K. M. HoSang1, T. P. Gao1, D. Tabla Cendra1, T. J. Gao3, A. D. Williams2, M. Pronovost1, L. E. Kuo1 1Temple University, Surgery, Philadelpha, PA, USA 2Fox Chase Cancer Center, Breast Surgery, Philadelphia, PA, USA 3Thomas Jefferson University, Philadelphia, PA, USA
Introduction: Early detection of breast cancer through screening mammography is crucial to reducing the risk of associated mortality. Patients often utilize the internet to learn more about health conditions, and information obtained online has the potential to influence decision-making. However, the accuracy of material online regarding breast cancer screening is unknown, and non-English speaking patients may face additional challenges based upon information available in their primary language. This study assesses the quality of online information regarding breast cancer screening in the three most-common languages spoken in the United States (US): English, Spanish, and Chinese.
Methods: Three search engines (Google, Yahoo, and Bing) were queried in July 2023. The terms “when do I need a mammogram” and “how to do a breast exam” were searched in three languages: English, Spanish, and simplified Chinese. The resulting websites were classified as academic, hospital-affiliated, foundation/advocacy, commercial, or unspecified; the origin (US or foreign) was noted. For each language, two fluent reviewers assessed each website. Quality of information was assessed using the JAMA Benchmark Criteria (score range 0-4), the DISCERN Instrument (score range 1-5), and the presence of a Health On the Net code (HONcode) seal. Scores from each reviewer were averaged to result in a final score for each language. Kappa scores calculated the degree of interrelatability between reviewers. Quality scores were compared between languages using chi-square analysis or one-way analysis of variance (ANOVA) as appropriate. A p<0.05 was considered statistically significant.
Results: Forty websites were reviewed for each language. Nine (7.5%) websites had an HONcode seal present. The majority (63%) of websites were US based. English language websites were primarily hospital-affiliated (37.5%), while Spanish and Chinese-language websites were predominantly from a foundation/advocacy source (42.5 and 45%, respectively). The mean JAMA score for English, Spanish, and Chinese-language websites were 2.3 ± 1.35, 1.8 ± 1.13, and 1.14 ± 0.77, respectively (p<0.001). The mean DISCERN score for English, Spanish, and Chinese-language websites were 3.61 ± 0.98, 3.33 ± 0.78, and 2.39 ± 0.55, respectively (p<0.001). The degree of interrater reliability for JAMA and DISCERN scores in English, Spanish, and Chinese showed a moderate degree of agreement (p<0.001).
Conclusion: The quality of online patient accessible information in the three most common languages in the US for breast cancer screening is overall poor. Notably, there were differences in the quality of information by language, as quality scores for Spanish and Chinese-language were significantly lower than English-language websites. There is ample opportunity to improve the quality of information provided to patients online, particularly in non-English languages.