Abstract
This pilot study constitutes the first exploration ofthe impact of breast cancer on Asian American women.Three hypotheses guided this study: (1) Asian Americanwomen would choose breast conserving therapy andbreast reconstruction at a lower rate than the AngloAmerican women due to cultural differences in bodyimage, (2) Asian American women with breast cancerwould express psychological distress somatically andAnglo American women would express distress emotionally, and acculturation levels of the AsianAmerican women would modify the expressions ofdistress such that women with high acculturation willexpress distress more emotionally and lessacculturated women would express distress moresomatically, and (3) Asian American women would seekassistance for psychosocial problems at asignificantly lower rate than Anglo women. Ethnicity,age, and levels of acculturation were found to besignificant variables that had to be consideredsimultaneously. The three hypotheses were onlypartially supported: (1) Asian American women chosebreast conserving therapy and adjuvant therapy at asignificantly lower rate than the Anglo Americanwomen, (2) Contrary to the hypothesis, somatization didnot appear to be a dominant form of symptompresentation for Asian American women regardless oflevel of acculturation, and (3) Asian American womensought professional assistance for psychosocialproblems at a significantly lower rate than Anglowomen. Asian American women reported using differentmodes of help-seeking behavior for emotional concernsand receiving different sources of social support thanthe Anglo American women. Cultural interpretations ofthe findings are offered to explain the differences inthe physical, emotional, and social responses to thebreast cancer experience of Asian American womencompared with the Anglo Americans, and notably betweenthe Chinese- and Japanese Americans as well. Thefindings of this study warrant more refinedexploration in order to improve the medical,psychological and social outcomes for Asian Americanwomen with breast cancer.
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REFERENCES
American Cancer Society 1984 California Facts and Figures. Oakland, CA: American Cancer Society, California Division.
Barrera, M. 1981 Social support in the adjustment of pregnant adolescents-assessment issues. In B.H. Gottlieb (ed.), Social Networks and Social Support. Beverly Hills, CA: Sage.
Bloom, J.R. 1986 Social support and adjustment to breast cancer. In B.L. Anderson (ed.), Women with Cancer–Psychological Perspectives. New York: Springer.
Bloom, J.R., R.D. Ross, and G.M. Burnell 1978 The effect of social support on patient adjustment after breast surgery. Patient Counselling and Health Education 1: 55–57.
Bloom, J.R., and D. Spiegel 1984 The effect of two dimensions of social support on the psychological well being and social functioning of women with advanced breast cancer. Social Science and Medicine 19: 831–837.
Cheung, F. 1989 The indigenization of neurasthenia in Hong Kong. Culture, Medicine and Psychiatry 13: 227–241.
Chipp, S., and J. Green (eds.) 1980 Asian Women in Transition. University Park/London: The Pennsylvania State University Press.
Chung, R., and M. Kagawa-Singer 1993 Predictors of psychological distress among Southeast Asian refugees. Social Science and Medicine 36(5): 631–639.
Cohen, J. 1986 Social support systems and the psychosocial consequences of cancer. In S.O. Isacsson and L. Jenzon (eds.), Social Support–Health and Disease (pp. 113–121). 6th International Bezelium Symposium, Malmo, Sweden. Stockholm: Almquist and Wiksell.
Cohen, J., M. Sullivan, and I. Branechoeg 1988 A comparative psychosocial study of surviving cancer patients in California, USA and the Western Region of Sweden. Gothenberg, Sweden: Ministry of Health and Social Affairs.
Degner, L.F., and J.A. Sloan 1992 Decision making during serious illness: What role do patients really want to play? Journal of Clinical Epidemiology 45(9): 941–950.
Dodd, M., S.G. Chen, A. Lindsey, and B. Piper 1985 Attitude of patients living in Taiwan about cancer and its treatment. Cancer Nursing 8(4): 214–220.
Durvasula, R.S., and S. Sue 1992 Severity of Psychiatric disorder among White and Asian outpatients. Paper presented at the Annual Convention of the American Psychological Association.
Furth, C., and Ch’en Shu-yueh 1992 Chinese medice and the anthropology of menstruation in contemporary Taiwan. Medical Anthropology Quarterly 6(1): 27–48.
Gilligan, C. 1982 In a Different Voice. Cambridge: Harvard University Press.
Gillis, D.L., C. Perkins, K. Snipes, W. Wright, and J. Young 1994 Factors affecting regional variation in breast conserving therapy. Abstract. California Tumor Registry. Paper presented at the National State Tumor Registry Conference, San Diego California.
Good, M.D. 1995 Cultural studies of biomedicine: An agenda for research. Social Science Medicine 41(4): 461–473.
Good, M.D., B.J. Good, C. Schaffer, and S.E. Lind 1990 American oncology and the discourse on hope. Culture, Medicine and Psychiatry 14: 59–79.
Good, M.D., L. Hunt, T. Munakata, and Y. Kobayashi 1993 A comparative analysis of the culture of biomedicine: Disclosure and consequences for treatment in the practice of oncology. In P. Conrad and E.B. Gallagher (eds.), Health and Health Care in Developing Countries: Sociological Perspectives (pp. 180–210). Philadelphia: Temple University Press.
Good, M.D., T. Munakata, Y. Kobayashi, C. Mattingly, and B.J. Good 1994 Oncology and narrative time. Social Science Medicine 38(6): 855–862.
Gordon, D.R. 1990 Embodying illness, embodying cancer. Culture, Medicine and Psychiatry 14: 275–297.
Gottschalk, L.A., and J. Hoigaard-Martin 1986 The emotional impact of mastectomy. Psychiatry Research 17: 153–167.
Grandstaff, N.W. 1976 The impact of breast cancer on the family. Front Rad Therapy Oncology 11: 146–156.
Haenszel, W. 1982 Migrant studies. In Schottenfeld and Fraumeni (eds.), Cancer Epidemiology and Prevention (pp. 194–207). W.B. Saunders.
Hessler, R.M., M.F. Nolan, B. Ogbru, and P.K.M. New 1975 Intraethnic diversity: Health care of the Chinese Americans. Human Organization 34(3): 253–262.
Heurtin-Roberts, S., and L. Snowden 1993 Comparison of ethnographic descriptors of depression and epidemiological catchment area data for African-Americans (submitted manuscript).
Hsu, F. 1971 Psychosocial homeostasis and Jen: Conceptual tools for advancing psychological anthropology. American Anthropologist 73: 23–44.
Hsu, J, W.S. Tseng, G. Ashton, J. McDermott, and W. Char 1985 Family interaction patterns among Japanese American and Caucasian families in Hawaii. Journal of Psychiatry 142(5): 477–581.
Ishiwata, R., and A. Sakai 1994 The physician-patient relationship and medical ethics in Japan. Cambridge Quarterly of Healthcare Ethics 3:60–66.
Kagawa-Singer, M. 1988 Bamboo and oak: Differences in adaptation to cancer between Japanese-American and Anglo-American patients. UCLA dissertation.
1990 Meta-analysis of psychosocial oncology studies, 1975–1990 (unpublished manuscript).
1993 Redefining health: Living with cancer. Social Science and Medicine 37(3): 295–304.
Kagawa-Singer, M., and R. Chung 1994 A paradigm for culturally based care in ethnic minority populations. Journal of Community Psychology 22(4):192–208.
Kalish, R., and D. Reynolds 1976 Death and Ethnicity: A Psychocultural Study. Los Angeles: University of California Press.
Kawanishi, Y. 1992 Somatization of Asians: An artifact of Western medicalization. Transcultural Psychiatric Research Review 29: 5–36.
Kemeny, M., D.K. Wellisch, and W.S. Schain 1988 Psychosocial outcome in a randomized trial for treatment of primary breast cancer. Cancer 62(6): 1231–1237.
Kesserling, A, M., A.M. Dodd, Lindse, and A. Strauss 1986 Attitudes of patients living in Switzerland about cancer and its treatment. Cancer Nurs 9(2): 77–85.
Kim, B.L.C. 1978 The Asian Americans: Changing Patterns, Changing Needs. Montclair, NJ: Association of Korean Christian Scholars in North America.
Kleinman, A. 1980 Patients and Healers in the Context of Culture (pp. 104–118). Berkeley and Los Angeles: University of California Press.
1982 Neurasthenia and depression: A study of somatization and culture in China. Culture, Medicine and Psychiatry 6: 117–190.
Kleinman, A., L. Eisenberg, and B. Good 1978 Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88: 251–258.
Lacey, L. 1993 Cancer prevention and early detection strategies for reaching underserved, urban, low-income black women. Cancer 72(3 Suppl): 1078–1083.
Lee, W.H., A. Lindsey, and K. Oh 1989 Social support as perceived by Korean patients with cancer compared to healthy Korean adults. Paper presented at the International Council of Nurses, 19th Quadrennial Congress.
LeMarchand, L., L.N. Kolonel, and A.M.Y Nomura 1984 Relationship of ethnicity and other prognostic factors to breast cancer survival pattern in Hawaii. Journal of the National Cancer Institute 73(6): 1259–1265.
Leung, P.W., F. Salili, and F.M. Baber 1986 Common adolescent problems in Hong Kong: Their relationship with self-esteem, locus of control, intelligence and family environment. Psychologia 29(2): 91–101.
Lin-fu, J.S. 1994 Asian and Pacific islander Americans: An overview of demographic characteristics and health care issues. Journal of Asian and Pacific Islander Health 1(1): 20–36.
Lin, K-M. 1980 Traditional Chinese medical beliefs and their relevance for mental illness and psychiatry. In A. Kleinman and T.Y. Lin (eds.), Normal and Abnormal Behavior in Chinese Culture (pp. 95–111). Dordrecht, The Netherlands: D Reidel.
Lock, M. 1983 Licorice in Leviathan: The medicalization of care for the Japanese elderly. Culture, Medicine and Psychiatry 8(2): 121–139.
1987 DSM-III as a culture-bound construct: Commentary on culture-bound syndromes and international disease classifications. Culture, Medicine and Psychiatry 11(1): 35–42.
Long, S., and B.S. Long 1982 Curable cancer and fatal ulcers: Attitudes toward cancer in Japan. Social Science and Medicine 16: 2101–2108.
Los Angeles United Way, Inc. 1988 Asian Pacific Needs Assessment.
Martin, E. 1987 The Women in the Body. Boston: Beacon Press.
Marshall, J.R., and D.P. Funch 1983 Social environment and breast cancer: A cohort analysis of patient survival. Cancer 52: 1546–1550.
Mechanic, D. 1972 Social psychologic factors affecting the presentation of bodily complaints. New England Journal of Medicine 286(21): 1132–1139.
Meredith, L. 1994 Health of Asian Pacific islanders in the medical outcome study. Paper presented at the UCLA MEDTEP/RAND Symposium.
Meyerowitz, B.E. 1983 Postmastectomy coping strategies and quality of life. Health Psychology 2: 117–132.
Miyamoto, F.S. 1987 Problems of interpersonal style of the Nisei personality. Ameriasia Journal. In International Examiner, Nov 18, p 4.
Mo, B. 1992 Modesty, Sexuality, and Breast Health in Chinese-American women. Western Journal of Medicine 154: 260–264.
National Cancer Institute 1988 SEER Data. Annual Cancer Statistic Review. Bethesda, MD, 1989.
Nilchaikovit, T., J. Hill, and J. Holland 1993 The effects of cultural on illness behavior and medical care: Asian American difference. General Hospital Psychiatry 15, 41–50.
Nihira, K., R. Webster, Y. Tomiyasu, and C. Oshio 1988 Child-environment relationships: A cross-cultural study of educable mentally retarded children and their families. Journal of Autism and Developmental Disorders 18(3): 337–341.
Nishida, T. 1979 Comparing Japanese-American person-to-person communication: A third culture approach. University of Minnesota, dissertation.
Northouse, L. 1994 The family impact of cancer in women. Paper presented at the Third National Conference on Cancer Nursing Research. Newport Beach, California.
Ohnuki-Tierney, E. 1984 Illness and Culture in Contemporary Japan: An Anthropological View. London: Cambridge University Press.
Okazaki, S. 1994 Cultural Considerations in Treating Asian Americans. Paper presented at the Second Annual Conference on Psychopathology, Psychopharmacology, Substance Abuse and Culture, Los Angeles, California.
Olivotto, I., C. Bajdik, M. Math et al. 1994 Adjuvant systemic therapy and survival after breast cancer. The New England Journal of Medicine 330(12): 805–810.
Ots, T. 1991 Angry liver, melancholy spleen. Culture, Medicine and Psychiatry 14: 21–58.
Penman, D.T., J.R. Bloom, S. Fotopoulas et al. 1987 The impact of mastectomy on self concept and social function: A combined cross-sectional and longitudinal study with comparison groups. In S. Stellman (ed.), Women and Cancer. New York: Haworth Press.
Radloff, L.S. 1977 The CES-D Scale: A self-report depression scale for research in the general population. Center for Epidemiology Study Applied Psychological Measurements 1(3): 385–401.
Richardson, J.L., B. Langholz, L. Bernstein, C. Burciaga, K. Danley, and R.K. Ross 1992 Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year. British Journal of Cancer 65(6): 922–926.
Rosaldo, M.Z., and L. Lamphere (eds.) 1974 Women, Culture and Society. Stanford: Stanford University Press.
Rowland, J.H., and J.C. Holland 1989 Breast cancer. In J. Holland and J.H. Rowland (eds.), Handbook of Psychosocial Oncology (pp. 188–208). New York: Oxford University Press.
Saint-Germain, M.A., and A.J. Longman 1993 Breast cancer screening among older Hispanic women: Knowledge, attitudes and practices. Health Education Quarterly 20(4): 539–553.
Saltman, R.B. 1994 Patient choice and patient empowerment in Northern European health systems: A conceptual framework. International Journal of Health Services 24(2): 201–229.
Schag, C.A.C., R.L. Heinrich, R.L. Aadland, and P.A. Ganz 1990 Assessing problems of cancer patients: Psychometric properties of the Cancer Inventory of Problem Situations. Health Psychology 9(1): 83–102.
Schain, W.S., E. Jacobs, and D.K. Wellisch 1984 Psychosocial issues in breast reconstruction: Intrapsychic, interpersonal, and practical concerns. In M. Scheflan (ed.), Clinics in Plastic Surgery 11(2): 237–253.
Shon, S.P., and D.Y. Ja 1982 Asian families. In M. McGoldrick, J.K. Pearce, and J. Giordano (eds.), Ethnicity and Family Therapy (pp. 208–228). New York: Guilford Press.
Simon, G.E., and M. VonKorff 1991 Somatization and psychiatric disorder in the NIMH epidemiologic catchment area study. American Journal of Psychiatry 148(11): 1494–1500.
Solis, J., J. Hisserich, and L. Birba 1989 Community based program for Minority groups, final report. ACS, California Division, NELAC Unit Project (unpublished).
Spiegel, D., J.R. Bloom, and E. Gottheil 1983 Family environment as a predictor of adjustment to metastatic breast carcinoma. Journal of Psychosocial Oncology 1: 33–44.
Spiegel, D. 1990 Can psychotherapy prolong cancer survival? (Editorial). Psychosomatics 31(4): 361–6.
Sue, S. 1992 Ethnicity and mental health: Research and policy issues. Journal of Social Issues 48: 187–205.
Suinn, R.M., K. Rickard-Figueroa, S. Lew, and P. Vigi 1987 The Suinn-Lew Asian self identify acculturation scale: An initial report. Education and Psychol Meas 47(2): 401–407.
Takahashi, M. 1995 Personal communication. Tokyo, Japan.
Takeuchi, D., R. C-Y. Chung, S. Sue, and K-M. Lin 1995 Chinese-American Psychiatric Epidemiological Study. National Research Center on Asian American Mental Health at UCLA, California.
Taylor, S.E., R.L. Falke, S.J. Shoptaw, and R.R. Lichtman 1986 Social Support groups and the cancer patient. Journal of Consulting and Clinical Psychology 54(5): 608–615.
Taylor, S.E., R.R. Lichtman, and J.V. Wood 1983 Breast cancer patients participation in cancer support groups. Unpublished raw data.
Tracy, T.J., F.T.L. Leong, and C. Glidden 1986 Help seeking and problem perception among Asian Americans. Journal of Counseling Psychology 33(3): 331–333.
Tseng, W-S., and J. Hsu 1969 Chinese culture, personality formation and mental illness. International Journal of Social Psychiatry 16(1): 5–14.
Uba, L. 1994 Asian Americans: Personality Patterns, Identity and Mental Health. New York, New York: The Guilford Press.
US Bureau of the Census 1993 Money income of households, families, and persons in the United States: 1992. Current Population Reports, Series P60-184. Washington, DC: Government Printing Office.
Weiner, H., and N. Adler 1989 Final report from the UCLA Node of the John D. and Catherine T. MacArthur Foundation Award–Network IV; Determinants & Consequences of Health Promoting/Damaging Behavior on the Psychometric Evaluation of the Symptoms Questionnaire.
Wellisch, D.K., R. DiMatteo, and M. Silverstein, et al. 1989 Psychosocial outcomes of breast cancer therapies: Lumpectomy versus mastectomy. Psychosomatics 30(4): 365–373.
Wellish, D.W., M. Kagawa-Singer, S. Reid et al. 1997 Cross-cultural variations in social support from husbands for Asian-and Euro-American women with breast cancer, Psychosocial Oncology (in press).
Yellen, S.B., and D. Cella 1995 Someone to live for: Social well-being, parenthood status, and decision-making in oncology. Journal of Clinical Oncology 13(5): 1255–1264.
Ying, Y. 1988 Depressive symptomatology among Chinese-Americans as measured by the Center for Epidemiological Studies-Depression Scale (CES-D). Journal of Clinical Psychology 44(5): 739–746.
Yuasa, Y. 1987 The Body: Toward an Eastern Mind-Body Theory. New York: State University of New York Press.
Zane, N. 1994 An empirical examination of loss of face among Asian Americans. Graduate School of Education, University of California Santa Barbara, CA 93106. Unpublished manuscript.
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Kagawa-Singer, M., Wellisch, D.K. & Durvasula, R. Impact of Breast Cancer on Asian American and Anglo American Women. Cult Med Psychiatry 21, 449–480 (1997). https://doi.org/10.1023/A:1005314602587
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DOI: https://doi.org/10.1023/A:1005314602587