BELIEFS RELATED TO BREAST HEALTH PRACTICES: THE PERCEPTIONS OF SOUTH ASIAN WOMEN LIVING IN CANADA JOAN L. BOTTORFF, 1 * JOY L. JOHNSON, 1 RADHIKA BHAGAT, 2 SUKHDEV GREWAL, 2 LYNDA G. BALNEAVES, 1 HEATHER CLARKE 3 and B. ANN HILTON 1 1 School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC, Canada V6T 2B5, 2 Vancouver/Richmond Health Board, Vancouver, BC, Canada and 3 Registered Nurses Association of British Columbia, Vancouver, BC, Canada AbstractÐBreast cancer is becoming a major concern for many South Asian women. Clinical obser- vations of women from a South Asian community living in Canada revealed an under use of early detection strategies. The purpose of this qualitative ethnoscience study was to examine breast health practices from the perspective of South Asian women to provide a foundation for the development of culturally suitable breast health services for this group. Open-ended interviews were conducted with a convenience sample of 50 South Asian women over the age of 30 who had not been diagnosed with breast cancer. Adequate representation of the main religious groups (i.e. Sikh, Hindu, Muslim and Christian) was ensured through sampling techniques. Analysis of translated interviews involved identi®- cation of themes and the development of a taxonomy to represent relationships among emerging cul- tural themes and domains. Four central domains of beliefs related to breast health practices were identi®ed: beliefs about a woman's calling, beliefs about cancer, beliefs about taking care of your breasts and beliefs about accessing services. These beliefs hold important implications for how health promotion strategies should be structured and oered. In particular, attention must be paid to the language that is used to talk about breast cancer, the importance of the role of the family in women's health decisions and traditions related to using narratives to share information and advice. # 1998 Elsevier Science Ltd. All rights reserved Key wordsÐSouth Asian women, breast cancer, screening, health promotion, cultural sensitivity INTRODUCTION Among women, breast cancer is the most com- monly diagnosed cancer. Recent sources indicate that one out of every nine women is likely to develop breast cancer (Spratt et al., 1995). The con- cern for breast cancer extends to all women. Considering the growing number of South Asian women residing in western Canada, it is particularly important that we turn our attention to the health needs of this group. While the majority of South Asians are from the subcontinent (India, Pakistan and Bangladesh), a large number have also immi- grated to Canada from Fiji and East Africa. However, because they originate from the same geographic region, South Asians share many cul- tural practices surrounding food, dress, ceremonies and cultural norms. Current data regarding the incidence of breast cancer among South Asian women living in Canada is limited because breast cancer registries do not collect information regarding ethnicity. However, there is some evidence that South Asian women are not excluded from breast cancer. For example, an increased incidence of breast cancer among women in India has been reported, with over 60,000 new cases identi®ed every year (Yeole et al., 1990; Nair et al., 1993). It is not unreasonable to suggest that breast cancer is also a signi®cant health problem for South Asian women in Canada. Particularly, as the majority of South Asian women residing in Canada are ®rst generation immigrants, with most having immigrated since 1960 (Assanand et al., 1990). Breast cancer is becoming a major concern for many South Asian women as they witness family members, friends and acquaintances in their community being diagnosed with and sometimes dying from, breast cancer. Since the causes of breast cancer are as yet unde- termined, the best approach to reducing the mor- tality associated with breast cancer is early detection using recommended breast health prac- tices including breast self-examination, clinical breast examination by a trained health professional, and regular mammography screening. The research literature supports the claim that breast cancer screening programs are less successful and underuti- lized by ethnic communities (Lovejoy et al., 1989; Soc. Sci. Med. Vol. 47, No. 12, pp. 2075±2085, 1998 # 1998 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0277-9536/98/$ - see front matter PII: S0277-9536(98)00346-3 *Author for correspondence. 2075