Adapting global tools for local realities: Linguistic validation of the BREAST-Q BCT module in Hindi and Marathi for breast cancer surgical management in India

Background: Patient-Reported Outcome Measures (PROMs) like BREAST-Q are vital for understanding patients' health and QoL after breast cancer treatment. However, its English-only format limits use in India, where cultural and language barriers affect data accuracy. With an 80 % breast-conserving surgery (BCS) rate at our center, far above the national average, capturing the unique socio-cultural experiences of Indian patients is crucial. This study focused on translating and validating the BREAST-Q BCT module into Hindi and Marathi to enhance its relevance in India. Methods: Following Q-Portfolio guidelines, the BREAST-Q BCT module underwent a rigorous linguistic validation process. This included two forward translations, reconciliation, back-translation, and cognitive debriefing with 15 native speakers each for Hindi and Marathi. Patients reviewed the clarity and cultural appropriateness of the translations, providing feedback that informed refinements to ensure conceptual equivalence. Results: The final translated versions of the BREAST-Q BCT module were completed and tested with a test cohort of 70 patients who underwent BCS. Patients were given the choice of their preferred language: 40 chose Marathi, 20 Hindi, and 10 English. Response rates improved significantly, from 83 % in previous cohorts to 94 % with the translated versions. Internal consistency and psycho-sociometric assessment for translated versions is ongoing. Conclusion: The linguistic validation of the BREAST-Q BCT module is a key step in breaking language barriers in India. However, a PROMs tool tailored to India's unique socio-cultural context is essential to fully capture the experiences of breast cancer patients.