Cancer patients who do not belong to the dominant culture and do not speak the dominant language are at greater risk for miscommunication, and suffer a disproportionate number of errors. The path to safety requires quality improvement strategies that are both system‐based and team‐based. Addressing language and cultural barriers demands the use of professional interpreters, and the establishment of a professional culture designed to minimize bias and to provide additional resources to patients from underserved communities. Patients with low health literacy and those who do not speak the dominant language typically encounter more difficulties and experience more hardship in their efforts to receive proper care. This impacts access to state of the art prevention, treatment and palliation and requires institutional commitment through programs specifically designed to improve safety for individuals and populations at risk.