(Original title: Chinese women, immigration, and breast cancer)
Breast cancer is the number one cause of cancer-related mortality for Asian American and Pacific Islander (AAPI) women, who have the lowest rate of both screening and early detection compared to all other ethnic groups. (1) The incidence of breast cancer is rising rapidly among the fast-growing demographic groups of AAPIs; in a recent ten-year period, incident cases of breast cancer in Los Angeles County doubled for AAPIs overall, and among women of Chinese descent specifically. (2) The incidence rate for AAPI breast cancer in the San Francisco Bay area, where our study was conducted, is approximately 50 percent higher than in Los Angeles County. (3) Among Asian American females in San Francisco, the annual age-adjusted incidence rate is 83.2 per 100,000 for invasive breast cancer and 24.6 per 100,000 for in-situ breast cancer. Between 1995 and 1999, a total of 774 Asian American women were diagnosed with breast cancer in San Francisco. (4) Of these women, 599 had invasive breast cancer and 175 had in-situ disease. According to the national Surveillance, Epidemiology, and End Results data from 1988-1992, the breast cancer rate among Chinese women was 55.0 per 100,000. (5)
According to the Year 2000 Census, Chinese make up the largest Asian group in the United States, constituting 23.8 percent of the nation's total Asian American population. Of the fifty states, California has the largest population of Asian Americans, and Chinese outnumber other Asian groups in the state, at 980,642 or 2.9 percent of the state's total population. (6) Foreign-born Asian women generally have a lower breast cancer rate when compared with U.S.-born Asian women; (7) however, Chinese immigrants are at a higher risk of being diagnosed with breast cancer than their peers living in China, and being diagnosed at a more advanced stage. (8)
Research on cancer-related beliefs indicates that some Chinese people believe cancer is contagious, (9) and that breast cancer is due to tragic luck. (10) These beliefs, combined with a low compliance with breast cancer screening, (11) may compromise the survival rate and quality of life of Chinese women. Further, little is known about the perceptions of complimentary and alternative therapy (CAM) among Chinese breast cancer survivors who are recent immigrants as well as CAM use among breast cancer survivors who were born and raised in the United States. Studies conducted in the area of CAM indicated the use of CAM includes herbs and vitamins, spiritual healing, relaxation, massage, acupuncture, energy healing, hypnosis, therapeutic spas, lifestyle diets, audio or videotapes, medication wraps, and osteopathic, homeopathic, and chiropractic treatment. (12) According to Correa-Velez, Clavarino, and Eastwood (2005), (13) most participants self-treated with CAM and perceived CAM modalities as complementary rather than alternative to conventional cancer treatments. Within this context, CAM is used to prolong survival, palliate symptoms, or alleviate the side effects of conventional cancer treatments, detoxify their bodies, boost immunity, and enhance their overall quality of life. In another study conducted by Yates and colleagues (2005), (14) 91 percent in their study sample reported using at least one form of CAM. The most widely used forms of CAM were prayer, relaxation, and exercise. In this study, CAM users tended to be women chemotherapy patients with at least a high school education. The most frequent CAM modalities discussed with at least one physician were diets, massage, and herbal medicine. Although more and more studies as well as clinical trials are conducted on CAM and the effectiveness of CAM, little is known about the attitude and utilization of CAM among Chinese diagnosed with cancer.
In this pilot study we utilized the qualitative method to ascertain attitudes toward CAM among breast cancer survivors and compared those who were born and raised in the United States to those who came from China, Hong Kong, or Taiwan. We speculate Chinese breast cancer survivors utilize CAM to alleviate pain and chemotherapy side effects. However, due to the limited research in this area, much information needs to be obtained to describe CAM use among Chinese breast cancer survivors. Besides attitudes toward CAM and what form of CAM they used, we were also interested to find out what were the factors that might influence these women to utilize CAM on a regular basis.
Research Design. A qualitative design was used to explore cancer-related beliefs and quality of life among Chinese women with breast cancer. In-depth, semistructured face-to-face interviews were conducted with fifteen foreign-born and fifteen U.S.-born Chinese women (N = 30).
Sample. The sample was comprised of Chinese women whose primary language was English, Mandarin, or Cantonese, who were diagnosed with breast cancer at any stage within twenty-four months of study initiation, and who were no longer on active treatment such as chemotherapy...