Cultural Cancer Care

Cultural Cancer Care

Northwestern Medicine’s new breast cancer clinic focuses on Hispanic women

Erika Aleman, of Berwyn, was diagnosed in 2022 with triple negative breast cancer — a particularly aggressive form of the disease. She received care at the Lurie Cancer Center at Northwestern Medicine, where Spanish-speaking nurses and doctors helped her better understand the treatment process. Aleman says she felt lucky to have that support in her native language.

“The medical terms are already very complicated,” says Aleman, 44, who migrated to Illinois from Mexico when she was 13. “But when they explained it to me step-by-step, in my language, I felt very confident that I could emerge victorious from this.”

Aleman says she wishes other Spanish-speaking women could have the same support and outcome.

And now, they have that chance. Northwestern Medicine — through the efforts of medical oncologist Claudia Tellez, MD — is prioritizing access to breast cancer treatment for Spanish-speakers through the Lurie Cancer Center Hispanic Breast Cancer Clinic at Northwestern Memorial Hospital. The clinic launched earlier this month. It operates on Fridays, from 8 a.m. to 1 p.m.

Tellez says she felt motivated to launch the clinic after looking at how her patient population reflected the city’s population.

“Through the years, I noticed that maybe 5% or 10% of my patients would be Hispanic, where if you look at the statistics of the city, a third of my patients should really be Hispanic. I think it became obvious pretty early on that these patients were not coming to Northwestern,” says Tellez, who migrated from Colombia when she was a teenager. “I started to investigate a little bit more, and with very few exceptions that’s the trend around the country as well.”

Hispanic women are diagnosed with breast cancer less frequently compared to non-Hispanic white women. Yet when Hispanic women are diagnosed, they tend to be at more advanced stages and are about 30% more likely to die from breast cancer

“This community of women is not undergoing the screening tests that [other] women are undergoing on a regular basis, so they’re not going in for their mammograms or routine breast exams,” Tellez says.

Though the new clinic focuses on treatment — not screening and diagnosis — Tellez says that they offer free second opinions to women who have received a treatment plan from another hospital. That way, the women can either go into their initial plan with more confidence or alter their treatment course.

Barriers to screening and treatment

If patients don’t speak English, seeking medical care can be intimidating throughout every step of the process — from scheduling appointments and navigating the parking lot and building, to communicating with staff.

During her 25 years as an oncologist, Tellez says that Hispanic patients have gravitated towards her because she speaks Spanish.

Samantha Stephenson, behavioral health therapist at City of Hope Chicago, notes that cultural values, family history, and language barriers can keep people out of the doctors office, too.

“Some populations tend to seek holistic or natural healing first. It may generally be unfamiliar to attend routine checkups with physicians because it is not a common practice through generations of the family. Others may avoid medical facilities for fear related to their citizen status or difficulties with the language barrier,” Stephenson says.

Time off work is another barrier, Tellez says. “Many women can’t take time off of work or they have to care for their kids, or paying for a ride to Northwestern is overwhelming,” Tellez says.

Stigma within the Hispanic community may also contribute to disparities. Tellez sees older women who have had tumors for a long time but ignored them or kept them secret from their family due to embarrassment and shame. For younger women, she says the delay often stems from family commitments they feel obligated to uphold.

“[They feel like] there is no room for them to be weak or have an illness because they need to continue to play the different roles they have,” Tellez says.

Care that crosses cultural and linguistic divides

For these reasons and others, Tellez says she’s proud to lead the first breast cancer clinic for Hispanic women in Chicago. In fact, Tellez says the only other Hispanic-specific cancer center she has found in the U.S. is the Latino Cancer Health Equity Research Center in San Antonio, Texas.

The clinic offers personalized care from a team of breast cancer experts, supportive care specialists, and administrative staff who all speak Spanish. The core clinic team includes Tellez, as well as a nurse, medical assistant, social worker, and research assistant.

“My passion is education, and I think with education and understanding you gain empowerment. So many of these patients come and expect to be told what to do, but I’m passionate [about] making people understand what they have, what it means for their prognosis. That empowerment helps them be a partner in their care,” Tellez says.

The clinic also focuses on increasing the number of Hispanic patients participating in clinical trials for breast cancer, an area where they are consistently underrepresented. Clinical trials offer the latest potential treatments, but Black and Hispanic people represent as little as 2% of the participants in them, although they make up 39% of the U.S. population.

Community outreach and partnerships with Hispanic health advocates will help reach people who need the clinic most.

While the most updated, state-of-the-art treatments and clinical studies come out of major academic medical centers, if that type of care is only available to some people, then it creates a health equity issue. And if the care Hispanic people receive doesn’t meet them where they are, how quality can it be?

“It is absolutely essential that care contain culturally informed components to guide treatment and be inclusive of valuable considerations for each patient’s orientation to healthcare,” Stephenson says.

A year after treatment, Aleman is cancer-free. The Hispanic Breast Cancer Clinic wasn’t in place during her time at Northwestern, but she is hopeful that it and other efforts focused on Spanish-speaking patients will help many women in her community.

“This Hispanic clinic will help a lot to obtain more personalized and comfortable care,” she says.

Other Latina-focused breast cancer groups — such as ELLAS (En La Lucha A Sobrevivir) based in Pilsen, and ALAS-Wings, throughout Chicago — work to support and advocate for women diagnosed with breast cancer.