New Cosmopolitanisms: South Asians in the U.S. (review)

Background: Breast cancer is the most common cancer worldwide. There has been emerging interest in studying differences in breast tumor phenotypes between South Asian and South American women given that racial/ethnic disparities in incidence and mortality have been demonstrated in multiple studies. South Asian women are more likely to be diagnosed with an advanced stage breast tumor despite lower incidence than in North American women. There is evidence that computer-extracted nuclear morphological features on H&E slide images may be associated with breast cancer aggressiveness, specifically recurrence and disease free survival. However, studies have mostly focused on North American women. In this work, we evaluated whether there is a difference in computer extracted features of nuclear morphology from H&E tissue slide images between South Asian (SA) and North American (NA) women and we also investigated how these differences could impact the development of population specific breast cancer prognostic models. Methods: H&E slides of breast tumors from patients who were diagnosed with ER+ early stage invasive breast cancer from Tata Memorial Centre, India (SA: 69 (20 recurrence)) and from University Hospitals Cleveland Medical Center (NA: 121 (20 recurrence)), along with outcome information were collected. All slides were digitized on either a Ventana DP 200 or a Roche Ventana iScan HT slide scanner. For each image, a conditional Generative Adversarial Network model was employed to segment the individual nuclei, which were used to generate 241 nuclear features including nuclear architecture, shape, orientation disorder, and texture features. Half of the patients (95) were randomly selected as the training set (Stra) with the remaining patients as the hold-out validation set (Stest). Three elastic net regularized Cox regression models (MSA, MNA, MSA+NA) were trained fitting between the nuclear features and disease free survival (DFS) respectively for SA subset, NA subset, and SA & NA set in Stra. The top five prognostic features were identified respectively from each of the three models (MSA, MNA, MSA+NA) which were further validated on Stest to evaluate their prognostic value in prediction of DFS. Results: We found that the prognostic features identified by MNA and MSA+NA were mostly shape features (three out of five for MNA, four out of five for MSA+NA), while the prognostic features identified by the model specifically trained with the SA population (MSA) were mostly texture features (three out of five), possibly reflecting chromatin patterns in the cell. MSA yielded a better performance (Hazard Ratio=4.99 (p=0.00928, CI=1.32-18.9) from log-rank test between model derived high and low risk categories) on SA population in Stest compared to MNA and MSA+NA. Conclusion: We found that nuclear histomorphometry features were different between breast cancer patients from South Asia and those from North America. The prognostic capability of the computational pathology-based models for South Asian women could be significantly improved by taking into account population-specific information. An additional independent validation set is needed to confirm the preliminary findings presented here. Citation Format: Haojia Li, Kaustav Bera, Paula Toro, Pingfu Fu, Vidya Rao, Shabina Siddique, Aparna Harbhajanka, Haley Sechrist, Zelin Zhang, Sangeeta Desai, Vani Parmar, Anant Madabhushi. Computerized image analysis of nuclear morphological features reveals differences in phenotype and prognosis of disease free survival of early stage ER+ breast cancers for South Asian and North American women [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-45.

Background: The Cancer Analytics and South Asian Health - Breast Cancer (CANSAH-BC) pilot study was launched in New Jersey (NJ) in 2022 to evaluate the drivers of aggressive breast cancer, familial aggregation, and quality of life among South Asian American (SAA) females, who are an understudied population. Purpose: To compare the CANSAH-BC cohort with SAA patterns in the National Health Interview Survey (NHIS), the California Health Interview Survey (CHIS), & breast cancer survivors identified in the Surveillance, Epidemiology, and End Results (SEER) NJ program, and assess familial aggregation. Methods: Eligible CANSAH-BC participants were SAA females aged 21+, diagnosed with primary invasive breast cancer in NJ (2017-2023), who provided consent. Sociodemographic, lifestyle factors, family, and medical history were collected via interviews, with tumor data from the NJ State Cancer Registry. We compared CANSAH-BC participants with SAA females from NHIS, CHIS, and SAA breast cancer survivors in SEER using descriptive statistics. Familial incidence rate was calculated by dividing breast cancers in relatives by total person-years. Using the Institute of Health Metrics and Evaluation (IHME) population rates for South Asia, we calculated the standardized incidence ratio (SIR) and its 95% confidence interval (CI). Assuming a lognormal distribution for breast cancer risk and leveraging the known relationship between SIR and coefficient of variation of the risk distribution, we estimated the proportion of breast cancers in SAA women at highest and lowest 25% risk. Results: Among 101 CANSAH-BC participants, most were first-generation immigrants (94%), married (86%), insured (99%), and non-smokers (99%). Compared to NHIS and CHIS, more participants held a college degree (71%, 82%, 87%, respectively), were employed (62%, 68%, 73%, respectively), and had hypertension (17%, 11%, 33%, respectively) or diabetes (9%, 8%, 22%, respectively). Stage (60% localized) and triple-negative subtype (10%) distributions were similar to SEER NJ SAA survivors (62% localized, 9% triple-negative) but CANSAH-BC participants were younger (Mean (SD) = 52 (12) years vs. 56 (13) years in SEER NJ; p = 0.0017). The SIR was 3.86 (95% CI: 3.11 - 4.74), indicating significant familial aggregation. Under a lognormal distribution of risk, 68.7% of breast cancers will occur in SAA women at the top 25% risk group, while only 3.3% in the lowest 25%. Conclusion: CANSAH-BC participants closely mirror NHIS and CHIS respondents, but are significantly younger than SEER NJ survivors. The significant familial aggregation and likely concentration of breast cancers in the top 25% risk group underscore the predictive influence of shared genetic and environmental factors among relatives of SAA women with breast cancer. Our future direction will investigate these shared factors using germline and genomic markers. Citation Format: Tina Dharamdasani, 1Anusha Addanki, 1Anushyaa Vasudevan, 1Prachi Trivedi, 2Caroline Morales, 3Lisa Paddock, 3Nur Zeinomar, 2Bo Qin, 2Shridar Ganesan, 2Anita Y. Kinney, 2Elisa V. Bandera, 2Jaya M. Satagopan1. Unveiling cohort profile and familial aggregation in South Asian American women with breast cancer: Insights from the CANSAH-BC study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 970.

Reviewed by: Desis Divided: The Political Lives of South Asian Americans by Sangay K. Mishra Nalini Iyer DESIS DIVIDED: The Political Lives of South Asian Americans. By Sangay K. Mishra. Minneapolis: University of Minnesota Press. 2016. Sangay Mishra's book breaks new ground in South Asian American studies because he moves beyond the work of earlier scholars such as Vijay Mishra, Kamala Visweswaran, Monisha Das Gupta who had critiqued the model minority discourse used to frame the experiences of South Asian Americans. Mishra builds on this earlier work but provides a systematic analysis of the divergences and schisms within the ethnic group to study how this immigrant community has mobilized politically in recent years and in particular post 9/11. Based on interviews with South Asians in New York city and Los Angeles as well as analysis of national data from the 2000–2001 Pilot Study of the National Asian American Political Survey and the 2008 National Asian American Survey, Mishra looks at the patterns of political participation amongst South Asians both within the US and transnationally. The book begins with a socio-political history of South Asians in the U.S. which is familiar territory for those working in the field but necessary to introduce the book's overall project. He continues with an analysis of theories of ethno-racial mobilization and their relevance to the study of South Asian Americans. He then proceeds to explore post 9/11 racial targeting of South Asians and how that shapes political mobilization. The book continues with an examination of dominant modes of political mobilization amongst South Asians and concludes with two chapters that examine the community's transnational political engagement and how diasporic nationalism influences the members' engagement with U.S. politics. This study is timely and conceptualized well. As an economically powerful and rapidly growing community, South Asian Americans are increasingly active in politics at the local, regional, and national levels. However, Mishra's major intervention is that the South Asian American community is not a monolith and that national origin, religion, caste, and class are important factors that complicate how we understand the community. This approach of considering vectors of identity within the group is necessary in the evolution of South Asian American studies and has a significant methodological impact on the field. There are a couple of aspects of this study that could have been nuanced. The first is the question of gender. Although Mishra does devote about a dozen pages to social justice politics in chapter four and addresses how organizations like Sakhi and Manavi among [End Page 117] others that did ground breaking work on domestic violence prevention and advocacy and provided an avenue for political mobilization, the issues of gender, sexuality, and working class issues are lumped into this section and the analysis feels perfunctory. Is gender not a major factor if turbaned Sikh men and hijabi women were targets of racial violence post 9/11? It is not clear what percentage of respondents to the interviews were women? The discussion of South Asian racialization needs to be an intersectional one that accounts for gender and sexuality in the formation of race. The second issue is that of national origins. Mishra admits in his introduction that despite his best attempts, the study is dominated by Indian American issues. He justifies this because Indian Americans are numerically the largest amongst South Asians and also because South Asian American studies as a field has not produced enough scholarship on Pakistani, Bangladeshi, and other smaller South Asian communities. Both these reasons are real and important, but this Indo-centrism skews the argument. In particular, much of the chapter on diasporic nationalism is Indo-centric. Had Mishra engaged in a discussion of a smaller South Asian community such as the Sri Lankan American community and their diasporic nationalism, a more nuanced picture would have emerged. Sri Lankan Tamils who escaped a decades-long civil war have had an active and different form of diasporic nationalism during and after the civil war. Does the different post-independence political history of India and Sri Lanka impact diasporic nationalism differently? These critiques of the question of gender and Indo-centrism do not...

The present study explores the lived experiences of South Asian American women and what elements shape their ethnic-racial identity (ERI). Particularly, it discovers what push and pull factors encourage South Asian American women to lean towards or away from their ERI. This qualitative study used an open-ended survey to gather responses from 38 South Asian American women. Our qualitative study findings suggest that there are diverse elements of South Asian culture that encourage South Asian American women to embrace and/or reject parts of their ERI. Data analysis revealed that cultural aspects are impactful elements (e.g., food, music, community) that sustain South Asian American women’s connection with their ERI. Alternatively, the presence of patriarchy, misogyny, and feeling “othered” are factors that disengage South Asian American women from their ERI. Findings from this study contribute to the ongoing and vital expansion of the discussion of ERI and tap into the nuances of South Asian American women’s ERI.

This study used focus group methodology to examine South Asian (SA) American women's conceptualizations of eating disorders (EDs) and body dissatisfaction, and their perspectives regarding cultural influences on these conditions. Using a qualitative descriptive approach, seven focus groups were conducted (N = 54, mean age = 20.11 years, SD = 2.52). Themes (n = 15) were organized according to the amended objectification theory framework. Women described experiences of cultural stressors specifically related to living in the United States, and weight stigma from multiple sources, especially older women (e.g., mothers, relatives, and aunties). Participants also experienced pressures to achieve competing body and appearance ideals ("thin" and "healthy"). In addition, they reported pressures to possess light skin, dark black hair, minimal body hair, and marry young, and noted these pressures negatively impacted their body esteem. Findings indicate that a combination of "traditional" and culturally-influenced factors are important to consider when conceptualizing eating pathology and body image in young SA American women.

242 Background: Comprehensive data on breast cancer outcomes among South Asian American (SAA) women are limited, limiting efforts to optimize screening and treatment for this rapidly growing population. This study utilizes data from the National Cancer Database (NCDB) to evaluate differences in tumor characteristics, treatment patterns, and survival outcomes in SAA. Methods: Female SAAs (Asian Indian or Pakistani) diagnosed with invasive breast cancer between 2004 and 2021 were extracted from NCDB. Overall survival (OS) was modeled with multivariable Cox regression adjusting for age, stage, tumor grade, molecular subtype, Charlson–Deyo comorbidity index (CDI), insurance category, treatment delays > 60 days (surgery or chemotherapy), receipt of surgery, radiation, hormone therapy, and facility type. Results: The cohort comprised 20 561 South Asian American women. 5‐year overall survival was 93 % (95 % CI 92–94). In multivariable analysis, mortality increased with age: HR 1.22 (95 % CI 1.07–1.39) for ages 50–64, HR 1.60 (95 % CI 1.38–1.87) for ages 65–74, and HR 5.02 (95 % CI 4.31–5.84) for ages ≥ 75, versus 20–49. Compared with stage I, stage II had HR 1.97 (95 % CI 1.71–2.28), stage III HR 4.69 (95 % CI 4.03–5.47), and stage IV HR 19.96 (95 % CI 17.14–23.25). Grade 3 tumors carried HR 2.55 (95 % CI 2.07–3.15) versus grade 1, and triple-negative subtype HR 1.74 (95 % CI 1.30–2.32) vs. HR-/HER2+. Comorbidity burden increased mortality stepwise: CDI 1 HR 1.42 (95 % CI 1.23–1.64), CDI 2 HR 2.61 (95 % CI 1.94–3.51), CDI ≥ 3 HR 4.21 (95 % CI 2.85–6.21) versus CDI 0. Surgical delay > 60 days was associated with HR 1.59 (95 % CI 1.40–1.81). Protective factors included surgery (HR 0.11, 95 % CI 0.09–0.12), radiation (HR 0.61, 95 % CI 0.55–0.68), private insurance (HR 0.38, 95 % CI 0.32–0.46), and treatment at academic/research centers (HR 0.75, 95 % CI 0.60–0.94). Delay in chemotherapy > 60 days was not associated with increased mortality (HR 0.56, 95 % CI 0.48–0.64). Neighborhood income and public insurance status were not independently associated with survival. Conclusions: In SAA, OS was associated with tumor grade, molecular subtype, disease stage, comorbidity burden, and interval to surgery. Higher-grade and triple-negative tumors, advanced stage at presentation, greater comorbidity, and surgical delays longer than 60 days were each linked to higher mortality. In contrast, private insurance coverage and treatment at academic centers were associated with improved outcomes. These findings indicate that, in this population, earlier detection, phenotype-directed therapy, meticulous management of co-existing conditions, and prompt surgical intervention are particularly important for enhancing survival. Prospective studies combining genomic, immunologic, social, and treatment-timing data are needed to clarify biological drivers and to determine whether reducing care delays further improves outcomes.

Candida auris is an emerging multiresistant yeast against which amphotericin B (AMB) is still the first therapeutic choice in certain clinical situations (i.e., meningitis, endophthalmitis, and urinary tract infections). As data about the in vitro killing activity of AMB against C. auris clades are lacking, we determined MICs, minimum fungicidal concentrations (MFCs), and killing activity of AMB against 22 isolates representing the 4 major C. auris clades (South Asian n = 6; East Asian n = 4; South African n = 6, and South American n = 6). MIC values were ≤1 mg/L regardless of clades; MFC ranges were, 1–4 mg/L, 2–4 mg/L, 2 mg/L, and 2–8 mg/L for South Asian, East Asian, South African, and South American clades, respectively. AMB showed concentration-, clade-, and isolate-dependent killing activity. AMB was fungicidal at 1 mg/L against two of six, two of four, three of six, and one of six isolates from the South Asian, East Asian, South African, and South American clades, respectively. Widefield fluorescence microscopy showed cell number decreases at 1 mg/L AMB in cases of the South Asian, East Asian, and South African clades. These data draw attention to the weak killing activity of AMB against C. auris regardless of clades, even when MICs are low (≤1 mg/L). Thus, AMB efficacy is unpredictable in treatment of invasive C. auris infections.

Model Minority Terrorist:Post-9/11 Asian American Racial Formation and Brown Peril Narrative Discourse in Mohsin Hamid's The Reluctant Fundamentalist Stephen Hong Sohn1 (bio) Over approximately a single decade (1965–1975), the landscape for Asian Americans changed radically: the harshest quotas for Asian immigrants were lifted, ethnic studies programs were created, and academic excellence became associated with Asian Americans. Given all these seemingly positive changes, how can we engage the continued production of novels that fixate upon damaged Asian American subjects? How does racism get configured in today's age of unparalleled legislative inclusion? If the model minority stereotype merely represents the flip side to the yellow peril (Okihiro 142), then Asian American racial formation continues to revolve around a subtle dialectic in which oppression and prejudice emerge in more insidious ways. We can thus read the work of contemporary Asian American fictions through their illumination of the malleable contours of racial formation, as it has changed during the post-1965 period. Since 1966, the predominant racial formation attached to Asian Americans has been that of the model minority. Presumed to be astute, hardworking, and obedient, Asian Americans have been promoted as the minority ideal. However, South Asian Anglophone and South Asian American fiction writers have been incisive in their attention to racial formation, as it was re-scripted in the post-9/11 moment and as civil liberties [End Page 232] began to erode in light of the war on terror. In a range of novels, the South Asian American body transforms into a site of racial anxiety that manifests in acts of prejudice and violence. Mohsin Hamid's The Reluctant Fundamentalist takes a prominent place within this grouping, which includes Marina Budhos's Ask Me No Questions, Saher Alam's The Groom to Have Been, H. M. Naqvi's Home Boy, Nafisa Haji's The Writing on My Forehead, and Chitra Banerjee Divakaruni's Queen of Dreams. But Hamid's status as a transnational author has moved critical considerations of his work largely into the purview of postcolonial and global studies. Though published in 2007, the novel has already received widespread critical attention in dozens of articles, book chapters, reviews, and conference papers. Some scholars read the novel as exemplary of a global or world novel (Medovoi; Morey, "'The Rules of the Game Have Changed'") or as a postcolonial narrative boasting a trenchant critique of American imperialism and globalization (Singh; Haider; Keeble). Others focus on its unique combination of formal elements and social contexts (Adami; Mandala White). My article builds upon the work of Anna Hartnell, who argues that the novel reveals the complicated dynamics of religion and racial formation. As Hartnell notes, "The fact that America hosts a far more assimilated and upwardly mobile population of Muslims and Arabs than any European country suggests" (340) a form of privilege that some minority groups could not claim, at least prior to 9/11. Hartnell's larger point is that the novel critiques the melting pot formulation precisely because America's racial and religious minorities rarely inhabit the same positions in social hierarchies and are often positioned against one another. I extend Hartnell's argument by emphasizing the shift in American ethnoracial and religious alignments that repositions South Asians alongside Arabs and Muslims in the period following 9/11. The novel's depiction of a Pakistani transnational necessarily places this text within the purview of Asian American Studies, its attendant critical methodologies, and its central thematics (such as racial formation). At the same time, this novel encourages further interdisciplinary dialogues. With respect to US ethnic studies after 9/11, Ibrahim G. Aoudé provocatively considers how "Ethnic Studies, especially Asian American Studies, is compelled to deal with Arab American issues if it wants to remain a relevant field and revitalize its traditional commitments" (144). [End Page 233] Nadine C. Naber notes the affiliations between Asian American and "Arab/South Asian/Muslim American(s)" in that same period through the germination of activist coalitions (217–27). In light of the heightened paranoia, Shireen Roshanravan investigates how the targeting of Filipino airport screeners after the terrorist attacks demonstrated a large-scale attack on civil liberties in the name of...

Using combined data from the population-based 2001 and 2003 California Health Interview Surveys, we examined ethnic and gender-specific smoking behaviors and the effect of three acculturation indicators on cigarette smoking behavior and quitting status among 8,192 Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese American men and women. After adjustment for potential confounders, current smoking prevalence was higher and the quit rate was lower for Korean, Filipino, and Vietnamese American men compared with Chinese American men. Women's current smoking prevalence was lower than men's in all six Asian American subgroups. South Asian and Korean American women reported lower quit rates than women from other ethnic subgroups. Asian American men who reported using only English at home had lower current smoking prevalence and higher quit rates, except for Filipino and South Asian American men. Asian American women who reported using only English at home had higher current smoking prevalence except for Japanese women. Being a second or later generation immigrant was associated with lower smoking prevalence among all Asian American subgroups of men. Less educated men and women had higher smoking prevalence and lower quit rates. In conclusion, both current smoking prevalence and quit rates vary distinctively across gender and ethnic subgroups among Asian Americans in California. Acculturation appears to increase the risk of cigarette smoking for Asian American women. Future tobacco-control programs should target at high-risk Asian American subgroups, defined by ethnicity, acculturation status, and gender.

Relation of Menopause With Cardiovascular Risk Factors in South Asian American Women (from the MASALA Study)

Reading Together, Reading Apart: Identity, Belonging, and South Asian American Community

Mental illness (MI) affects one in four people in their lifetime and a failure to seek help for MI can have grave consequences. To decrease stigma and increase help seeking, prior campaigns have promoted the biological origins of MI. Even though some research supports the efficacy of this approach, other research does not. We propose cultural differences as a partial explanation for these inconsistent results. The current study assessed ethnic differences in the relationship between perceived causes of MI, shame associated with MI and perceived family support for help seeking. White and South Asian American (SAA) undergraduate students completed an online survey (n = 177). Results indicated that SAAs were significantly more likely than whites to perceive character deficits as the cause of MI. Further, among those who had sought help for MI, ethnic differences emerged in perceptions of MI based on perceived cause. SAAs who believed that MI had biological origins perceived more shame and less family support for seeking help compared to SAAs who believed MI was due to character deficits. The converse was true for whites – those who believed that MI had biological origins perceived less shame and more family support for help seeking compared to whites who believed MI was due to character deficits. The results of the current study illuminate the role that culture plays in perceptions of MI. Further, these results have implications for interventions targeting South Asian populations and for mental health outreach in general.

10574 Background: Studying racial-ethnic disparities in cancer risk can help in identifying underlying factors and developing targeted screening and education strategies. South Asian Americans (SAA), Asian Indians and Pakistanis, are a fast-growing ethnic group in the US, but there is limited research on their cancer risks. This study examines cancer prevalence patterns in the SAA population compared to Whites in the US. Methods: We analyzed cancer prevalence in 5,120,423 patients diagnosed with 23 different types of cancer between 2000 and 2018, using data from 18 SEER cancer registries. We compared cancer prevalence between SAA and Whites and examined factors such as cancer types, demographics, socioeconomic status, and urban vs. rural residency. Χ2 test was used to determine statistical significance (p<0.001). Results: Our analysis revealed higher prevalence of breast (19.0% vs. 14.6%) and thyroid (5.9% vs. 2.8%) cancers among SAAs compared to Whites, but lower rates of lung (6.5% vs. 12.0%), colorectal (5.9% vs. 7.4%), and melanoma (0.8% vs. 5.4%) cancers; p<0.001. Demographically, a significantly larger proportion of younger individuals (22.3% vs. 10.0%, ages 00-44) were found in the SAA cohort. The SAA survivor cohort also had a significantly higher percentage of females (50.8% vs. 48.6%) and married individuals than their White counterparts (69.3% vs 55.3%). Lastly, there were significant state-based variances in cancer prevalence. In California, SAAs had a lower cancer prevalence (23%) compared to Whites (38.5%), while in New Jersey, SAAs had a higher cancer prevalence (36.7%) than Whites (12.3%). Conclusions: Our analysis shows a disparity, highlighting the need for culturally attuned healthcare policies to enhance cancer education and screening among diverse groups. The higher prevalence of breast cancer in SAAs suggest possible effective screening, while lower rates of colorectal and lung cancers point to potential awareness gaps or cultural barriers. Addressing these, alongside researching genetic, environmental, and lifestyle influences—particularly given the younger SAA cancer population—is prudent. A focused approach, emphasizing targeted public health initiatives and further research, is necessary to enhance cancer outcomes and ensure health equity.

South Asian American (SA) women are diagnosed with more aggressive breast cancer than non-Hispanic White (NHW) women. Understanding the factors associated with the types of surgery received by these women sheds light on disease management in these culturally distinct populations. We used data on age at diagnosis, stage, grade, estrogen and progesterone receptors, and surgery from 4,590 SA and 429,030 NHW breast cancer cases in the Surveillance, Epidemiology and End Results (SEER) program. We used logistic regression with surgery as the binary outcome (subcutaneous, total, or radical mastectomy (STRM) versus partial mastectomy, no, unknown or other (PNUM)) and included additive effects of all the variables and interactions of age, stage, grade, and estrogen and progesterone receptors with race/ethnicity. Type I error of 5% was used to assess statistical significance of the effects. SA were significantly more likely than NHW cases to receive STRM relative to PNUM surgery among women diagnosed at or after age 50 years and having localized stage disease (Odds Ratio (OR) = 1.27, 95% Confidence Interval (CI) = 1.06 - 1.52). Further, SA were significantly less likely than NHW cases to receive STRM relative to PNUM surgery among those diagnosed before age 50 years and having regional or distant stage disease (OR = 0.75, 95% CI = 0.59 - 0.95 for age at diagnosis < 40 years; OR = 0.77, 95% CI = 0.62 - 0.95 for age at diagnosis 40-49 years). The type of surgery received by SA and NHW women differ according to age at diagnosis and disease stage.

Scholars in both the disciplines of folklore and rhetoric have shown interest in exploring the connections between social change and storytelling (Bauman). In the discipline of folklore, scholarly conversations concerning such intersections were initiated first by Roger Abrahams (Introductory Remarks) who drew heavily from the work of Kenneth Burke (A Rhetoric of Motives and Language as Symbolic Action), as did many rhetoricians during that period. In recent years, a growing number of folklorists have reinvigorated Abrahams's groundbreaking investigations into the interconnections among folklore, rhetoric, and narrative.1 This article explores the ways in which Indian folk traditions are reinterpreted and appropriated to serve as inventional resources in rhetorical texts that create constituencies and support social transformation. I hope to contribute to this ongoing conversation, particularly in regard to diasporic folklore performance contexts.My analysis of these narratives includes a description of the social and cultural milieu in which these stories are created and performed, as well as a close rhetorical analysis. More specifically, I trace appropriations of the Hindu folk heroine Savitri as she is transfigured within two different texts. The first is a liberal feminist of the tale by Madhur Jaffrey. The second is a diasporic revision of this story by a student (identified with the pseudonym Radhika for the purposes of this article) at the School for Indian Languages and Cultures (SILC). This retelling is accomplished through a pictoral representation-a piece of visual rhetoric-that imagines Savitri as exhibiting a type of Girl Power. I argue that these representations are characterized by a critical that treats Savitri as a hermeneutic resource for rhetorical invention. Each appropriation draws its force from the tensions and incongruities it strategically manifests by critically playing with notions of women's fearlessness in various discourse, from traditional Hindu, to liberal feminist, to pop culture Girl Power. In doing so, they advance complex arguments about the social conditions for women and their roles in various Indian and South Asian American contexts. This provides an important example of the ways in which individuals use folk narrative practices and performance to participate in pressing social issues at hand and engage in the rhetorical work of speaking, listening, and deliberating about them.In particular, Radhika2 constructs a representation of a fearless woman that presents seemingly irreconcilable cultural elements. She plays with the tension this produces and embraces the fact that a synthesis is neither possible nor desirable. Indeed, the rhetorical power of this play comes from the fact that there is no closure or resolution in this representation. Instead there is an acknowledgment of the diversity and uniqueness of South Asian American experiences. Radhika's work ultimately argues that public recognition of these divisions and differences are important to the ways South Asian American women and girls understand and explore gender issues in their lives.The School for Indian Languages and CulturesIn 1979-80, in St. Paul, Minnesota-a place typically known for its Norwegian, Swedish, Danish, Finnish, and German immigrant communities-a small group of Indian immigrants established a community institution called the School for Indian Languages and Cultures. Initially, this school remained unfamiliar to most outside of the South Asian community; for many people, Minnesota still epitomizes the culturally homogeneous, or white agricultural interior, of the United States, despite substantial diasporic movements of Mexican, Hmong, Somali, and Ethiopian individuals. Nevertheless, like many of the larger Indian communities in the United States located in urban centers such as New York City, Chicago, and Houston, the Twin Cities area has seen an increase in Indian regional groupings. …