Hawaiian Women Research Articles

Legacies from decolonizing methodologies

PurposeThis study aims to reflect and honor Linda Smith and her seminal work Decolonizing Methodologies.Design/methodology/approachReflecting on Linda Smith’s Decolonizing Methodologies: Research and Indigenous Peoples, I discuss my own application of Smith’s major contributions to my research, teaching- and community engaged work. I begin with my positionality and detail my journey as a Native Hawaiian teacher and researcher who has been influenced by the major tenants of Decolonizing Methodologies. After 25 years, Smith continues to empower Indigenous scholars and reminds us of the importance of the process of research and the necessary actions to collaborate with Indigenous communities towards knowledge production.FindingsReflections of how the tenants of Decolonizing Methodologies have influenced my own research, teaching and community engaged work.Research limitations/implicationsThis is my personal reflection and so it is limited.Practical implicationsOther Indigenous scholars can relate to my reflections of Linda Smith and Decolonizing Methodologies.Social implicationsMany of us can attest to the power of Decolonizing Methodologies.Originality/valueMy reflections as a Native Hawaiian woman will add value to the special issue.

Differences in Breast Cancer Subtypes among Racial/Ethnic Groups.

Differences in the incidence of breast cancer subtypes among racial/ethnic groups have been evaluated as a contributing factor in disparities seen in breast cancer prognosis. We evaluated new breast cancer cases in Hawai'i to determine if there were subtype differences according to race/ethnicity that may contribute to known disparities. We reviewed 4591 cases of women diagnosed with breast cancer from two large tumor registries between 2015 and 2022. We evaluated breast cancer cases according to age at diagnosis, self-reported race, breast cancer subtype (ER, PR, and HER2 receptor status), histology, county, and year. We found both premenopausal and postmenopausal Native Hawaiian women were less likely to be diagnosed with triple-negative breast cancer (OR = 0.26, 95% CI 0.12-0.58 p = 0.001; OR = 0.54, 95% CI 0.36, 0.80 p = 0.002, respectively). The results of our study support that there are racial/ethnic differences in breast cancer subtypes among our population, which may contribute to differences in outcomes. Further evaluation of clinical and pathological features in each breast cancer subtype may help improve the understanding of outcome disparities seen among different racial/ethnic groups.

Abstract 3407: Physical activity and post-menopausal breast cancer in the Multiethnic Cohort Study

Abstract Much research has been conducted on the relationship between physical activity and breast cancer, with meta-analyses showing 10 – 21% reduction in breast cancer risk for postmenopausal women with high compared to low level of physical activity. However, few studies have explored this relationship in non-Caucasian women. We analyzed data from 74,177 post-menopausal African American, Caucasian, Japanese American, Latina, and Native Hawaiian women in the Multiethnic Cohort in Hawaii and California. Data on physical activity (hours and metabolic equivalents (METs)) was based on a self-administered questionnaire at baseline (1993–1996). Multivariate Cox proportional hazards models provided estimates of hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for risk factors. We observed no associations between breast cancer risk and hours of moderate/vigorous activity per week (HR=1.01, 95% CI: 0.91-1.10, Ptrend=0.71), MET-hours of moderate/vigorous activity per week (HR=1.03, 95% CI: 0.94-1.13, Ptrend=0.92), and total METs-measured as average MET level per day multiplied by 7 (HR=0.94, 95% CI: 0.86-1.03, Ptrend=0.37) when comparing the highest quartile to the lowest. When examining the data across race/ethnicity, we observed a reduction in risk of breast cancer for total METs (HR=0.75, 95% CI: 0.61-0.94, Ptrend=0.05) among Latina women. Analysis across strata of BMI showed no differences across subgroups. In this study, we did not observe any consistent protective association between physical activity and breast cancer risk. Citation Format: Jasmeet K. Gill, Gertraud Maskarinec, Song-Yi Park, Lynne Wilkens, Loic Le Marchand. Physical activity and post-menopausal breast cancer in the Multiethnic Cohort Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3407.

Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States.

While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer. We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks. Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer healthequity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.

An Exploratory Study of Bone Health Among Native Hawaiian Women in Rural Hawai'i.

The purpose of this study was to obtain baseline data on bone mass density for Native Hawaiian women and to better understand the socio-cultural context for assessing bone health and risk of osteoporosis for this underserved population. A sequential mixed-method design guided by Leininger's Culture Care Theory of Diversity and Universality consisted of two phases: (a) an initial exploratory focus group and (b) dual-energy X-ray absorptiometry (DEXA) scans and individual interviews. Data were analyzed using descriptive statistics and thematic analysis. Phase a (n = 12) suggested that Native Hawaiian women have limited knowledge of bone health, but recognize traditional and cultural ways of health. Phase b (n = 50) showed that Native Hawaiian women have healthy bones, according to the T-score results. The interviews suggested that perspectives of bone health are culturally anchored. Understanding cultural values and practices are vital for care. Preliminary recommendations for health professionals are included.

“There is no room for me, for a Hawaiian, in science”: Rightful presence in community science

AbstractThis paper shares the experiences, engagement, and struggle of one young Indigenous Hawaiian woman as she grapples with her sense of disconnect with STEM while serving as a land protector on the Mauna Kea, the home of the Thirty Meter Telescope being built over the objection of the local Indigenous community. I examine her changing perspectives and connections to STEM through her engagement during a summer school enrichment class focused on science and technology learning in service of community goals. Findings indicate that her sense of agency and autonomy were greatly improved by engaging in a space where science and technology were tools serving her goals of protecting the Mauna Kea from further development.

Aurum by Santee Frazier (review)

Reviewed by: Aurum by Santee Frazier No'u Revilla (bio) Aurum by Santee Frazier University of Arizona Press, 2019 IN HIS SECOND COLLECTION OF POEMS, Santee Frazier is attentive to the work of shaping sound to place. An enrolled member of the Cherokee Nation of Oklahoma and director of the Institute of American Indian Arts Low Residency MFA program, Frazier has composed a collection that capably builds a world in which the unwanted, discarded, and forgotten of extractive capitalism sound their stories. To read Aurum is to listen. The sounds in Frazier's collection are at once desperate, menacing, and redemptive. Instead of the so-called postcolonial question of "now what?" Frazier's characters haunt the equally, if not more, prismatic problem of "now where?" What do these places sound like? Who is listening to the "where" of second, third, and fourth chances, to the "where" of hustling and hunger? The first poem of Aurum is faithfully driven by sound. Bladed by runs of alliteration and consonance, "Lactification" portrays a scene in which settler violence diminishes an Indigenous man to a mere body, an object to be inspected, punished, and domesticated. The poem's title gestures to the work of Frantz Fanon and the notion that white supremacy incentivizes (if not threatens) people of color to reject their racial identity, spurn their communities, and assimilate. Or, as "Lactification" rehearses: "a culling of melanin" (2). In the next poem, "Ore Body," the sound of machines interrupts land, and rituals of progress are juxtaposed with rituals "before mineral, polygon, the invention of the wheel, story of flat, firing / of clay" (4). Whereas progress is a linear narrative with clear winners and losers, Frazier's poems are non-linear and lyrical. Arguably, in "Ore Body," the "tongue of digging" works on two levels (4). First, it represents the language of labor on which industry and its fixation on all things pickaxed, dug out, and stolen are based. Second, the "tongue of digging" captures the intensity with which Frazier records the afterlives of industry. Enter: Mangled. Mangled Creekbed is a persona who appeared in Frazier's first book, Dark Thirty. In Aurum, he continues to embody Indigenous struggle for belonging. [End Page 193] We first see Mangled pretending to play music with an imaginary accordion. Apropos of Frazier's lyrical work, Mangled's gritty survival is defined by music rather than victimhood. In the "knife-etched stall" of "Mangled & the Accordion," for example, he tamps the tiled floor. Frazier adds: "When he mashes the keys and squeezes, daylight tunnels to fuzz" (18). Readers are subsequently privy to the crunching of bugs and the "shine of their bodies" between Mangled's fingers and teeth (21), to the rev and rumble of a demolition derby and the cheering audience Mangled imagines for himself (22), and to "the music of frying meat, of squirrel thighs dredged in corn meal" and the "[m]usic of lice wilting in kerosene" (23). In the final sequence of "Mangled & the Accordion," it is affirmed: "It was Mangled's tune, his humming of the knife, the slow slimming of his lips / to song" (25). The places we meet Mangled crunch, wilt, and buzz alongside him. Importantly, he is both witness to and maker of this music. In addition to sound, readers can also track motifs of light and dark in Frazier's collection. Aurum, itself, is the Latin name for gold. In the context of Frazier's worldbuilding, the title points to genocidal campaigns waged against Indigenous peoples for the promise of gold and to ongoing acts of environmental racism that yoke Indigenous lands and bodies to extractive capitalism. In fact the motif of gold throughout the book is anticipated by the repetition of the word "shine" in "Ore Body." Yet who or what is shining? And why? What relationship between light and dark are we readers invited to consider? As a Native Hawaiian woman reading Frazier's collection, I dwelled here. Light and dark are frequently rendered as antithetical, but how useful is this opposition? Where did it come from? How is it used? American settler colonialism perverted my ancestors' sense of dark and consequently corrupted our relationship to light. This...

Abstract 3630: Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups

Abstract Introduction: Breast cancer survivors have an increased risk of contralateral breast cancer (CBC), among whom minority breast cancer patients are at increased risk of this adverse outcome. Studies evaluating CBC risk by race/ethnicity frequently aggregate Asian/Pacific Islanders (API) into a single group or exclude them. The purpose of this study was to determine the impact of socioeconomic status (SES) on the risk of CBC among subgroups of API breast cancer survivors. Method: We conducted a population-based retrospective cohort study of women ages 18+ years diagnosed with unilateral Stage I-III breast cancer using the Surveillance, Epidemiology and End Results Census Tract-level SES and Rurality Database (2000-2016). Women included in the study received cancer-directed surgery and the primary outcome of interest was asynchronous CBC occurring. SES was classified using the Yost index, a validated time-dependent composite score with the 1st quintile representing the lowest and 5th quintile being the highest SES. API women were categorized into Chinese, Japanese, Filipina, Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other Asian/Pacific Islanders. We determined overall associations between SES and the risk of CBC using Fine and Gray regression models accounting for competing risks comparing API women to Non-Hispanic White (NHW) women. Multivariable adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. Results: From a cohort of 44,362 API female breast cancer patients included, one quarter of the cohort were Filipina (25%), 18% were Chinese, 14% were Japanese, 8% were Indian/Pakistani, and 17% were other API. API women living in the lowest SES areas were more likely to be uninsured or have Medicaid coverage (21% vs. 6%) and have Stage lll first primary breast cancer (14% vs. 10%) compared to API women living in the highest SES areas. Overall, API breast cancer patients as an aggregate group did not have significantly increased risk of CBC compared to NHW patients. In stratified subgroups, risk estimates for CBC were higher among Chinese women (SHR 1.24, 95% CI 1.08-1.41), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Hawaiian women (SHR 1.67, 95% CI 1.37-2.08) when compared to NHW women after adjusting for demographics and baseline clinical characteristics. Lower SES was not associated with increased CBC risk among API women overall. However, the risk of CBC is significantly lower among Chinese and Vietnamese women and higher among Filipina women who lived in areas lower SES quintile compared to women who lived in area with the highest SES quintile when examining impact of SES within API subgroups. Conclusion: Chinese, Filipina, and Hawaiian women have higher risk of CBC when compared to NHW. When disaggregated API women into subgroups, the impact of SES on the risk of CBC differs significantly across API subgroups. Citation Format: Hsiao- Ching Huang, Jenny S. Guadamuz, Kent F. Hoskins, Naomi Y. Ko, Gregory S. Calip. Impact of socioeconomic status on the risk of contralateral breast cancer among Asian/Pacific Islander subgroups [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3630.

A multilevel intervention increased accrual of Native Hawaiians and other Pacific Islanders to a national breast cancer screening trial.

6547 Background: The University of Hawaii Cancer Center (UHCC) Minority/Underserved NCI Community Oncology Research Program (Hawaii MU NCORP) provides access to NCI-sponsored clinical trials in Hawaii. The Hawaii MU NCORP is dedicated to increasing minority and underserved accruals to clinical trials. Native Hawaiian women have the highest breast cancer incidence and mortality; only 26% of Micronesian women in Hawaii over the age of 40 have ever had a mammogram. In 2018, the Hawaii MU NCORP became a recruitment site for the ECOG-ACRIN Tomosynthesis Mammographic Imaging Screening Trial (TMIST). A pilot study was launched in 2019, to support our NCORP recruitment of underrepresented Native Hawaiian and other Pacific Islander (NHPI) women to the TMIST study. Subsequently, specific funding was provided by the NCI’s Center to Reduce Cancer Health Disparities that enabled the UHCC’s Office of Community Outreach and Engagement (COE) to develop an effective multilevel recruitment strategy together with the Hawaii MIU NCORP. Methods: To foster community awareness of the TMIST study among NHPI women, the UHCC COE hired a Community Health Educator (CHE). The CHE, a Pacific Islander woman, utilized small group educational sessions to provide culturally and linguistically appropriate cancer prevention information and promote the TMIST study to NHPI women in Hawaii. The CHE worked in partnership with Hawaii MU NCORP clinical research associates (CRAs) in these efforts. In 2020, statewide COVID-19 health and safety protocols were enacted, limiting public group interactions in Hawaii. Despite this challenge, the CHE successfully adapted the in-person educational sessions on clinical trials and TMIST to conduct sessions using Zoom and Facebook Messenger. Results: Before the hire of the CHE in 2019, only one Pacific Islander (Micronesian) woman was recruited to the TMIST in Hawaii. The CHE conducted 21 community health events with 426 attendees from 2019 to 2021. The Hawaii MU NCORP NHPI TMIST enrollment went from the 9.9% in 2018 to 2019, to 20.1% in 2019 to 2020 and to 33% in 2020 to 2021. To date, 18 Micronesian, 52 Native Hawaiian and 6 Other Pacific Islander women out of 353 participants ware enrolled. Conclusions: The multilevel intervention of our CHE, in collaboration with NCORP staff providing clinical trial awareness training and community outreach, resulted in increasing the enrollment of NHPI women to the TMIST Trial. CHE-led community health education sessions on cancer prevention can be delivered using emergent technologies and social media. The use of culturally and gender concordant CHEs working with CRAs have the potential to increase awareness and accruals to cancer clinical trials.

Invisible Currents of Power Course Beneath the Surface of Our Rivers

ABSTRACT This triptych uses academic literature, poetry, and personal reflection to illustrate the impact of the invisible currents of power that run through society and history on three fictional individuals—a Native Hawaiian woman on the Hamakua coast of the Island of Hawai`i, a girl in a refugee camp on the Thailand-Myanmar border, and a military general in a government building in Naypyidaw, the capital of Myanmar.

Prognostic utility of self-reported sarcopenia (SARC-F) in the Multiethnic Cohort.

BackgroundAge‐related loss in skeletal muscle mass, quality, and strength, known as sarcopenia, is a well‐known phenomenon of aging and is determined clinically using methods such as dual‐energy X‐ray absorptiometry (DXA). However, these clinical methods to measure sarcopenia are not practical for population‐based studies, and a five‐question screening tool known as SARC‐F has been validated to screen for sarcopenia.MethodsWe investigated the relationship between appendicular skeletal lean mass/height2 (ALM/HT2) (kg/m2) assessed by DXA and SARC‐F in a subset of 1538 (778 men and 760 women) participants in the Multiethnic Cohort (MEC) Study after adjustment for race/ethnicity, age, and body mass index (BMI) at the time of DXA measurement. We then investigated the association between SARC‐F and mortality among 71 283 (41 757 women and 29 526 men) participants in the MEC, who responded to the five SARC‐F questions on a mailed questionnaire as part of the MEC follow‐up in 2012–2016.ResultsIn women, SARC‐F score was significantly inversely associated with ALM/HT2 after adjusting for race/ethnicity, and age and BMI at DXA (r = −0.167, P < 0.001); the result was similar in men although it did not reach statistical significance (r = −0.056, P = 0.12). Among the 71 000+ MEC participants, SARC‐F score ≥ 4, as an indicator of sarcopenia, was higher in women (20.9%) than in men (11.2%) (P < 0.0001) and increased steadily with increasing age (6.3% in <70 vs. 41.3% in 90+ years old) (P < 0.0001). SARC‐F score ≥ 4 was highest among Latinos (30.8% in women and 16.1% in men) and lowest in Native Hawaiian women (15.6%) and Japanese American men (8.9%). During an average of 6.8 years of follow‐up, compared with men with SARC‐F score of 0–1 (indicator of no sarcopenia), men with SARC‐F 2–3 (indicator of pre‐sarcopenia) and SARC‐F ≥ 4 had significantly increased risk of all‐cause mortality [hazard ratio (HR) = 1.00, 1.77, 3.73, P < 0.001], cardiovascular disease (CVD) mortality (HR = 1.00, 1.85, 3.98, P < 0.001), and cancer mortality (HR = 1.00, 1.46, 1.96, P < 0.001) after covariate adjustment. Comparable risk association patterns with SARC‐F scores were observed in women (all‐cause mortality: HR = 1.00, 1.47, 3.10, P < 0.001; CVD mortality: HR = 1.00, 1.59, 3.54, P < 0.001; cancer mortality: HR = 1.00, 1.30, 1.77, P < 0.001). These significant risk patterns between SARC‐F and all‐cause mortality were found across all sex–race/ethnic groups considered (12 in total).ConclusionsAn indicator of sarcopenia, determined using SARC‐F, showed internal validity against DXA and displayed racial/ethnic and sex differences in distribution. SARC‐F was associated with all‐cause mortality as well as cause‐specific mortality.

Abstract PO-175: Neighborhood segregation typology and breast cancer risk: The Multiethnic Cohort Study

Abstract Background: Chronic stress as a result of residing in neighborhoods with higher levels of racial/ethnic segregation may increase a woman's risk of breast cancer. There is strong evidence of increased breast cancer risk due to social stress from animal models. Furthermore, epidemiologic studies have suggested links between racial/ethnic segregation and poor breast cancer outcomes. While a limited number of studies have demonstrated increased breast cancer risk and worse prognostic factors for African American women residing in neighborhoods with high racial/ethnic segregation compared to White women, no studies have examined this potential association in other racial/ethnic groups. Methods: Using data from the Multiethnic Cohort (MEC) (1993-2014), we examined the association between a neighborhood segregation typology of racial/ethnic compositions and incidence of primary, invasive breast cancer in a population-based sample of 101,811 African American, Japanese American, Latina, Native Hawaiian, and White women primarily residing in Los Angeles County, California and Hawaii. Segregation typology was based on the distribution of racial/ethnic groups across census tracts and linked to participants' geocoded baseline residential addresses. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer risk were estimated using multivariable Cox proportional hazards regression adjusted for age, family history of breast cancer, reproductive and lifestyle risk factors for breast cancer, and stratified by state and self-reported race/ethnicity. For each state and racial/ethnic group, the reference typology was specific to co-ethnic residents. Results: A median follow-up of 20 years yielded 6,398 breast cancer cases. In California, African American women living in predominantly White neighborhoods had reduced risk of breast cancer (HR=0.68, 95%CI=0.46-0.99) compared to African American women living in predominantly Black neighborhoods. Among Latina women, compared to residents in predominately Latino neighborhoods, those in mixed White and Asian American/Pacific Islander (AAPI) (HR=1.54, 95%CI=1.05-2.25) and multiethnic White neighborhoods (HR=1.34, 95%CI=1.07-1.69) had increased risk of breast cancer. In Hawaii, Native Hawaiian women in predominantly AAPI neighborhoods had increased breast cancer risk (HR=1.20, 95%CI=1.04-1.38) compared to Native Hawaiian women in mixed White and AAPI neighborhoods. For Japanese American women in Hawaii, those living in mixed Native Hawaiian (HR=1.28, 95% CI=1.05-1.55) and multiethnic (HR=1.61, 95% CI=1.36-1.90) neighborhoods had higher breast cancer risk than those living in predominately Asian neighborhoods. Conclusion: This large-scale prospective study in a multiethnic population found differential associations between neighborhood racial/ethnic segregation and breast cancer risk by state of residence and self-reported race/ethnicity. Future research should aim to identify pathways through which segregation measures influence breast cancer risk in specific racial/ethnic populations. Citation Format: Meera Sangaramoorthy, Joseph Gibbons, Juan Yang, Katherine Lin, Yuqing Li, Jenna A Khan-Gates, Pushkar Inamdar, Christopher A. Haiman, Loïc Le Marchand, Lynne R Wilkens, Scarlett L. Gomez, Salma Shariff-Marco, Iona Cheng. Neighborhood segregation typology and breast cancer risk: The Multiethnic Cohort Study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-175.

Abstract PO-171: Local economic and racial/ethnic segregation and breast cancer risk: The Multiethnic Cohort Study

Abstract Introduction: Residential segregation has been documented to contribute to health inequities. The Index of Concentration at the Extremes (ICE) is a local measure of residential segregation that can capture economic, racial, and combined racialized economic residential segregation. ICE measures have only recently been examined in cancer studies, few of which have focused on breast cancer risk and none among Asian American or Pacific Islander (AAPI) groups. In the Multiethnic Cohort Study (MEC), we examined the associations of neighborhood ICE measures with breast cancer incidence among 101,811 female participants in five racial/ethnic groups (African American, Latino, Japanese American, Native Hawaiian, and White). Methods: ICE measures were developed based on 1990 U.S. census tract-level data, categorized in quintiles based on Los Angeles county and Hawai'i state-specific distributions, and assigned to the residential census tract of MEC female participants residing, at study baseline, in California (CA) (primarily Los Angeles, n=56,880), and Hawai'i (HI) (n=44,931). Separate ICE measures were created for household income, education, race/ethnicity, and combined household income and race/ethnicity. Women, aged 45-75 at enrollment, completed a comprehensive lifestyle questionnaire and were followed from baseline (1993-1996) to earliest date of invasive breast cancer diagnosis (n=6,398), death, or end-of-follow-up (12/31/2014). Invasive breast cancer incidence was modeled using Cox proportional hazards regression adjusted for demographics, family history of breast cancer, reproductive and lifestyle factor factors. Stratified analyses were conducted by race/ethnicity and stage at diagnosis. Results: For women in CA MEC, there were significantly higher risks of breast cancer for those living in neighborhoods with more versus less concentrated privilege [Q5 v Q1 Hazard Ratios (HR): ICE income 1.16 (1.03-1.31), ICE education 1.21 (1.05-1.39)]. In stratified analyses, these patterns of associations were seen for African Americans, Latinos, and Japanese Americans. Risks were also higher among Japanese American women living in neighborhoods with greater concentrations of Whites versus AAPI [Q5 v Q1 ICE Race HR: 1.77 (1.22-2.57)] and for Latino women living in neighborhoods with greater concentrations of high income-White households versus low income-Hispanic households [Q4 v Q1 ICE Race + Income HR: 1.48 (1.20-1.82)]. For women in HI MEC, those living in neighborhoods with higher versus lower ICE income or ICE education had higher risk of localized stage at diagnosis and lower risk of regional &amp; distant diagnosis (p Het &amp;lt;0.01). No associations were found among White or Native Hawaiian women. Conclusions: Our findings suggest economic residential segregation plays an important role in breast cancer risk among African American, Latino, and Japanese American women. This study also highlights the importance of examining racial and racialized economic residential segregation separately across racial/ethnic groups. Citation Format: Jenna Khan-Gates, Salma Shariff-Marco, Katherine Lin, Pushkar Inamdar, Juan Yang, Yuqing Li, Meera Sangaramoorthy, Christopher Haiman, Loïc Le Marchand, Lynne R Wilkens, Scarlett L Gomez, Iona Cheng. Local economic and racial/ethnic segregation and breast cancer risk: The Multiethnic Cohort Study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-171.

Racial and Ethnic Disparities in Rates of Invasive Second Breast Cancer Among Women With Ductal Carcinoma In Situ in Hawaiʻi

Women with ductal carcinoma in situ (DCIS) may develop a subsequent invasive second breast cancer (SBC). Understanding the association of racial and ethnic factors with the development of invasive SBC may help reduce overtreatment and undertreatment of women from minority groups. To evaluate risk factors associated with developing invasive ipsilateral SBC (iiSBC) and invasive contralateral SBC (icSBC) among women with an initial diagnosis of DCIS who are from racial and ethnic minority populations. This retrospective cohort study used deidentified data from the Hawai'i Tumor Registry of 6221 female Hawai'i residents aged 20 years or older who received a diagnosis of DCIS between January 1, 1973, and December 31, 2017. The 5 most populous ethnic groups were compared (Chinese, Filipino, Japanese, Native Hawaiian, and White). Data analysis was performed from 2020 to 2021. Patient demographic and clinical characteristics and the first course of treatment. The a priori study outcome was the development of invasive SBC. Logistic regression was used to identify factors associated with invasive SBC. Factors that were significant on unadjusted analyses were included in the adjusted models (ie, age, race and ethnicity, diagnosis year, DCIS histologic characteristics, laterality, hormone status, and treatment). The racial and ethnic distribution of patients with DCIS across the state's most populous groups were 2270 Japanese women (37%), 1411 White women (23%), 840 Filipino women (14%), 821 Native Hawaiian women (13%), and 491 Chinese women (8%). Women of other minority race and ethnicity collectively comprised 6% of cases (n = 388). A total of 6221 women (age range, 20 to ≥80 years) were included in the study; 4817 (77%) were 50 years of age or older, 4452 (72%) received a diagnosis between 2000 and 2017, 2581 (42%) had well or moderately differentiated histologic characteristics, 2383 (38%) had noninfiltrating intraductal DCIS, and 2011 (32%) were treated with mastectomy only. Of these 6221 women, 444 (7%) developed invasive SBC; 190 developed iiSBC (median time to SBC diagnosis, 7.8 years [range, 0.5-30 years]) and 254 developed icSBC (median time to SBC diagnosis, 5.9 years [range, 0.5-28.8 years]). On adjusted analysis, women who developed iiSBC were more likely to be younger than 50 years (adjusted odds ratio [aOR], 1.49; 95% CI, 1.08-2.06), Native Hawaiian (aOR, 3.28; 95% CI, 2.01-5.35), Filipino (aOR, 1.94; 95% CI, 1.11-3.42), Japanese (aOR, 1.58; 95% CI, 1.01-2.48), and untreated (aOR, 2.29; 95% CI, 1.09-4.80). Compared with breast-conserving surgery (BCS) alone, there was a decreased likelihood of iiSBC among women receiving BCS and radiotherapy (aOR, 0.45; 95% CI, 0.27-0.75), BCS and systemic treatment with or without radiotherapy (aOR, 0.40; 95% CI, 0.23-0.69), mastectomy only (aOR, 0.23; 95% CI, 0.13-0.39), and mastectomy and systemic treatment (aOR, 0.57; 95% CI, 0.33-0.96). Women who developed an icSBC were more likely to be Native Hawaiian (aOR, 1.69; 95% CI, 1.10-2.61) or Filipino (aOR, 1.70; 95% CI, 1.10-2.63). Risk of both iiSBC and icSBC decreased in the later years of diagnosis (2000-2017) compared with the earlier years (1973-1999). This study suggests that Native Hawaiian and Filipino women who initially received a diagnosis of DCIS were more likely to subsequently develop both iiSBC and icSBC. Japanese women and younger women were more likely to develop iiSBC. Subpopulation disaggregation may help guide clinical treatment and screening decisions for at-risk subpopulations.

Racial disparities among women who develop invasive secondary breast cancer.

e18523 Background: Noninvasive breast cancers ( e.g. ductal and lobular carcinoma in situ) are highly treatable nonobligate precursors to invasive breast cancers. However, even after treatment, some women develop second breast cancers (SBCs), increasing their mortality risk. Prognosticators may inform treatment recommendations for women at higher risk of SBC. In this study, risk factors for SBC were evaluated using deidentified data from the Hawaiʻi Tumor Registry (HTR), an NCI SEER registry. The HTR covers a uniquely multiethnic, statewide population allowing for elucidation of disparities in understudied U.S. populations. Methods: Women initially diagnosed between 1973-2017 with noninvasive (ductal and lobular) breast cancer were identified. Patient demographics, cancer characteristics, and treatment information were collected. Univariate (UVA) and multivariate (MVA) logistic regression analyses were used to identify factors associated with SBC, defined as a breast cancer diagnosis &gt; 6 months after their prior cancer. Results: Of 7,057 women diagnosed with a first noninvasive breast cancer, 696 (10%) developed SBC. Invasive ipsilateral (iiSBC) and invasive contralateral (icSBC) disease represented 9% and 20% of patients who developed SBC, respectively. The five most prevalent ethnic groups were Chinese, Filipino, Japanese, Native Hawaiian, and White. When adjusting for confounders, women who developed iiSBC were more likely to be Native Hawaiian (odds ratio [OR] = 3.20, 95% CI = 2.07-4.94) or Filipino (OR = 1.72, 95%CI = 1.02-2.91) when compared to Whites; diagnosed between 1990-1999 (OR = 2.06, 95%CI = 1.27-3.34); and not have undergone surgical treatment (OR = 2.93, 95%CI = 1.42-6.04). Women who developed iiSBC were less likely to be &gt; 50 years old (OR = 0.67, 95%CI = 0.49-0.90); diagnosed between 2010-2017 (OR = 0.18, 95%CI = 0.09-0.35); received lumpectomy with radiation therapy (OR = 0.54, 95%CI = 0.35-0.72); and undergone mastectomy (OR = 0.48, 95%CI = 0.32-0.72). Women who developed an icSBC were more likely to be Native Hawaiian (OR = 1.58, 95%CI = 1.06-2.35) or Filipino (OR = 1.60, 95%CI = 1.06-2.42). These women were also less likely to have been diagnosed between 2010-2017 (OR = 0.30, 95%CI = 0.17-0.53). On a subset analysis separating all patients with SBC by first course treatment type, there were no statistically significant differences for treatment type based on race/ethnicity. Conclusions: Overall, in this observational study, Native Hawaiian women, Filipino women, and younger women had increased odds of developing invasive SBC. This study highlights racial disparities in SBC development risk that was not previously appreciated among disaggregated groups of Pacific Islanders and Asian women when compared to White women. This may help oncologists understand the risk of developing SBC in these understudied populations.

Urinary phthalate exposures and risk of breast cancer: the Multiethnic Cohort study

BackgroundThe epidemiologic evidence from observational studies on breast cancer risk and phthalates, endocrine disrupting chemicals, has been inconsistent. In the only previous study based on pre-diagnostic urinary phthalates and risk of breast cancer, results were null in mostly white women.MethodsWe examined the association between pre-diagnostic urinary phthalates and breast cancer in a nested case-control study within the Multiethnic Cohort (MEC) study, presenting the first data from five major racial/ethnic groups in the USA. We measured 10 phthalate metabolites and phthalic acid, using a sensitive liquid chromatography mass spectrometry assay on 1032 women with breast cancer (48 African Americans, 77 Latinos, 155 Native Hawaiians, 478 Japanese Americans, and 274 Whites) and 1030 matched controls. Conditional logistic regression was used to examine risk with individual metabolites and ratios of primary (MEHP, mono-2-ethylhexyl-phthalate) to secondary (MEHHP, mono(2-ethyl-5-hydroxyhexyl); MEOHP, mono(2-ethyl-5-oxohexy)) metabolites of di-2-ethylhexyl phthalate (DEHP), a widely used plasticizer. In addition, we investigated risk associations with high (∑HMWP) and low molecular weight (∑LMWP) phthalates, as well as total phthalates which included high and low molecular weight phthalates with phthalic acid (∑LMHMPA) or without phthalic acid in molar ratios (∑LMHMmolar) and adjusted for creatinine and potential confounders.ResultsAmong all women, breast cancer risk was higher for those in tertile 2 and tertile 3 of primary to secondary metabolites of DEHP (MEHP/(MEHHP + MEOHP)) in comparison to those in tertile 1; the respective odds ratios were 1.32 (95% CI 1.04–1.68) and 1.26 (95% CI 0.96–1.66) (Ptrend = 0.05). Risk among Native Hawaiian women increased with exposures to eight of ten individual phthalates and total phthalates (∑LMHMPA ORT3 vs T1 = 2.66, 95% CI 1.39–5.12, Ptrend = 0.001). In analysis by hormone receptor (HR) status, exposure above the median of ∑LMWP was associated with an increased risk of HR-positive breast cancer (OR = 1.30, 95% CI 1.05–1.60) while above the median exposure to phthalic acid was associated with an increased risk of HR-negative breast cancer (ORabove vs below median = 1.59, 95% CI 1.01–2.48).ConclusionsFurther investigations of suggestive associations of elevated breast cancer risk with higher ratios of primary to secondary metabolites of DEHP, and differences in risk patterns by race/ethnicity and HR status are warranted.

Abstract PS7-67: Breast cancer subtype differences according to race/ethnicity

Abstract Background:Breast cancer incidence and mortality rate differ across racial/ethnic population in the US, little is known about Asian and Pacific Island subpopulations. For the Asian subgroups (Japanese, Chinese, Korean, Filipino, Vietnamese, etc.) in the U.S., overall incidence has increased over recent decades. From 2012-2016 Hawai’i incidence rates were significantly higher than the US overall for breast cancer, although cancer mortality rates in Hawai’i were significantly lower than the US overall for breast cancer. Significant disparities in breast cancer incidence and mortality exist, with Native Hawaiian and Filipino women particularly affected. Native Hawaiian women have the highest incidence and also have a 50% higher risk of breast cancer mortality compared to White women. In addition, there are dramatic racial/ethnic differences in mortality rates in the state, with Native Hawaiians having the highest mortality rates compared to all other major racial/ethnic groups. Methods:We examined unique breast cancer cases in a major health system in Hawai’i from 2013-2019 according to race/ethnicity. We found statically significant differences in breast cancer subtype according to race/ethnicity and menopausal status. Results:In 561 premenopausal breast cancer cases, we found that Native Hawaiians were less likely to have triple negative breast cancer (OR 0.2, p=0.02) and Japanese were less likely to have triple positive breast cancer (OR 0.17, p=0.002) compared to other race/ethnicities. In 1,954 postmenopausal breast cancer cases, we found that Filipino women were more likely to have hormone negative/HER2 positive breast cancer (OR 2.38, p=0.006) compared to other race/ethnicities. Table 1-Breast cancer subtype according to race/ethnicity in premenopausal women Table 2-Breast cancer subtype according to race/ethnicity in postmenopausal women Summary:Although behavioral, environmental, social, economic, and biological factors have been shown to influence risk and survival for breast cancer, they do not entirely explain the differences observed across populations. These findings show the need to characterize the underlying differences in breast tumor biology of breast cancer patients from different racial/ethnic groups to better understand known health disparities. Our hypothesis is that molecular characteristics are key contributors to the disparities in disease outcome across the different racial/ethnic groups. We have previously shown the importance of the tumor microenvironment differences in racial/ethnic groups in our population. Citation Format: Jami Fukui, Surbhi Bansil, Anthony Silva, Jeffrey Killeen, Ian Pagano. Breast cancer subtype differences according to race/ethnicity [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 PS7-67.

Hawaiian Women's Fashions: Kapa, Cotton and Silk by Agnes Terao-Guiala

Reviewed by: Hawaiian Women's Fashions: Kapa, Cotton and Silk by Agnes Terao-Guiala Linda Arthur Bradley Hawaiian Women's Fashions: Kapa, Cotton and Silk. By Agnes Terao-Guiala. [n.p.]: Agnes Terao-Guiala, 2019. 288 pp. Illustrated. Bibliography. Index. $49.00 paper Terao-Guiala's book on Hawaiian women's fashions is the result of extensive research on Hawaiian clothing and history. It is a big, beautiful book, lavishly illustrated with line drawings and photos that enrich our understanding of the era prior to the overthrow of the Hawaiian monarchy. The last chapters discuss Hawai'i's contemporary designers who continue traditional Hawaiian designs within the global fashion industry. It is in these areas, the 19th century, and the 21st century, that the book shines. While there are many books on the aloha shirt, this is only the second book produced that covers Hawaiian women's dress. It is a welcome addition to the literature. As a trade book, it is written in a comfortable style intended for a wide audience of readers in Hawai'i. It is neither an academic or history book, as there are no footnotes and few source citations. Beginning with a discussion of Hawaiian material culture and of kapa designs in pre-contact times, the author sets the frame for examining later Hawaiian textile designs and their focus on Hawaiian flora, fauna, and culture. The shift from wearing kapa to clothing of woven fabric began in 1820 when American missionary wives arrived and first made garments for royalty inspired by their own western styles, but without waistlines. That has remained a unique feature of aloha attire. From then on, Hawaiian fashion developed through the interplay of western styles and Hawaiian print designs. This book is as much about history as fashion. Within each chapter, the author presents a long discussion of Hawaiian history and key personages followed by information on clothing and textiles from that era. The evolution of [End Page 177] style lines is presented through stories of significant Hawaiian women from the nineteenth century forward as they interacted with missionaries and others, then adapted western styles to their own use. This approach makes for fascinating reading, but along the way, there are contradictions regarding terms used, but none are defined. The reader is left confused as to the differences between the four basic styles of women's aloha attire, and that was also apparent in the identification of garments in the book's twentieth century photos, where half of the garments labeled as holokū would generally be classified as mu'umu'u. Key terms need to be defined and a glossary of Hawaiian terms is needed for readers unfamiliar with the Hawaiian language. With regard to women's aloha attire of the twentieth century, there are recognized definitions of the types of aloha attire based on the Hawaiian Garment Industry's nomenclature, found in academic articles and encyclopedias of fashion, and used by the University of Hawai'i at Mānoa's Historic Costume Collection. The holokū is a long gown, generally with long sleeves; it could be loose or fitted and became a formal garment with a train. A mu'umu'u is a loose day dress with a variety of sleeves and lengths. The holomu'u is a more fitted dress, like a holokū, but without a train. Aloha shirts were made for both men and women. Terao-Guiala does not discuss women's aloha shirts, though some remarkable ones were produced in the 1940s and 1950s. The book's subtitle, "Kapa, Cotton and Silk", refers to the dominant fibers for fabric used in Hawai'i's clothing. Each chapter title begins with whichever of these fibers seemed to be most important for that era. Unfortunately, rayon and polyester were completely ignored, even though most of the fabrics used in aloha attire in the last half of the twentieth century were rayon, cotton, polyester and cotton-polyester blends. Rayon was used in the post WWII period for about a decade. Aloha attire produced in rayon from the late 1940s through late 1950s is highly collectible today and can cost well over $1,000.00. Cotton dominated the 1960s, polyester came...

Possessing Polynesians: The Science of Settler Colonial Whiteness in Hawai’i and Oceania by Maile Arvin

Reviewed by: Possessing Polynesians: The Science of Settler Colonial Whiteness in Hawai’i and Oceania by Maile Arvin Xine Yao (bio) Possessing Polynesians: The Science of Settler Colonial Whiteness in Hawai’i and Oceania, by Maile Arvin. Durham: Duke University Press, 2019. Xi + 313 pp. $27.95 paper. ISBN 978-1-4780-0633-6. Maile Arvin’s Possessing Polynesians was prominently displayed alongside other works by Native Hawaiian scholars at the 2019 American Studies Association conference in Honolulu, Hawai’i. The conference included the celebration of legendary activist-scholar Haunani-Kay Trask, who received the Angela Y. Davis Prize, as well as panels featuring the kia’i (guardians) defending Mauna Kea against the threat of the Thirty Meter Telescope. The American Studies Association is another home to many fields of critical race and ethnic studies, Asian American studies included. I wondered about Asian Americanists and Asian diasporic scholars who might attend but not deign to go to any of the events centering Native Hawaiians. On the one hand, there are Asian settlers, like Candace Fujikane and Dean Saranillio, committed to working in coalition with Kānaka Maoli and Indigenous Pacific Islanders. On the other hand, what of those of us content not to engage settler colonialism and Indigeneity, content to be tourists or interpellated as “locals” (which Fujikane and Trask decry as a settler colonial ruse)—and content to unquestioningly use the category of “Asian American Pacific Islander”? Possessing Polynesians argues powerfully about the ways Polynesia and Polynesian peoples are claimed as contingently white, tracking the unsettled convergences of processes of racialization and imperial and colonial regimes writ large. Native Hawaiian feminist Maile Arvin’s monograph, like David Chang’s acclaimed The World and All the Things Upon It before it, foregrounds Hawai’i to reorient understandings of global modernity in contrast to the islands’ settler colonial image as an exotic, escapist fantasy. Using an Indigenous feminist methodology that engages an archive ranging from over two centuries of science to contemporary art, Arvin interrogates the construction of Polynesia and Polynesian peoples: feminized as the possessions of white [End Page 337] settler colonialism, structured by antiblackness, and with its Indigeneity further dispossessed by a “postracial” multiracialism that privileges Asianness. She writes, “The relation between the logics of possession through whiteness and antiblackness, and between anti-indigeneity and anti-immigration, is not merely one of analogy or comparison, even as they are distinct logics; rather, they are inextricable.” Sometimes these discourses have been leveraged by Native Hawaiians for self-determination—at the expense of other Kānaka Maoli and Pacific Islanders, thus enabling a settler colonial haunting within ostensible projects of decolonization. Nonetheless, as Arvin underlines through discussions of activism and cultural production, possession can be unsettled through “regenerative refusal” as Indigenous feminist analytic. Such Indigenous refusals across past and present point toward resurgent Pacific Islander futures, regenerating kinships between Kānaka Maoli and other Indigenous peoples of Oceania, which include work that Arvin highlights for being in promising coalition with Black Lives Matter. “What is a Polynesian?” is Arvin’s central question. For Arvin, heteropatriarchy functions as the crux of whiteness that claims Polynesians as possessions without ever conceding the power of whiteness to them. She stresses “the logic of possession” over the more familiar framing “logic of elimination” in order to emphasize “the gendered aspects of settler colonialism” dependent upon heteropatriarchy that either implicates Native Hawaiian women as producers of mixed-race children toward a white futurity or requires them to be responsible for “race-saving” by only having children with men of high Native Hawaiian blood quantum. The global workings of antiblackness are central to her theorization: Melanesians were racialized as Black, while Polynesians could also be coded as such despite their conditional whiteness and tactics of Polynesian exceptionalism. Triangulated as non-Black and non-Indigenous, Asian immigrants, particularly Chinese, are co-opted by whiteness as evidence of a utopian multiracialism that erases Native Hawaiians, especially through intermarriage. Undergirding Arvin’s discussions is Denise Ferreira da Silva’s theory of raciality and spirit via Hegel that deliberately departs from the Foucauldian model of biopolitics to account for spiritual investments in the logics of racism that haunt the present beyond...

Curating Koreanness: Musical Activities of Elite Korean Women in Hawai'i during the Japanese Colonial Period, 1910–1945

Curating KoreannessMusical Activities of Elite Korean Women in Hawai'i during the Japanese Colonial Period, 1910–1945 Heeyoung Choi (bio) During the early twentieth century, residents of Honolulu regularly witnessed multiethnic groups dressed in traditional costumes presenting music and dance of their own culture onstage for tourists and residents. Koreans were among such performers. Beginning in the late 1920s, an increasing number of Korean cultural organizations in Hawai'i prompted a surge of cultural interaction among diverse ethnic groups, including those from Japan, China, and the Philippines. At such multicultural events, where immigrant communities shared their traditional culture, Koreans frequently performed traditional dance, folk songs, and new dramatic plays incorporating Korean folktales. Traditionally in Korea, the works of preserving, adapting, and presenting Korean performing arts had been performed by "professional" female entertainers called kisaeng. And as such, the growing popularity and sightings of Korean cultural presentations in Hawai'i raise questions about who took the role of Korea's professional entertainers in Hawai'i far away from their homeland. This study examines women's status and their evolving role in music in early twentieth-century Hawai'i, identifying factors that motivated and contributed to their musical activities. During this period, Korean Hawaiians were in a precarious position. Most first-generation Korean Hawaiian immigrants were legally considered Japanese nationals, as the Empire of Japan annexed Korea from 1910 to 1945. Furthermore, the Korean population in Hawai'i, although about five times as big (per capita) as that in the US mainland, was significantly less than that of other ethnic groups: Koreans comprised less than 5 percent of the Hawaiian population, while 40 percent of the total population was made up of those of Japanese descent.1 [End Page 110] There is no record indicating that professional entertainers were among Korean immigrants in early twentieth-century Hawai'i. Instead, Korean women living in Hawai'i were mostly "picture brides" who came to the United States through a matchmaking system using photographs to match women in Korea and Korean men who were already resident in Hawai'i.2 Korean picture brides were often given a recommendation from a Christian missionary or pastor, and many opted for a picture marriage in order to pursue the dream of a modern education in America.3 The picture brides came to Hawai'i with the hope of living a better life, knowing neither the living environment in plantation villages nor (in most cases) English. By 1905 approximately 7,400 Korean laborers had immigrated to Hawai'i as contracted laborers in Hawaiian sugarcane plantations; most were single men in their twenties and thirties.4 An estimated 900 Korean brides who arrived in Hawai'i After the Empire of Japan annexed Korea had to go through the immigration process via Japanese authorities, and Korean laborers sending spousal permission to their future wives had to obtain a new passport from the Japanese consulate in Honolulu.5 Still, during the first two decades the cohort of married Korean immigrants grew quickly.6 Even though the Korean immigrants were legally Japanese, they enjoyed their own ethnic culture as a separate ethnic group within Hawai'i's multiethnic community. At this time, over 80 percent of plantation workers in Hawai'i were Asians from China, Japan, Korea, and the Philippines. Hawaiian authorities, including Hawaiian elites and American sugar planters, encouraged residents of Asian descent to maintain their own culture, promoting multicultural environments and events. They emphasized such efforts in order to instill a feeling of satisfaction and pride at living in a "democratic" society where people of different ethnic backgrounds could live in harmony.7 [End Page 111] Using newspaper articles, interview resources, and archival documents, my research reveals that Korean Hawaiian women from the yangban class took the initiative to preserve traditional Korean performing arts.8 These women were highly educated prior to moving to Hawai'i; examples include Ha-soo Whang and Susan Chun Lee. Members of the younger generation, including Mary Lee and Sarah Lee Yang, presented performances incorporating Korean traditional music and dance as amateur performers. By covering these specific historical personages with a focus on their social and educational backgrounds, I argue that elite Korean women, despite...