For women whose first language is Spanish, translation may be an issue. They may have a hard time finding a physician with whom they feel comfortable, and who can adequately explain treatment options and procedures.
When family members step in to translate to doctors, some women hold back important details. For instance, one woman Graves met didn't tell her doctor about the problems with sexual functioning she was having during treatment, because her daughter was translating for her.
In her study, Graves will be testing an intervention in which survivors and caregivers share their concerns separately, in different groups, led by a facilitator, and then everyone comes together to talk about the topic.
When tried on a smaller scale, "(facilitators) delivered information separately to the survivors and caregivers; it seemed that each group could open up further and talk about their own specific needs," Graves said.
Another community organization supporting Hispanic breast cancer patients is called Comadre a Comadre in Albuquerque, New Mexico. A comadre is a "non-biological close female kinship" in "the Hispanic/Latino extended family unit," the website explains.
This group was founded by six survivors and director Elba Saavedra, who is also an assistant professor for research at the University of New Mexico College of Education.
The organization works with women in a nonclinical setting, giving them resources and support during their breast cancer treatment. A grant from the Susan G. Komen for the Cure helped jump-start Comadre a Comadre in 2003. The organization offers support groups and classes in Spanish and English, one-on-one support and financial assistance.
Comadre a Comadre is trying to get out positive messages about screening and break down some of the cultural barriers. For instance, many women put the needs of the rest of their family before their own.
"We need to be there for children and grandchildren; it's important we get in there and get those mammograms," Saavedra said.
Dalila Romero, a co-founder of Comadre a Comadre, had breast cancer in her mid-40s. At the time, she had recently lost her mother to pancreatic cancer.
The support group she tried didn't resonate with her; she couldn't connect with the women there, who had different backgrounds and life stories from her own.
"Not knowing the resources in the community, I had to basically support myself because I didn't know what the outcome was going to be," Romero said.
Now she goes with women with recent diagnoses to their initial appointments for chemotherapy, radiation and surgery to help them navigate the system.
Some women are private about their struggle with cancer, so much so they don't want to sit around other women who have it. Romero knows of one woman who moved because she didn't want anyone in her town to know she had cancer.
When she learned about Nueva Vida, Rodriguez immediately liked the idea of finding support in other women who also had cancer, but she held back at first in telling her parents in Peru until doctors were sure of what it was.
"I didn't want my mom to get sad because she's over there and I'm here," she said. "I didn't want to worry them. I took time to tell them."
Clear of cancer, Rodriguez is currently a Zumba instructor through Nueva Vida, and loves teaching. The women in this organization have a lot of need, she said.
They are, she said, her "sister survivors."