AbstractBackground and objectivesThe purpose of this study was to determine how well breast cancer patients at a County hospital understood breast cancer concepts and treatment at time of operation.MethodsAn 11 question multiple‐choice examination was devised at a Flesch‐Kincaid grade level of 5.8. This was administered to patients prior to undergoing their definitive cancer operation.ResultsForty‐one of 42 consecutive women agreed to participate in the study. Seventy‐eight percent self identified as Hispanic and 64% had less than a High School education. For the question “Which surgery gives me a better chance to live?” 51% said mastectomy and lumpectomy are equal and 33% thought mastectomy was superior. Interestingly, 88% of respondents understood that screening mammograms are important. Sixty‐two percent of the patients, however, did not get screening mammograms. Multivariate analysis revealed that highest level of education (P < 0.001) and employment status (P = 0.007) correlated significantly with test score. Age, insurance status, household income, and ethnicity did not significantly predict test score.ConclusionAlthough the correct answer was the most frequently selected answer, this examination revealed deficits in the understanding of this undereducated population. Higher level of education and employment status did correlate with improved score. J. Surg. Oncol. 2010;102:398–403. © 2010 Wiley‐Liss, Inc.