Asian Women Research Articles

Factors associated with bacterial sexually transmitted infections among people of South Asian ethnicity in England

ObjectivesDespite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services (SHS) and sexually transmitted infection (STI) diagnoses, although...

Hope theory as resistance: narratives of South Asian scholars in Australian academia

PurposeIdentity, positioning and possibilities intersect differently for South Asian women in white academia. Within a broader migrant community that defines Australian life, these identities and positioning imply great possibility, but pursuing such pathways within academia is a walk on the last strand of resilience. This paper explores this tension of possibilities and constraints, using hope theory to highlight the cognitive resistance evident in the narratives of three South Asian women in Australian academia.Design/methodology/approachThe authors use collaborative autoethnography to share their narratives of working in Australian universities at three different stages of careers, utilising Snyder's model of hope theory to interrogate their own goal-setting behaviours, pathways and agentic thinking.FindingsThe authors propose that hope as a cognitive state informs resistance and enables aspirations to contribute within academia in meaningful ways whilst navigating the terrain of inequitable structures.Originality/valueThe authors' use of hope theory as a lens on the intersectional experiences of career making, building and progression is a new contribution to scholarship on marginalised women in white academe and the ways in which the pathways of resistance are identified.

The Experiences of Asian Americans Who Intermarry in the United States: A Qualitative Study

Intermarriage is noted to be a difficult adjustment as culture, language, and family expectations can clash. Given the rising intermarried population and the challenges they may face, social workers need an up-to-date understanding of these couples’ experiences to better provide services. Surveys and interviews with 10 Asian women and 3 Asian men who intermarried were conducted from 2020 to 2021. Using grounded theory coding, each author on our biracial (Asian and white) team read interviews and identified themes. We identified five themes from the data: Societal Press, White Privilege, Family Relations, Communication, and Parental Responsibilities. Social work practitioners may employ these results in providing culturally sensitive strength-based services for interracial families.

A Novel Profound Learning-Based System for Breast Cancer Location and Classification Utilizing Exchange Learning

Breast cancer is the leading cause of death in Asian women. Breast cancer can be detected early and treated aggressively. In this paper, we propose a new deep learning framework utilizing the index learning concept for breast cancer diagnosis and imaging. Typically, in-depth questions from experts are designed and presented in a specific format. Unlike classical learning paradigms, which are based on parallel development and emergence, the goal is to use the knowledge gained from solving one problem to solve another problem. In this study, we used CNN pretrainers to extract features from images, such as Google Net, VGGNet (Visual Geometry Group Network), and ResNet (Unsupervised Network), which combine the principles of neural networks and social networks. This has already happened. Contains partial information. Use the blunt treasure in the veil. A standard data model was used to evaluate the proposed optical products. Chemical images of different types of breast cancer have been discovered in archaeological finds and have proven useful in educational exploration into the unknown.

Using a participatory approach to encourage uptake of breast, colorectal, and cervical cancer screening for Scottish Muslim women: a pilot qualitative study

BackgroundMuslim women use cancer screening less often than the general female population, which puts them at risk of delayed detection. We used an asset-based approach to co-design a faith-based intervention to increase uptake of breast, colorectal, and cervical screening in Scottish Muslim women. MethodsIn this pilot qualitative study, we recruited Muslim women (n=28) of Asian and Arab ethnicity, aged 25–74 years, through snowball sampling from community organisations in Glasgow and Edinburgh. Ten of these women participated in four online workshops in February, 2021, with the aim to codesign the intervention, underpinned by the socio-ecological model and the behaviour change wheel. The final intervention included health education delivered by doctors, testimonials by Muslim women sharing experiences of cancer or screening, and the perspective on cancer screening from a female religious scholar. The intervention was delivered to two groups of eight and ten Muslim women respectively, in March 2021. A week later, the 18 women participated in two focus groups to qualitatively evaluate the intervention. Analyses were conducted thematically. FindingsThemes included barriers to screening, acceptability of content and delivery, attitudinal change, and intervention improvement. Participants believed that lack of awareness was an important barrier to screening. They found the intervention informative. They particularly liked the combination of multiple components, including spirituality, culture, and health education. They valued the faith-based element and highlighted how Islam could facilitate overcoming cultural barriers including social stigma, embarrassment, and modesty, although this could vary with different levels of religiosity. Participants also emphasised that faith-based approaches in isolation would not be enough. They appreciated input of trusted sources such as doctors and religious scholars and were especially drawn to personal narratives. Participants expressed preference for face-to-face delivery and advised using translators to overcome language barriers. InterpretationBarriers to screening are complex. Using faith as an asset, integrated with the socio-ecological model and behaviour change wheel, resulted in a holistic intervention tackling multiple barriers, which appealed to participants. Collaborating with communities and faith leaders can help to develop culturally sensitive interventions that harness positive aspects of faith for better health outcomes. Intervention effectiveness needs more robust investigation, which we are undertaking in a feasibility study with 200 Muslim women in northeast England and Scotland. FundingScottish Inequalities Fund, the Scottish Government.

Asian Female Athlete's Heart: The CHIEF Heart Study.

The cardiac characteristics of Asian female endurance athletes and strength athletes have rarely been investigated. This study included 177 Taiwanese young women undergoing military training. Cardiac features were assessed by electrocardiography (ECG) and echocardiography. Then, all participants completed a 3000-meter run to assess endurance capacity, and 89 participants completed a 2-minute push-up test to assess muscular strength. Athletes were those whose exercise performance fell one standard deviation above the mean, and the remaining participants were defined as controls. Multiple logistic regression analysis was used to determine the predictors of the cardiac characteristics of female athletes. Compared to the female controls, female endurance athletes had a greater QRS duration (ms) (92.12 ± 10.35 vs. 87.26 ± 9.89, p = 0.01) and a higher prevalence of right axis deviation (RAD) (34.9% vs. 11.1%, p < 0.001). There were no differences in any echocardiographic parameters. Greater QRS duration and RAD and lower systolic blood pressure were independent predictors of female endurance athletes [odds ratios (OR) and 95% confidence intervals: 1.05 (1.01-1.09), 2.91 (1.12-7.59) and 0.93 (0.88-0.98), respectively]. Female strength athletes had a greater right ventricular outflow tract (RVOT) (mm) (28.06 ± 3.57 vs. 25.38 ± 3.61, p = 0.007) but revealed no differences in ECG variables. Greater RVOT was the only predictor of female strength athletes [OR: 1.26 (1.05-1.50)]. In Asian military women, a wider QRS duration and the presence of RAD in ECG rather than heart structure and function were found to characterize endurance athletes, whereas a wider RVOT but no ECG features were found to characterize strength athletes.

Aborto e raça no Brasil, Pesquisa Nacional de Aborto 2016 a 2021

Abstract We examine racial differentials in abortion among women in Brazil using data from three editions of the Brazilian National Abortion Survey (PNA), 2016, 2019 and 2021. We test the difference in means in data from separate surveys, combined surveys without reweighting, and combined and reweighted surveys. We also use logistic models for the chance of having an abortion. The results indicate that there is a consistent racial differential in the three editions of PNA, with the percentage of abortions among Black women being higher than among white women. In the combined and reweighted surveys, among Black women of all ages the probability of having had an abortion is 11.03% while among white women it is 7.55%. This means a difference of 3.5 percentage points, which translates into a 46% higher probability for Black women, statistically significant values for a 5% interval. Logistic regressions produce similar results, with an average predicted probability of 12.61% for Black women and 8.90% for white women, also significant. Racial differences remain statistically significant for various combinations of PNA editions. However, in the separate surveys, the difference in means tests are only statistically significant in 2016. Black refers to the group formed by Black and Brown women (pretas and pardas). Due to the small sample size, it is not possible to say much about the differences with Asian and Indigenous women.

Disparities in clinical trial participation beyond first-line treatment among patients with metastatic breast or colorectal cancer.

97 Background: Disparities in clinical trial participation beyond first-line (1L) treatment of metastatic cancer have not been well studied. Using real-world data from patients diagnosed with metastatic breast cancer (mBC) or metastatic colorectal cancer (mCRC), this study evaluated 1) patterns of participation in trials by treatment line and 2) factors associated with participation in trials of second-line (2L) and subsequent lines of treatment. Methods: Patients diagnosed with mBC or mCRC between 2013 and 2021 who received at least 2L treatment were retrospectively identified from the Flatiron Health electronic health record database. Clinical trial participation was defined as receipt of “clinical study drug.” Participation in trials for treatment lines 2L to 6L were assessed, and multivariable logistic regression models were used to evaluate associations between sociodemographic and clinical factors, including age, race/ethnicity, socioeconomic status (SES), stage at diagnosis, year of metastatic diagnosis, practice type, and total lines of treatment, with participation in trials of 2L and subsequent lines of treatment. Results: Overall, participation in trials was low for patients with mBC or mCRC. For patients with mBC (n=14,590), participation in trials was similar from 2L (2.6%) to 6L (2.7%) (Table 1). Among these patients, age, race/ethnicity, and practice type were associated with participation in trials, while SES was not. For example, women age 18-49, 50-64, and 65-74 years were more likely to participate than women 75 or older (aORs: 2.88, 2.45, 1.84), and non-Hispanic Asian, non-Hispanic Black, and Hispanic women were less likely to participate than non-Hispanic white women (aORs: 0.41, 0.47, 0.61). In contrast to patients with mBC, participation in trials increased from 2.0% (2L) to 6.6% (6L) for patients with mCRC (n=7,303; Table 1). Among these patients, age, practice type, and SES were associated with participation in trials. Specifically, patients treated in academic compared to community settings (aOR: 4.25, 95% CI: 3.33, 5.42) and patients with higher SES (aOR: 2.00, 95% CI: 1.29, 3.08) were more likely to participate. For both patients with mBC (aOR: 5.00, 95% CI, 3.87, 6.46) or mCRC (aOR: 7.91, 95% CI: 5.63, 11.10), those who received more than five treatment lines compared to only two treatment lines were more likely to participate in a trial. Conclusions: These real-world findings highlight disparities in participation in clinical trials of 2L and subsequent lines of treatment by age, race/ethnicity, practice type, and SES among patients with mBC or mCRC. Further policy efforts and interventions are needed to address systematic barriers to increase participation of underrepresented groups in clinical trials.[Table: see text]

428P What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries

428P What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries

Changes in primary care engagement and communication from breast cancer treatment to longer-term survivorship.

475 Background: Primary care physicians (PCPs) have varying roles in a patient’s care across the cancer continuum. However, little is known about how PCP engagement and communication change over time in the transition from breast cancer treatment to longer-term survivorship. Methods: The iCanCare study is a longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia Surveillance, Epidemiology and End Results registries. Women were surveyed during initial treatment and again 6 years later during survivorship (2021-22) (Expected final N=1430, 60% current response rate). At both time points, respondents were asked to rate on a 5-point Likert scale, how often they talked with their PCP about their breast cancer follow up (communication), and how informed their PCP was about their breast cancer (engagement). Scores ³3 during initial treatment were considered strong. We then evaluated change in PCP engagement and communication over time from initial treatment to survivorship, with decreases reflecting worse engagement and communication. We evaluated factors associated with worse engagement and communication using multi-variable logistic regression modeling, adjusted for clinical and sociodemographic characteristics, PCP relationship, baseline communication/engagement, and COVID-19 impact. Results: In this sample of 807 women, most women reported strong PCP engagement (62.7%) and strong PCP communication (58.6%) during treatment. Over time, 40.4% reported worse PCP communication and 38.5% reported worse PCP engagement in survivorship compared to treatment(p&lt;0.0001). Women who had comorbidities and women who changed their PCP between treatment and survivorship more commonly reported worse communication and engagement (p&lt;0.05). Fewer women who had chemotherapy reported worse engagement and more Black and Asian women reported worse communication (p&lt;0.05). Women who changed their PCP were more likely to report worse communication than women with the same PCP (adjusted Odds Ratio (aOR) 2.52, 95%CI: 1.52, 4.19). Women who had chemotherapy (vs. not) were less likely to report worse communication over time (aOR 0.59 CI 0.37, 0.95). Women who changed their PCP had higher odds of worse engagement over time compared to those with the same PCP (aOR 1.69, 95%CI: 1.05, 2.72). Women who had chemotherapy (vs. not) were less likely to have worse PCP engagement over time (aOR 0.59, 95%CI: 0.37, 0.92). Conclusions: In this population-based sample of breast cancer survivors, many women experienced worse communication and engagement with their PCP over time in survivorship, despite reporting high engagement and communication during initial treatment. Effective engagement and communication are key to delivery of high-quality survivorship care, thus future work focused on maintaining survivor-PCP relationships over time is needed.

Breaking the Bamboo Ceiling: An Examination of the Root Causes and Potential Solutions for Educational Opportunity Inequality Faced by Asian Women

This paper critically addresses the significant issue of educational opportunity inequality faced by Asian women, exploring its root causes and potential solutions, predicated on principles of justice and social development. The subjects of the study are Asian women, who are encumbered by intersecting societal stereotypes, cultural expectations, and institutional barriers, thereby curtailing their educational prospects. The study deploys an analytical interpretative approach, analyzing various societal stereotypes and prejudices, cultural factors, and systemic constraints, substantiated through a qualitative method. Findings reveal a collective imposition of an educational opportunity ceiling or Bamboo Ceiling on Asian women, proposing potential solutions including policy reforms, awareness initiatives, and educational strategies. Innovative methods are suggested, inspired by the narratives of Asian women, Li Ziqi and Papi Jiang, who overcame such inequalities. Ultimately, the study posits that acknowledging and addressing these entrenched sources of inequality could engender an environment fostering equal educational opportunities for Asian women, aiding in the demolition of the Bamboo Ceiling.

Racial, Ethnic, and Immigrant Generational Disparities in Physically Strenuous and Hazardous Work Conditions

Despite the importance of work in adult life, research on the social determinants of health often ignores its effects. We examine race/ethnic, immigrant generational, and gender differentials in exposure to work conditions associated with poor health outcomes, using a nationally-representative sample of adults. On average, Latino 1st generation workers are more exposed to strenuous and hazardous work conditions than other workers, even after adjusting for sociodemographic differences. Exposure is lower for 2nd and 3rd generation Latinos. In contrast, Asian 1st generation men often have the lowest exposure levels of all groups and Asian 2nd and 3rd generation men have higher levels of exposure than the first generation, primarily due to intergenerational differences in education. Asian 1st generation women have higher exposures than those in the 2nd or 3rd generation. These results illustrate the importance of considering work conditions in research and policy related to the social determinants of health.

The Visual Representation of Chinese and Thai Women in the Contemporary Media

In recent years, the role of women has become a heated topic, dominating the trend of gender studies in many academic studies in sociology and anthropology, and the question of whether or not women have completed their role change and broken the mould of traditional styles has become one of the cultural connotations of multimedia on the Internet. As large Asian countries, China and Thailand are both growing countries in which traditional agrarian societies are gradually moving towards new technologies. This paper makes an exploration of the power and image of Chinese and Thai females in different magazines, media and films over time, including the media representation of Asian women in western countries and the local media effects. Whereas, further expansion of the definition of femininity as distinct from biological sex, in different countries, religious regions, technological means and other multifaceted individual representations, a deeper perspective on the culturally unfolding nature of gender definitions, promoting an extension of the fixed term feminine.

Clinical Study on the Thoracodorsal Artery Perforator Flap in Breast-Conserving Reconstruction of T2 Breast Cancer.

Breast-conserving surgery combined with oncoplastic breast surgery has become the standard surgical treatment for early breast cancer. The purpose of this study was to investigate the safety and efficacy of the thoracodorsal artery perforator flap (TDAPF) in breast-conserving reconstruction of T2 breast cancer. Thirty patients with T2 breast cancer admitted to our hospital from January 2019 to December 2020 were enrolled to receive pedicled TDAPF for repairing breast defects after breast-conserving surgery. Intraoperative conditions, postoperative complications, and shape satisfaction after breast reconstruction were recorded. The operation was successfully completed in all 30 patients, with an operation time of 177.77 ± 24.39min, bleeding of 44.17 ± 7.67mL, and length of hospital stay of 5.23 ± .97d. There was no deformity or seroma at the donor site. Breast shape recovered well after operation. After operation, one patient had fat liquefaction in the recipient site, which healed well after wound treatment. The incidence of postoperative complications was 3.33%. Postoperative follow-up lasted 16-28months, with a median of 22months. The Breast-Q score for breast satisfaction was 61.83 ± 12.87 at 6months after operation, compared to 62.07 ± 11.78 before operation (P > .05). TDAPF, featuring a high survival rate, moderate flap area, fewer postoperative complications, and high satisfaction with breast shape after operation. For east asian women with moderate breast size, TDAPF is a safe, effective choice for repairing defects in breast-conserving surgery for T2 breast cancer.

World Cafés as a participatory approach to understanding research agendas in primary care with underserved communities: reflections, challenges and lessons learned

BackgroundCertain communities are underserved by research, resulting in lower inclusion rates, under researched health issues and a lack of attention to how different communities respond to health interventions. Minoritised ethnic groups are often underserved by research and services. They experience health inequalities and face significant barriers to accessing health services. It is recognised that new approaches are needed to reach underserved communities and make research more relevant. The purpose of this work was to utilise World Cafés, a participatory method, to explore research agendas with diverse communities.MethodsTwo World Cafés were conducted as research agenda setting activities with individuals from minoritised ethnic communities in Bristol, UK. World Café 1 explored Black and Asian women’s perspectives about supporting mental health. World Café 2 with men from the Somali community, focused on prostate cancer. Community members co-developed the focus and questions of each World Café and were also instrumental in recruiting individuals to the sessions and facilitating discussions, including translation. Audio and written records were made of the discussions and from these key issues about each topic were identified, and a visual representation of the discussion was also generated. These were shared with participants to check for accuracy.ResultsCommunity members identified a range of issues that are important to them in relation to mental health and prostate cancer, including barriers to help seeking and accessing primary and secondary care, ideas for service improvements and a need for health information that is accessible and culturally relevant.ConclusionsWorld Cafés are a flexible method that can be successfully adapted for research agenda setting with individuals from minoritised ethnic communities. The role of community members in co-developing the focus of sessions, recruiting community members and co-facilitating sessions is crucial to this success. The discussions at both World Cafés provided a rich insight into the experiences of participants in relation to the topics mental health and prostate cancer and identified issues that are important to these communities that will be followed-up with communities, researchers and clinicians to co-develop research and service improvement strategies.

A point-of-care urine test to predict adverse maternal and neonatal outcomes in Asian women with suspected preeclampsia.

To assess clinical utility of the urine Congo red dot test (CRDT) in predicting composite adverse maternal and neonatal outcomes in women with suspected preeclampsia (PE). CRDT result and pregnancy outcomes were prospectively documented in women with new onset or pre-existing hypertension, new or pre-existing proteinuria, PE symptoms and suspected PE-related fetal growth restriction or abnormal Doppler presenting from 20weeks' gestation between January 2020 and December 2022. Participants and clinicians were blinded to the CRDT result and managed according to internally agreed protocols. Composite maternal outcome was defined as PE, postpartum hemorrhage, intensive care unit admission, and maternal death. Composite neonatal outcome was defined as small for gestational age, preterm birth, 5-min Apgar score < 7, neonatal intensive care unit admission, and neonatal death. Two hundred and forty-four women out of two hundred and fifty-one (97.2%) had a negative CRDT. All seven women with positive CRDT had both adverse maternal and neonatal outcomes, giving positive predictive values (PPV) of 100%. Rates of composite adverse maternal and neonatal outcomes in CDRT negative women were 103/244 [42.2%, 95% confidence interval (CI) 36.2%-48.5%] and 170/244 (69.7%, 95% CI 63.6%-75.1%), respectively. CRDT negative predictive values (NPV) for adverse maternal and neonatal outcomes were, respectively, 141/244 (57.8%, 95% CI 48.6%-68.2%) and 74/244 (30.3%, 95% CI 23.8%-38.1%). CRDT had low NPV but high PPV for adverse maternal and neonatal outcomes in women with suspected PE. Its role in clinical management and triage of women with suspected PE is limited as it cannot identify those at low risk of developing adverse outcomes.

Perinatal Trajectories of Maternal Depressive Symptoms in Prospective, Community-Based Cohorts Across 3 Continents

Depressive symptoms during pregnancy influence the development and health of the offspring, underscoring the need for timely intervention. However, the course of depressive symptoms across the perinatal period remains unclear, thus complicating screening and referral guidelines. To examine the course and stability of depressive symptoms across the perinatal period in multiple, ethnically diverse independent observational cohorts. This cohort study included self-reported depressive symptoms at multiple time points from 7 prospective cohorts spanning 3 continents (United Kingdom: Avon Longitudinal Study of Parents and Children from 1991 to 1995; Canada: Maternal Adversity, Vulnerability and Neurodevelopment from 2003 to 2007; Montreal Antenatal Well-being Study from 2019 to 2022; Alberta Pregnancy Outcomes and Nutrition from 2009 to 2014; and Singapore: Growing Up in Singapore Toward Healthy Outcomes from 2009 to 2013; Singapore Preconception Study of Long-Term Maternal and Child Outcomes from 2015 to 2019; and Mapping Antenatal Maternal Stress from 2019 to 2022). Participants were recruited either during preconception or pregnancy and observed into the postnatal period. All data from each cohort were analyzed from July 2022 to April 2023. Self-reported depressive symptoms from pregnancy to 2 years following childbirth using either the Edinburgh Postnatal Depression Scale or the Center for Epidemiological Studies Depression were analyzed independently within each cohort using item response theory (IRT) techniques. K-means clustering was used to identify groups of participants with similar trajectories. A total of 11 563 pregnant women (mean [SD] age, 29 [5] years; 569 [4.9%] East Asian women; 304 [2.6%] Southeast Asian women; 10 133 [87.6%] White women) self-reported depressive symptoms from pregnancy to 2 years following childbirth. Analytic methods from Item Response Theory identified 3 groups of mothers based on depressive symptoms: low, mild, and high levels in each of the 7 cohorts. Mothers within and across all cohorts had stable trajectories of maternal depressive symptoms from pregnancy onwards. Mothers with clinical levels of depressive symptoms likewise showed stable trajectories from pregnancy into the postnatal period. In this study, trajectories of depressive symptoms remained stable from pregnancy across the perinatal period, a finding that conflicts with a continuing emphasis on postpartum or postnatal onset of depression that persists in some health policy guidelines. Interventions and public health initiatives should focus on reducing depressive symptoms during pregnancy in addition to following birth.

Social support and emotional wellbeing among women living with bacterial vaginosis in new york city

Abstract Background Bacterial Vaginosis (BV) is a common pathological vaginal condition in women and is disproportionately higher among Black (33%) and Hispanic women (31%) than among non-Hispanic White (23%) or Asian women (11%). BV can have highly distressing impacts on women, yet the role of social support has received limited attention. This paper aimed to explore women's experiences of social support for BV. Methods We conducted semi-structured interviews with women (n = 41) aged 18 years or older and who had a BV diagnosis in the past year. Interviews examined women's infection history and symptoms, BV management approaches, the impact of BV on women's lives, and BV clinical care experiences. Qualitative data were analyzed with an a priori coding framework based on key domains, followed by open-coding to uncover emergent themes. Results The majority of participants were Non-Hispanic Black/African American (63.4%). Nearly a quarter (22.0%) of participants identified as lesbian or bisexual or reported having sex with a woman in the past year. Most women with BV expressed feelings of shame. Many women noted a lack of social support, particularly from sexual partners, which might lead to relationship mistrust and blame for the infection. Sexual partners’ inadequate knowledge of BV resulted in women's reluctance to discuss their diagnosis and avoidance of sexual activities. Supportive partners or friends helped women recognize BV infection and seek treatment earlier, provided emotional support and reduced feelings of isolation. In addition, women reported receiving greater support and care from sexual health clinics than from other healthcare settings. Conclusions The study highlights the importance of social support in women's experiences of BV. Findings imply that enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women's emotional well-being and overall BV experiences. Key messages • The study highlights the importance of social support in women’s experiences of BV. • Enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women’s overall BV experiences.

The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches.

The South African Breast Cancer and HIV Outcomes prospective cohort (SABCHO) study was established to investigate survival determinants among HIV-positive and HIV-negative SA women with breast cancer. This paper describes common and unique characteristics of the cancer centres and their participants, examining disparities in pathways to diagnosis, treatment resources and approaches adopted to mitigate resource constraints. The Johannesburg (Jhb), Soweto (Sow), and Durban (Dbn) sites treat mainly urban, relatively better educated and more socioeconomically advantaged patients whereas the Pietermaritzburg (Pmb) and Empangeni (Emp) sites treat predominantly rural, less educated and more impoverished communities The Sow, Jhb, and Emp sites had relatively younger patients (mean ages 54 ±14.5, 55±13.7 and 54±14.3 respectively), whereas patients at the Dbn and Pmb sites, with greater representation of Asian Indian women, were relatively older (mean age 57 ±13.9 and 58 ±14.6 respectively). HIV prevalence among the cohort was high, ranging from 15%-42%, (Cohort obesity (BMI ≥ 30 kg/m2) at 60%, self-reported hypertension (41%) and diabetes (13%). Direct referral of patients from primary care clinics to cancer centre occurred only at the Sow site which uniquely ran an open clinic and where early stage (I and II) proportions were highest at 48.5%. The other sites relied on indirect patient referral from regional hospitals where significant delays in diagnostics occurred and early-stage proportions were a low (15%- 37.3%). The Emp site referred patients for all treatments to the Dbn site located 200km away; the Sow site provided surgery and endocrine treatment services but referred patients to the Jhb site 30 Km away for chemo- and radiation therapy. The Jhb, Dbn and Pmb sites all provided complete oncology treatment services. All treatment centres followed international guidelines for their treatment approaches. Findings may inform policy interventions to address national and regional disparities in breast cancer care.

Asian American Surgery: A Short History of Immigration, Naturalization, and Refugee Laws and Policies that Brought Asians to America.

Chinese immigration in America in the mid-nineteenth century incited violence and governmental sanctions to restrict Asian immigration and reject citizenship rights. In 1870, Chinese strikebreakers in Massachusetts ignited nationwide demonstrations against Chinese immigration, which ended altogether with the Chinese Exclusion Act (1882). Japanese schoolchildren in San Francisco public schools sparked rioting in 1907, leading Japan to unilaterally limit emigration to the United States (Gentlemen's Agreement, 1908). Congress responded to anti-Punjabi riots (Bellingham, WA, 1907) by refusing naturalization rights to Asians (Barred Zone Act, 1917), policies supported by the Supreme Court (Ozawa, 1922; Thind, 1923). All immigration from Asia was soon prohibited (Johnson-Reed Act, 1924). Anti-Asian measures peaked in 1942 with imprisonment of Japanese in concentration camps, including those with birthright citizenship. Anti-Asian policies unwound in the last half of the 20th century, culminating in sweeping changes in US immunization policy. Naturalization rights were granted to wartime allies against Japan (China, 1943; the Philippines and India, 1946) and the Japanese themselves (1952). Asian women marrying American servicemen were allowed entry into the country (1945, 1950). Prohibitions against Asian immigration were lifted in 1965 (Hart-Celler Act), with preference for those trained in science, technology, and medicine. The refugee crisis that followed the fall of Saigon (1975) drove humanitarian policies that brought evacuees from Southeast Asia and others from throughout the world seeking freedom from persecution (Refugee Act, 1980). Hundreds of thousands from China, South Asia, the Philippines, and Southeast Asia thus settled in the United States, changing American society and medicine.