Readability of online patient resources for the operative treatment of breast cancer

Surgery. 2014 Aug;156(2):311-8. doi: 10.1016/j.surg.2014.03.004. Epub 2014 Mar 14.


Background: Increasing use of Internet resources for health information is important in promoting patient involvement in medical care and decision-making. The National Institutes of Health and American Medical Association have recommended that patient health information should be written at a sixth-grade reading level. This study evaluates the readability of the most commonly used Internet resources for the operative treatment of breast cancer in the context of average American literacy.

Methods: The top 10 websites for "breast cancer surgery" based on public Internet search engines were identified. Patient-directed content was downloaded from all relevant articles on these sites. A total of 104 articles were assessed with the use of 10 established readability analyses. Average readability scores were analyzed for all articles as well as by website.

Results: The overall average reading level across all sites was 12.9; this was similar between tests (Coleman-Liau 12.6, Flesch Kincaid 12.3, FORCAST 11.2, Fry 14, Gunning Fog 14.4, New Dale-Chall 12.4, New Fog 11, Raygor 14, and Simple Measure of Gobbledygook 14.3). Comparing readability by website showed disparity in average reading level from 11.2 to 16.5.

Conclusion: Online patient resources for breast cancer surgery exceed recommended reading levels and are too difficult to be understood by a large portion of the United States population.

MeSH terms

  • Adult
  • Breast Neoplasms / surgery*
  • Comprehension*
  • Consumer Health Information*
  • Female
  • Health Resources
  • Humans
  • Internet*
  • Medical Informatics
  • Search Engine
  • United States