Increased Axillary Nodal Metastasis in Patients with Breast Cancer and Limited English Proficiency

Abstract Background 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). Patients and Methods 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. Results A cohort of 299 patients were included with a total of 304 breast tumors. Patients with LEP comprised 36.1% ( n = 108) of the cohort and were significantly more likely, compared with EP, to be living in an impoverished neighborhood (37.6% versus 25.1%; p = 0.017), underinsured/uninsured (51.3% versus 31.1%; p = 0.0004), and reporting health literacy barriers (79.8% versus 44.6%; p < 0.0001). LEP was significantly associated with axillary nodal metastasis (pN + ) compared with EP (31.2% versus 18.5%; p = 0.012) and was significantly associated with completion axillary lymph node dissection compared with EP (12.8% versus 3.6%; p = 0.0041). Patients with LEP had significantly longer time-to-therapy intervals from biopsy to first therapy compared with EP (52 versus 49 days; p = 0.041). On multivariate analysis, both LEP and delays to first therapy were significantly associated with axillary nodal metastasis. Conclusions 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.