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Cultural considerations for South Asian women with breast cancer

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Abstract

Purpose

Cultural values shape a woman’s experience of disease and introduce novel stressors that influence psychosocial needs and adaptation. This literature review examines the psychosocial impact of breast cancer in South Asian women, a large group that has received little attention in this regard.

Methods

We conducted a comprehensive review of the literature published before April 2014 using Ovid MEDLINE, PsychINFO, PubMED, CINHAL, EMBASE, and Sociological Abstracts. We searched for articles about the psychosocial impact of breast cancer in South Asian women. We retained 23 studies for review.

Results

The literature concerning South Asian women’s experiences identified culturally linked themes that play significant roles in shaping the illness experience; e.g., stigma and breast cancer, low priority of women’s health, collective experience of disease, and religion and spirituality.

Conclusion

There is a growing need for culturally sensitive care for South Asian women. By understanding the core cultural values and integrating them into clinical practice, Western healthcare providers may improve the quality of care they deliver and help women to extract the maximum benefit.

Implications for Cancer Survivors

Developing culturally competent support services may enhance effectiveness in addressing the healthcare needs of South Asian women and may serve other ethnic minorities in North America.

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References

  1. Canadian Cancer Society. Breast cancer statistics at a glance. 2012. http://www.cancer.ca/Canada-wide/About%20cancer/Cancer%20statistics/Stats%20at%20a%20glance/Breast%20cancer.aspx?sc_lang=en. Accessed 2 Jan 2013.

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29.

    Article  PubMed  Google Scholar 

  3. National Cancer Institute. SEER stat fact sheets: breast cancer. Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/statfacts/html/breast.html Accessed 4 Dec 2014.

  4. Sankaranarayanan R, Ramadas K, Thara S, Muwonge R, Prabhakar J, Augustine P, et al. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011;103:1476–80.

    Article  PubMed  Google Scholar 

  5. National Cancer Institute-PDQ Cancer Information Summaries. Breast cancer treatment (PDQ): patient version. 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032825/. Accessed 2 Jan 2013.

  6. Ramanakumar AV, Balakrishna Y, Ramarao G. Coping mechanisms among long-term survivors of breast and cervical cancers in Mumbai, India. Asian Pac J Cancer Prev. 2005;6(2):189–94.

    PubMed  Google Scholar 

  7. Pandey M, Thomas BC, Ramdas K, Ratheesan K. Early effect of surgery on quality of life in women with operable breast cancer. Jpn J Clin Oncol. 2006;36(7):468–72.

    Article  PubMed  Google Scholar 

  8. Balneaves LG, Bottorff JL, Grewal SK, Naidu P, Johnson JL, Howard AF. Family support of immigrant Punjabi women with breast cancer. Fam Commun Health. 2007;30(1):16–28.

    Article  Google Scholar 

  9. Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L. Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat. 1996;38(2):183–99.

    Article  PubMed  CAS  Google Scholar 

  10. Karbani G, Lim JN, Hewison J, Atkin K, Horgan K, Lansdown M, et al. Culture, attitude and knowledge about breast cancer and preventive measures: a qualitative study of South Asian breast cancer patients in the UK. Asian Pac J Cancer Prev. 2011;12(6):1619–26.

    PubMed  Google Scholar 

  11. Bottorff JL, Johnson JL, Bhagat R, Grewal S, Balneaves LG, Clarke H, et al. Beliefs related to breast health practices: the perceptions of South Asian women living in Canada. Soc Sci Med. 1998;47(12):2075–85.

    Article  PubMed  CAS  Google Scholar 

  12. Banning M, Hafeez H. A two-center study of Muslim women’s views of breast cancer and breast health practices in Pakistan and the UK. J Cancer Educ. 2010;25(3):349–53.

    Article  PubMed  Google Scholar 

  13. Meana M, Bunston T, George U, Wells L, Rosser W. Older immigrant Tamil women and their doctors: attitudes toward breast cancer screening. J Immigr Health. 2001;3(1):5–13.

    Article  PubMed  CAS  Google Scholar 

  14. Raza S, Sajun SZ, Selhorst CC. Breast cancer in Pakistan: identifying local beliefs and knowledge. J Am Coll Radiol. 2012;9(8):571–7.

    Article  PubMed  Google Scholar 

  15. Hoeffel E, Rastogi S, Kim M, Shahid H. The Asian Population: 2010, 2010 Census briefs. 2012. http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf. Accessed 7 Jan 2013.

  16. Humes K, Jones N, Ramirez R. Overview of race and Hispanic origin: 2010, 2010 census briefs. 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf. Accessed 7 Jan 2013.

  17. Statistics Canada. Visible minority groups, percentage distribution for Canada, provinces and territories—20% sample data (table). Ethnocultural portrait of Canada highlight tables. 2006 Census. http://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-562/pages/page.cfm?Lang=E&Geo=PR&Code=01&Table=1&Data=Count&StartRec=1&Sort=2&Display=Page. Accessed 7 Jan 2013.

  18. Islam N, Kwon SC, Senie R, Kathuria N. Breast and cervical cancer screening among South Asian women in New York City. J Immigr Minor Health. 2006;8(3):211–21.

    Article  PubMed  Google Scholar 

  19. Ahmad F, Cameron JI, Stewart DE. A tailored intervention to promote breast cancer screening among South Asian immigrant women. Soc Sci Med. 2005;60(3):575–86.

    Article  PubMed  Google Scholar 

  20. Choudhry UK, Srivastava R, Fitch MI. Breast cancer detection practices of south Asian women: knowledge, attitudes, and beliefs. Oncol Nurs Forum. 1998;25(10):1693–701.

    PubMed  CAS  Google Scholar 

  21. Kruper L, Holt A, Xu XX, Duan L, Henderson K, Bernstein L, et al. Disparities in reconstruction rates after mastectomy: patterns of care and factors associated with the use of breast reconstruction in Southern California. Ann Surg Oncol. 2011;18(8):2158–65.

    Article  PubMed  Google Scholar 

  22. Tseng JF, Kronowitz SJ, Sun CC, Perry AC, Hunt KK, Babiera GV, et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer. 2004;101(7):1514–23.

    Article  PubMed  Google Scholar 

  23. Hermans H, Kempen H. Moving cultures: the perilous problems of cultural dichotomies in a globalizing society. Am Psychol. 1998;53(10):1111–20.

    Article  Google Scholar 

  24. Ritzer G. Rethinking globalization: glocalization/grobalization and something/nothing. Sociol Theory. 2003;21(3):193–209.

    Article  Google Scholar 

  25. Redfield R, Linton R, Herskovits MJ. A memorandum for the study of acculturation. Am Anthropol. 1936;16:149–52.

    Article  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):1–6.

    Article  Google Scholar 

  27. Bottorff JL, Grewal SK, Balneaves LG, Naidu P, Johnson JL, Sawhney R. Punjabi women’s stories of breast cancer symptoms: Gulti (lumps), bumps, and Darad (pain). Cancer Nurs. 2007;30(4):E36–45.

    Article  PubMed  Google Scholar 

  28. Gurm BK, Stephen J, MacKenzie G, Doll R, Barroetavena MC, Cadell S. Understanding Canadian Punjabi-speaking South Asian women’s experience of breast cancer: a qualitative study. Int J Nurs Stud. 2008;45(2):266–76.

    Article  PubMed  Google Scholar 

  29. Howard AF, Bottorff JL, Balneaves LG, Grewal SK. Punjabi immigrant women’s breast cancer stories. J Immigr Minor Health. 2007;9(4):269–79.

    Article  PubMed  Google Scholar 

  30. Banning M, Hafeez H, Faisal S, Hassan M, Zafar A. The impact of culture and sociological and psychological issues on Muslim patients with breast cancer in Pakistan. Cancer Nurs. 2009;32(4):317–24.

    Article  PubMed  Google Scholar 

  31. Banning M, Hassan M, Faisal S, Hafeez H. Cultural interrelationships and the lived experience of Pakistani breast cancer patients. Eur J Oncol Nurs. 2010;14(4):304–9.

    Article  PubMed  Google Scholar 

  32. Banning M, Tanzeen T. Living with advanced breast cancer: perceptions of Pakistani women on life expectations and fears. Cancer Nurs. 2014;37(1):E12–8.

    Article  PubMed  Google Scholar 

  33. Banning M, Tanzeem T. Managing the illness experience of women with advanced breast cancer: hopes and fears of cancer-related insecurity. Eur J Cancer Care (Engl). 2013;22(2):253–60.

    Article  CAS  Google Scholar 

  34. Braun CM, Itano JK. Cancer care in Nepal: variables that affect diagnosis, treatment, and prognosis: a case study. Cancer Nurs. 2001;24(2):137–42.

    Article  PubMed  CAS  Google Scholar 

  35. Singh U, Verma N. Psychopathology among female breast cancer patients. J Indian Academy Appl Psychol. 2007;33(1):61–71.

    Google Scholar 

  36. David AJ, Roul RK, Kuruvilla J. Lessons of self-help for Indian women with breast cancer. Cancer Nurs. 1988;11(5):283–7.

    Article  PubMed  CAS  Google Scholar 

  37. Agrawal S, Goel AK, Lal P. Participation in decision making regarding type of surgery and treatment-related satisfaction in North Indian women with early breast cancer. J Cancer Res Ther. 2012;8(2):222–5.

    Article  PubMed  Google Scholar 

  38. Khan MA, Bahadur AK, Agarwal PN, Sehgal A, Das BC. Psychosocial disorders in women undergoing postoperative radiation and chemotherapy for breast cancer in India. Indian J Cancer. 2010;47(3):296–303.

    Article  PubMed  CAS  Google Scholar 

  39. Nausheen B, Kamal A. Familial social support and depression in breast cancer: an exploratory study on a Pakistani sample. Psychooncology. 2007;16(9):859–62.

    Article  PubMed  Google Scholar 

  40. Story HL, Love RR, Salim R, Roberto AJ, Krieger JL, Ginsburg OM. Improving outcomes from breast cancer in a low-income country: lessons from Bangladesh. Int J Breast Cancer. 2012;2012:423562.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  41. Banning M, Hafeez H. Perceptions of breast health practices in Pakistani Muslim women. Asian Pac J Cancer Prev. 2009;10(5):841–7.

    PubMed  Google Scholar 

  42. Johnson JL, Bottorff JL, Balneaves LG, Grewal S, Bhagat R, Hilton BA, et al. South Asian women’s views on the causes of breast cancer: images and explanations. Patient Educ Couns. 1999;37(3):243–54.

    Article  PubMed  CAS  Google Scholar 

  43. Carey MA. The group effect in focus groups: planning, implementing, and interpreting focus group research. In: Morse JM, editor. Critical issues in qualitative research methods. California: Sage; 1994. p. 225–41.

    Google Scholar 

  44. Tracy SJ. Qualitative research methods: connecting evidence, crafting analysis, communicating impact. Malden: Wiley-Blackwell; 2013.

    Google Scholar 

  45. Lederman LC. Assessing educational effectiveness: the focus group interview as a technique for data collection. Commun Educ. 1990;39(2):117–27.

    Article  Google Scholar 

  46. Nausheen B, Kamal A. Familial social support scale for breast cancer patients: development and validation. Pak J Psychol Res. 2003;18:119–30.

    Google Scholar 

  47. Siddiqui S, Shah A. Siddiqui-Shah depression scale (SSDS): development and validation. Psychol Dev Soc. 1997;2:245–62.

    Google Scholar 

  48. Grewal S, Bottorff JL, Hilton BA. The influence of family on immigrant South Asian women’s health. J Fam Nurs. 2005;11(3):242–63.

    Article  PubMed  Google Scholar 

  49. Kohli N, Dalal AK. Culture as a factor in causal understanding of illness: a study of cancer patients. Psychol Dev Soc. 1998;10(2):115–29.

    Google Scholar 

  50. Markus HR, Kitayama S. Culture and self: implications for cognition, emotion, and motivation. Psychol Rev. 1991;98:224–53.

    Article  Google Scholar 

  51. Straughan PT, Seow A. Fatalism reconceptualized: a concept to predict health-screening behavior. J Gend Cult Health. 1998;3(2):85–100.

    Article  Google Scholar 

  52. Jandt FE. Defining culture and identities. An introduction to intercultural communication: identities in a glocal community. 7th ed. San Bernardino: Sage Publications Inc; 2012. p. 5–33.

    Google Scholar 

  53. Nilchaikovit T, Hill JM, Holland JC. The effects of culture on illness behavior and medical care. Asian and American differences. Gen Hosp Psychiatry. 1993;15(1):41–50.

    Article  PubMed  CAS  Google Scholar 

  54. Uba L. Cultural barriers to health care for Southeast Asian refugees. Public Health Rep. 1992;107(5):544–8.

    PubMed  CAS  PubMed Central  Google Scholar 

  55. Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55 Suppl 2:S299–309.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Whitman SM. Pain and suffering as viewed by the Hindu religion. J Pain. 2007;8(8):607–13.

    Article  PubMed  Google Scholar 

  57. Searight HR, Gafford J. Cultural diversity at the end of life: issues and guidelines for family physicians. Am Fam Phys. 2005;71(3):515–22.

    Google Scholar 

  58. Kozikowski D. “A dirty crab eating away at the breast”: the stigma of cancer in post-socialist Czech Republic. Anthropol East Eur Rev. 2010;23(1):63–78.

    Google Scholar 

  59. Kaiser K. The meaning of the survivorship identity for women with breast cancer. Soc Sci Med. 2008;67(1):79–87.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bartley SJ, Blaton PW, Gilliard JL. Husbands and wives in dual-earner marriages: decision-making, gender role attitudes, division of household labor, and equity. Marriage Fam Rev. 2005;37(4):69–94.

    Article  Google Scholar 

  61. Blair SL, Lichter DT. Measuring the division of household labor: gender segregation of housework among American couples. J Fam Issues. 1991;12(1):91–113.

    Article  Google Scholar 

  62. Parsons T. The social system. London: Routledge & Kegan Paul; 1951.

    Google Scholar 

  63. Hoeman SP, Ku YL, Ohl DR. Health beliefs and early detection among Chinese women. West J Nurs Res. 1996;18:518–33.

    Article  PubMed  CAS  Google Scholar 

  64. Mo B. Modesty, sexuality and breast health in Chinese-American women. West J Nurs Res. 1992;157:260–4.

    CAS  Google Scholar 

  65. Salazar MK. Hispanic women’s beliefs about breast cancer and mammography. Cancer Nurs. 1996;19:437–45.

    Article  PubMed  CAS  Google Scholar 

  66. Rutledge DN, Hartmann WH, Kinman PO, Winfield AC. Exploration of factors affecting mammography behaviors. Prev Med. 1988;17:412–22.

    Article  PubMed  CAS  Google Scholar 

  67. Rimer BK, Keintz MK, Kessier HB, Engstrom PF, Rosan JR. Why women resist screening mammography: patient-related barriers. Radiology. 1989;172:243–6.

    Article  PubMed  CAS  Google Scholar 

  68. Ahmad F, Jandu B, Albagli A, Angus JE, Ginsburg O. Exploring ways to overcome barriers to mammography uptake and retention among South Asian immigrant women. Health Soc Care Community. 2013;21(1):88–97.

    Article  PubMed  Google Scholar 

  69. Pack GT, Gallo JS. The culpability for delay in the treatment of cancer. Am J Cancer. 1938;33:443–62.

    Google Scholar 

  70. Talley A, Molix L, Schlegel RJ, Bettencourt A. The influence of breast cancer survivors’ perceived partner social support and need satisfaction on depressive symptoms: a longitudinal analysis. Psychol Health. 2010;24(4):433–49.

    Article  Google Scholar 

  71. Gill A. Voicing the silent fear: South Asian women’s experiences of domestic violence. Howard J Crim Justice. 2004;43(5):465–83.

    Article  Google Scholar 

  72. Mehrotra M. The social construction of wife abuse: experience of Asian Indian women in the Unites States. Violence Against Women. 1999;5(6):619–40.

    Article  Google Scholar 

  73. Raj A, Silverman J. Intimate partner violence against South Asian women in greater Boston. J Am Med Womens Assoc. 2002;57(2):111–4.

    PubMed  Google Scholar 

  74. Grunfeld E, Coyle D, Whelan T, Clinch J, Reyno L, Earle CC, et al. Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. CMAJ. 2004;170(12):1795–801.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O’Neil J, et al. Information needs and decisional preferences in women with breast cancer. JAMA. 1997;277(18):1485–92.

    Article  PubMed  CAS  Google Scholar 

  76. Gall TL, Charbonneau C, Clarke NH, Grant K. Understanding the nature and role of spirituality in relation to coping and health: a conceptual framework. Can Psychol. 2005;46(2):88–104.

    Article  Google Scholar 

  77. Best M, Butow P, Olver I. Spiritual support of cancer patients and the role of the doctor. Support Care Cancer. 2014;22(5):1333–9.

    Article  PubMed  Google Scholar 

  78. Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;23 Suppl 3:49–55.

    Article  PubMed  Google Scholar 

  79. Ferrell B, Otis-Green S, Economou D. Spirituality in cancer care at the end of life. Cancer J. 2013;19(5):431–7.

    Article  PubMed  Google Scholar 

  80. Levine EG, Aviv C, Yoo G, Ewing C, Au A. The benefits of prayer on mood and well-being of breast cancer survivors. Support Care Cancer. 2009;17(3):295–306.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Lord K, Ibrahim K, Kumar S, Mitchell AJ, Rudd N, Symonds RP. Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey. BMJ Open. 2013;3(6):1–11.

    Article  Google Scholar 

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Manveen Bedi and Gerald M. Devins declare that they have no conflict of interest.

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Bedi, M., Devins, G.M. Cultural considerations for South Asian women with breast cancer. J Cancer Surviv 10, 31–50 (2016). https://doi.org/10.1007/s11764-015-0449-8

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