Breast cancer among Filipina American women is a major but largely neglected cancer disparity. First, though not as highly visible as other Asian subgroups, the Filipina population in the United States is large, second among Asians only to the Chinese. Second, Filipinas have higher rates of breast cancer incidence than most other Asian subgroups (Chockburn & Deapen, 2004
; Keegan, Gomez, Clarke, Chan, & Glaser, 2007
; McCracken et al., 2007
). Third, there is a dearth of resources for and data regarding Filipinas with breast cancer. Breast cancer is the most commonly diagnosed type of cancer among Filipinas in the United States, and the leading cause of cancer death (Maxwell, Bastani, Vida, & Warda, 2003
). Compared with White women, Filipinas are more likely to be diagnosed at later stages and are more likely to die from the disease (Maxwell et al.). Filipinas have much higher rates of breast cancer incidence than most other Asian subgroups (second only to Japanese women), and the highest rates of mortality among Asian subgroups in California (Chockburn & Deapen; Keegan et al.; McCracken et al.). Reporting findings from a 4-year community-based participatory research study, we seek to contribute to an increased understanding of breast cancer support disparities among Filipina immigrants in the United States.
Filipinos are among the earliest U. S. immigrants, having arrived in the United States in the mid-1700s (Cordova, 1983
). This was followed by four waves of immigration, the largest taking place after the 1965 Immigration Act (Hart-Cellar, 1965
), which abolished national origin quotas and permitted family reunification and occupational visas. The passage of this Act permitted the migration of educated, professional (e.g., nurses, physicians, other health care professionals), largely English-speaking Filipinos. Since 1965, Filipinos have made up the highest number of Asian immigrants admitted annually in the United States (Vergara, 2008
), constituting more than 18% of the Asian population (1.9 million in 2000; United States Census Bureau, 2001
). The majority of U.S. Filipinos live in California (49.7%), with the largest concentration in the San Francisco Bay Area, where they make up 25% of the Asian population (Vergara).
Filipinos travel to the United States from an archipelago of 7,107 islands with more than 60 cultural groups and where 80 to 100 different languages are spoken. Cultural studies scholars and social scientists have argued that the emergence of ethnicity and racialized identity among Filipinos in the United States is distinct from that of other Asian immigrants. They attribute this distinction to the colonial and neocolonial presence of U.S. institutions and representatives in the Philippines since at least the late 1800s, and Filipinos’ particular history of immigration to the United States (Espiritu, 2001
; Rafael, 1997
; Vergara, 2008
). The longstanding presence of the United States in the Philippines infers familiarity with U.S. lifestyles, cultural practices, and consumption patterns (Espiritu, 2002
). Migration scholars argue that this familiarity affords somewhat smoother integration when compared with other Asian subgroups (Espiritu, 2003
). Nevertheless, economic, language, and cultural barriers to health promotion programs and practices impede access to cancer care and support services (Ko, Sadler, Ryujin, & Dong, 2003
). Understanding this migration and colonial history, and its relevance to daily lives and experiences of health and illness (Espiritu, 2001
; Strobel, 2001
), is a critical component of community-based health programs, survivorship services, and culturally appropriate education and outreach focused on Filipinos in the United States (Kagawa-Singer, 1998
; Marín et al., 1994
; Smedley, Stith, & Nelson, 2004
Despite high rates of breast cancer incidence and mortality, very little is known about how cancer is understood and treated among Filipino immigrants, and how they manage survivorship. Although the literature on support groups for women of other ethnic groups is growing (Doyle, 2008
; Kaiser, 2008
), support group services are almost nonexistent in the Filipino community, and research evaluating their effectiveness in providing emotional support and easing the stress of daily life apparently nonexistent. Recent research has elucidated that autonomous individual decision making, a fundamental feature of mainstream Euro-American culture, is an elemental component of the dominant model of cancer survivorship in the United States (Mathews, 2009
). Sports and military metaphors are used in this model to portray the “fighting spirit” and “unrelenting optimism” as the ideal mind set for recovery (Coreil, Wilke, & Pintado, 2004
; Mathews, 2000
). Such a focus reflects a mainstream “individualistic” outlook, which is distinct from that of cultural groups whose basic understanding of and approach to illness and coping draw on values of harmony (with others, nature, forces beyond one’s control), as well as diminution of the individual in the context of family and community (Becker, 2003
; Pe-Pua & Protacio-Marcelino, 2000
Anthropologist Holly Mathews’ research with African American breast cancer survivors shows the importance of cultural variations on manifestations of survivorship identity (Mathews, 2000
). The women she interviewed were uncomfortable with the individualistic model of breast cancer survivorship promoted by their hospital-sponsored support group—expressed in militaristic and sports metaphors—yet felt pressure to conform to this dominant identity. In response, these women formed their own support group and negotiated a different cultural consensus regarding breast cancer. Rather than focusing on war metaphors, their group accepted feelings of doubt and pessimism, and emphasized quality of life, spiritual values, and family relationships. Such findings illustrate variations in the configurations and meanings of “support” and “survivorship,” as well as the existence of preexisting acceptable mechanisms for the provision of support (e.g., via social connections and networks). We designed our study to contribute to the elucidation of the meanings Filipino women attribute to survivorship and support. As a Filipina social worker serving Filipino elders in San Francisco told us,
We have our own different ways of support groups. One of them, you know, is the mahjong [Chinese table game], or you know, it’s the social groups. And even though a lot of discussion may be teasing or maybe joking, they learn a lot from each other that way.
In this article we report findings from a 4-year community-based participatory research study of breast cancer support disparities among Filipinas in the San Francisco Bay Area. We partnered with two community-based organizations in this study (West Bay Pilipino Multi-Services Center and Pilipino Senior Resource Center). Our collaboration began in 2004 when West Bay, the University of California, San Francisco (UCSF) Comprehensive Cancer Center, and the San Francisco General Hospital (SFGH) Avon Breast Care Program joined forces to establish the first Filipina breast cancer support group under the name Sinag Tala (Bright Star) in the San Francisco Bay Area. In the course of the first year, it became apparent that group attendance was uneven, and West Bay was concerned that not all Filipinas with breast cancer who could benefit from the group were being reached. This concern served as the basis for a partnership that has continued through a change in West Bay leadership, disbanding of the Sinag Tala breast cancer support group in 2006, and resurgence of the group in a neighboring organization (Pilipino Senior Resource Center) under the name Filipina Breast Cancer Support Program.
Because we wanted to understand the meanings that cancer, survivorship, and support held for Filipinas who had experienced breast cancer, we focused our ethnographic study on the sociocultural contexts that shaped participants’ day-to-day experiences and which directly and indirectly affected their health and behavior (Burke, Joseph, Pasick, & Barker, 2009
; Pasick & Burke, 2008
). These contexts included historical, political, and legal structures and processes such as migration experiences, racism, and colonialism (Rafael, 1997
; Strobel, 2001
); organizations and institutions, such as schools and health care clinics; as well as individual and personal trajectories, including family, workplace, community, church, and interpersonal relationships (Burke et al., 2009
). In this report we focus on findings related to meanings of survivorship and support in this group of women, with the intent that such meanings serve as the basis for the development of culturally resonant and sustainable support services and outreach.