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Disparities in Breast Cancer Survival among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study
In this article, the author is determined in establishing and explaining the possible causes of disparities in the incidence rates and survival probabilities of breast cancer among the Asian women in the United States. For this reason, the author considers ethnic enclave, immigration status, and neighborhood socio-economic status, to have great influence in explaining the cause of breast cancer disparities among these populations (Gomez et al. 2010). Therefore, this population study aims at examining whether these factors really influences ethnic disparities in breast cancer survival.
Background of the population
The participants of these study were Asian women who had been diagnosed with breast cancer and living in California. However, these Asian women had six different places of origin; Korea, Vietnam, China, Filipina, Japan, and South Asia. Moreover, this population is composed of women who were born within the United States, and those who were foreign born. In addition, this population is the only one that has high incidence and mortality rates due to cancer, especially breast cancer, as opposed to the other ethnic groups that mostly suffers from heart disease (Gomez et al. 2010). Consecutively, this population has varying socio-economic status, age, year and marital status at which they are diagnosed with breast cancer, stage, and grade of cancer tumors.
Type of study
Prospective cohort study was used in establishing the association between immigration and various acculturation characteristics, and the survival of the U.S Asian women diagnosed with breast cancer. The study involved reviewing medical data of Asian women (both U.S born and foreign born) who had been diagnosed with breast cancer between 1st January, 1988, and 31st December, 2005, their neighborhood social economic status and ethnic enclave, and then conducting hospital follow-up in order to establish their survival time. The population`s data was obtained from the California Cancer Registry. In addition, through hospital follow-ups, death records, vital statistics, and other databases, the date and underlying cause of death of these cancer patients was being obtained and recorded, while the survival time was calculated by subtracting the date when death due to breast cancer occurred, date of last known contact, or date when this study ended (December 31, 2007), from the date at which the patient was diagnosed with breast cancer. Nevertheless, the survival time between U.S born and foreign born Asian Breast cancer women is computed separately, and then compared in order to establish whether immigration status and acculturation factors influence the survival of breast cancer among U.S Asian women.
Type of sampling technique used
In this study, stratified sampling technique was used in order to select the sample of patients to be used. In this case, four strata (groups), which represents the six Asian countries of interest are formed, and then sample is selected based on additional characteristics such as survival time, diagnosis at the time of death, and the patient`s place of residence at the time of diagnosis. As a result, a sample of 20747 patients was used in this study (Gomez et al. 2010).
Findings and Results
In this study, 27% were Chinese, 6% South Asian, 17% Japanese, 6% Korean, 36% Filipina and 8% Vietnamese (Gomez et al. 2010). Moreover, with the exception of Japanese women whose high population was U.S born, most of the other women were foreign born. In addition, the U.S born Japanese women were slightly at diagnosis compared to their foreign-born counterparts while most of the foreign-born women form the other Asian countries were older at diagnosis compared to their U.S born counterparts. In addition, all U.S born women were highly likely to be diagnosed with localized diseases than foreign-born women, who were more likely to be diagnosed with higher grade cancer tumors. Additionally, U.S born women were more likely to live in higher social economic neighborhoods, in ethnic enclaves, fewer deaths, and higher survival probabilities compared to foreign-born women.
However, it was established that though foreign-born Asian women are not fatty, consume more soy and vegetables, engage in physical exercises, have children earlier in life, and rarely receive post menopausal hormone replacement therapies than their U.S born counterparts, these population have other factors that results in poor health outcomes after they are diagnosed with breast cancer. For example, these groups have lower social-economic status, linguistic barriers, health beliefs, and lack of breast cancer screening behaviors, all of which negatively affect breast cancer treatment choices (Gomez et al. 2010).
Recommendations to improve this study
It is more advisable to follow the case from when they are diagnosed with breast cancer or any other characteristic of interest, and then recording the appearance of the expected outcome, rather than relying on medical records as the latter may inconvenience study conclusions due to inconsistent recording from the reporting facilities. In addition, it is better to use a higher sample size of each ethnic group of Asian women in order to reduce biases of the study.
From this study, it is evident that immigration status and acculturation traits influence the disparities between the survival rates of breast cancer Asian women living in California. In addition, healthy behaviors, such as taking soya, bearing children at earlier ages, avoiding hormone replacement therapies after menopause, physical exercises among others, greatly contributes to the development of breast cancer among women.
Gomez, S., L., et al. (2010). Disparities in Breast Cancer Survival among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study. American Journal of Public Health, Vol 100, No. 5. American Public Health Association, U.S.A.