Surgical treatment preferences in Chinese-American women with early-stage breast cancer.

Breast-conserving treatment (BCT) is considered preferable to radical or modified radical mastectomy (MRM) for most women diagnosed with early-stage breast cancer. Studies have found that Chinese-American women are more likely to be treated with MRM, regardless of age or stage of disease. The central question posed in this study is: what are the cultural factors that influence the selection of treatments by Chinese-American patients and the presentation of treatment options by providers? Focused group discussions, semi-structured interviews, and ethnographic observations were conducted with 69 Chinese-American women and 14 health professionals. Results indicated that (1) many Chinese-American women, regardless of age, migration status, education, and income level, expressed a preference for MRM because it was seen as safer; (2) this was primarily a communal belief that even women who had BCT felt pressure to conform to; (3) some women felt pressured into the BCT decision by their physician and/or were unhappy with their choice; (4) patient and physician bias and difficulties with translation issues and supplemental materials all led to cross-cultural miscommunication; and (5) this miscommunication was cited as a reason for (a) not completing treatment regimes or (b) drastic changes in the treatment selected.

Survey nonresponse bias among young adults: the role of alcohol, tobacco, and drugs.

The purpose of this study is to determine the role of alcohol, tobacco, and drug use as predictors of survey panel attrition among an occupational cohort of young adults in the U.S. military. Baseline data on substance use and sociodemographic factors were obtained from 2838 men and women through confidential, self-administered questionnaires while they attended Navy basic training or Officer Candidate School in 1998. Longitudinal follow-up using mailed self-administered questionnaires was begun in 2000. Multivariate logistic regression models were developed to estimate the odds of attrition in relation to baseline substance use. Results revealed that tobacco use was a significant predictor of attrition [Odds ratio (OR) = 1.63; 95% Confidence Interval (CI): 1.37, 1.95]. A significant interaction between level of education and drug use indicated that respondents with less than a college education who were also drug users were at elevated risk for attrition (OR = 2.39; 95% CI 1.09, 5.28). Other significant predictors of panel attrition were male gender and younger age. Alcohol use was not significantly associated with attrition. The findings suggest that tobacco users and drug users with less than a college education may be an important source of nonresponse bias in longitudinal surveys of employed young adults.

"Unremarkable" recoveries: normalizing adversity and cancer survival.

Much of the existing popular literature suggests that survival from life-threatening diseases encourages a process of self-transformation. Seventeen long-term survivors of metastatic cancer were interviewed about the impact of a life-threatening condition on their life stories. Contrary to the existing literature, which suggests such an event greatly transforms the individual, nearly all of those interviewed for this study framed their unusual recoveries as being largely unremarkable. Traditional North American cultural values, which normalize adversity, appear to bolster the participants' beliefs that one can have control over one's health and can even resist a recurrence of cancer.