are often rooted in access, with cost being a limiting factor for many patients. The scarcity of Spanish-speaking genetic counselors also contributes to these disparities, with the language barrier leading to frequent miscommunications. One potential solution may be alternative delivery models such as genetic counselor extenders (e.g. group counseling), telephone genetic counseling, and patient-facing materials such as brochures and websites.
Disparities in follow-up risk management are also a factor. Current translational genetics research focuses primarily on utilization of genetic testing, and inequities in this area. However, it is vital to address barriers to downstream care especially for patients from underserved groups. This means consideration of barriers at the health system-level, clinician-level, and patient-level.
An educational video
One example of a multilevel intervention to decrease disparities involves recent research by Dr. Hurtado de Mendoza and colleagues. As part of the work, interviews with providers and at-risk women revealed both barriers to (health care access, low awareness) and facilitators for (education on how testing can inform family risk and treatment and prevention decisions) genetic counseling and testing. In partnership with academic institutions, artists, and community based organizations, an educational video was developed in response to this formative work.
A single arm pilot study was then conducted assessing the video’s effectiveness. Results of the pilot showed statistically significant increases in knowledge (p<.001), intentions (p=.001), positive attitudes (p=.04) and emotions (p=.04) towards genetic counseling and testing. Furthermore, participants reported high satisfaction with the video, with 67% attending genetic counseling.
Following the single arm pilot study, a randomized controlled trial called the CONTIGO study was initiated with the aim of assessing the efficacy of the culturally targeted narrative video in enhancing genetic counseling and testing uptake, compared with a fact sheet. The study also seeks to assess the barriers to and facilitators for implementing hereditary breast and ovarian cancer (HBOC) screening tools at community based organizations. The study aims to recruit 300 at-risk Latina participants to randomize them into a video arm (n=150) and a fact sheet arm (n=150). Two-week follow-up surveys and four-month follow-up surveys are planned.
Telephone counseling and future work
Telephone genetic counseling (TGC) can be an alternative strategy to enhance reach and access to genetic counseling and testing. TGC is safe, acceptable, effective, and less costly than in-person genetic counseling. It also reduces logistic barriers and can facilitate access to Spanish-speaking counselors. However, studies show that TGC can lead to lower testing uptake compared to in-person genetic counseling, especially in patients from minority groups, patients with high distress and risk perceptions, or those with a lower education.
Future work in this area involves the assessment of barriers to and facilitators for the completion of genetic testing in response to telephone genetic counseling. Dr. Hurtado de Mendoza and colleagues also plan to refine culturally targeted materials and develop a community based organization toolkit that helps employees navigate genetic counseling and testing and provides them with risk management tools. Partnership with advocacy organizations will be a priority throughout these efforts.
The Critical Role of Language in Latino Cancer and Health Outcomes
Dr. Glenn A. Martinez is the Dean of the College of Liberal and Fine Arts, Professor of Spanish Bicultural/Bilingual Studies and Public Health, and Stumberg Distinguished University Chair at the University of Texas San Antonio.
Language Concordance

Dr. Marinez’s presentation covered 4 main topics: language concordance and the promise of “direct in-language communication” for Latino health, language concordance and cancer, the National Association of Medical Spanish, and the Physician Oral Language Observation Matrix (POLOM). The presentation began by discussing language concordance and its impact on Latino health. According to the US Department of Health and Human Services (HHS), part of language concordance is the hiring and equitably supporting of “qualified bilingual and multilingual staff, and staff proficient in American Sign Language (ASL), to provide direct ‘in-language’ communication.”
Language concordance offers many advantages, including improved quality of care, with patients that are less likely to feel confused and frustrated, and greater patient satisfaction. Likewise, health outcomes are positively affected, with improvements noted in glycemic control, medication adherence, and understanding of medication and dosage. Finally, relationship factors are impacted by language concordance, with greater agreement with physician recommendations, more questions asked by the patient, and greater disclosure of sensitive information.
In the specific area of cancer in Latino patients, language concordance also plays a major role. Although language concordance seems to have no effect on the likelihood of Spanish speakers to obtain screening, it is associated with timelier resolution of abnormalities within 90 days. Furthermore, language concordance is associated with greater communication of biomedical information from providers, and greater agreement among patients. Finally, language concordance is associated with more general satisfaction among cancer patients, improved perceived interpersonal skills of the care team, and greater time spent with patients.
The National Association of Medical Spanish
In light of these improved outcomes, it is imperative to build a pipeline of Spanish-speaking providers to address cancer in Latinos. The National Association of Medical Spanish was formed in response to this need. Although the association is composed of physicians, professors, and other professionals, the largest portion of members (44%) are medical students. This infusion of youth in the area of language concordance provides hope for the future of Spanish-speaking medical professionals.
Several core competencies were proposed by the Association at the Medical Spanish Summit. First, fluency in Spanish is not sufficient for medical professionals; medical Spanish knowledge regarding organ systems and common disease entities are also needed. Second, providers must be able to provide patient-centered explanations of medical diagnoses and treatment plans. Finally, providers must achieve a self-assessed confidence that allows them to have meaningful patient interactions.
Many collaborators have made key contributions to the foundation of the National Association of Medical Spanish, including Drs. Glenn Martinez, Alyssia Miller De Rutte, Pilar Ortega, Marco Aleman, Alejandra Zapien Hidalgo, Cristina Perez-Cordon, Robert Mueller, Karol Hardin, Lisa Diamond, and Norma A. Perez.
The Physician Oral Language Observation Matrix
Another tool for the advancement of language concordance is the Physician Oral Language Observation Matrix (POLOM), which is a rater-based tool for assessment of medical oral language skills as contextualized for patient care. This matrix provides a way to reliably evaluate whether a physician is ready to perform their patient care responsibilities in a non-English language. The goal of the POLOM is to improve health outcomes and satisfaction for patients, to support multilingual physicians and enhance wellbeing, and to address patient communication aspects of all medical specialties.
The six categories assessed by the POLOM are comprehension, fluency/fluidity, vocabulary, pronunciation, grammar, and communication. Each category is rated on a scale of 1 to 5. Level 5 for comprehension, for example, indicates that the candidate understands conversation at normal speed without difficulty. Occasional requests for clarification of regionalisms, or repetition of the same word or phrase, may be acceptable in the context of overall excellent comprehension for Level 5.
With organizations like the National Association for Medical Spanish, and tools like the POLOM, the future of language concordance looks somewhat brighter. This future may be filled with better provider-patient communication, leading to greater trust and more positive patient outcomes.
Access to Psychosocial Care for Latinos in the US and Latin America
Dr. Rosario Costas-Muñiz is Assistant Attending Psychologist in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center.
Psychosocial Care for Latinos

Dr. Costas-Muñiz’s presentation began by focusing on several key messages:
- “Psychological and social problems created or exacerbated by cancer – including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life – cause additional suffering, weaken adherence to treatments, and threaten patients’ return to health.”
- Latinos have a different pattern of access, use, and availability of psychosocial services and face unique challenges in accessing psychosocial care.
- Psychosocial oncology is either not established or not completely established, or not an integral part of cancer care for Latino patients in many countries, especially developing nations, where basic care is sometimes not provided to cancer patients.
- Interventions for Latino cancer patients are being developed, adapted, tested, and studied, but they need to be developed or adapted with a cultural, linguistic, and contextual lens, drawing from intervention development, cultural adaptation, and implementation and dissemination science.
- Professional networks like the Formación de Investigacion Psicosocial Oncológica Latinoamenricana (FIPOL) network can promote the field by implementing initiatives in capacity building, research collaborations, resources development, and science dissemination and communication.
Mental health and distress screening and management is mandated or recommended by several organizations, including the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the International Psycho-Oncology Society (IPOS) Standard on Quality Cancer Care. However, studies have shown that racial and ethnic minority (REM) patients in the US show significantly worse depression than non-Hispanic White patients. Those with limited English proficiency and lower income are at even higher risk. Furthermore, REM patients are less likely to receive psychological or psychiatric services and interventions.
A recent study published by Dr. Costas-Muñiz and colleagues assessed a sample of 265 Latina and non-Latina White women who received treatment in a comprehensive cancer center in New York City. A similar proportion of both cohorts expressed a need for mental health, discussed this need with their cancer care provider, and received a referral. However, significantly fewer Latina patients had contact with a mental health professional, received psychosocial services, had contact with social workers, or received psychotropic medication.
The greatest barrier to psychosocial care was the desire to return to normal. Patients who reported this desire had less access to mental health therapy, either individual or group therapy, and had fewer contacts with mental health providers. Other barriers included not understanding the benefits of mental health therapy, not knowing where they can receive services, stigma about mental health, the belief that it is normal to have emotional discomfort, the belief that providers will not understand cultural background or values, and feeling uncomfortable with interpreters, if necessary.
Interventions for Latino Cancer Patients
Dr. Costas-Muñiz and colleagues are also currently conducting a systematic review of studies evaluating interventions for Latino cancer patients. Of over 13,000 titles reviewed, 140 have been included in the study and discuss interventions such as cancer education, palliative care, exercise or nutrition, relaxation techniques, parenting intervention, multimodal intervention, medication, survivorship care plan, cognitive behavioral therapy (CBT), and cognitive behavioral therapy for insomnia (CBT-i).
A great need exists to support these interventions in the context of psycho-oncology care for Latino cancer patients, caregivers, families, and community members. This support should come in the form of policy changes, evidence-based practice guidelines and recommendations, training for providers and researchers, and research collaboration.
FIPOL
In response to this great need, in 2017, the Formación de Investigacion Psicosocial Oncológica Latinoamenricana (FIPOL) was founded to connect clinicians, educators, and researchers from Latin America and Spanish-speaking countries interested in psychosocial oncology, behavioral medicine, and palliative care. FIPOL’s unique approach is centered in interregional collaboration with the aim of psychosocial oncology capacity building. Activities include hosting seminars and courses, developing collaborative research projects and programs, disseminating psychosocial oncology research, and distributing information about training opportunities, collaborations, and developments in the field.
Several lessons have been learned through this important collaboration. First, there is a need for further development, study, and cultural adaptation of interventions in the oncological context for patients, survivors, and caregivers/family members. Second, greater access to training and clinical and research resources is needed. Finally, there is a need for validated instruments and/or having access to validated instruments in the context of cancer to support clinical work and research. FIPOL has already begun to develop tools to address these important needs.
By The Numbers
142
Percent
Expected rise in Latino cancer cases in coming years