Factors Associated with Surgery Among South Asian American and Non-Hispanic White Women with Breast Cancer

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

Reflexive Identity Construction in South Asian American Diaspora in Jhumpa Lahiri’s The Namesake

Cultural identity in contemporary diasporic communities is dynamic, multifaceted, and cyclical. In the age of reflexive modernity, it is imperative to think about new ways of conceptualizing the experience of individuals straddling multiple geographies. A model of identity for such individuals should not only explain the plurality of “being” but also the fluidity of “becoming.” In this article, the question of multiple and shifting identities of the four main characters in Jhumpa Lahiri’s intergenerational novel, The Namesake, is explored using an interdisciplinary model from the field of business management based on Giddens’ theorization of reflexivity. The inward reflexive relationship between the “self” and the “other” through the discursive articulation of the ontological journey of the novel’s characters highlights the complex nature of diasporic identity construction.

Association of Social Network Characteristics With Cardiovascular Health and Coronary Artery Calcium in South Asian Adults in the United States: The MASALA Cohort Study

Background South Asian adults have worse cardiovascular health (CVH) and more coronary artery calcium compared with other race/ethnicities. The impact of the social environment has not been examined as a potential driver of CVH or coronary artery calcium in this population. We evaluated associations of social network characteristics with CVH and coronary artery calcium in South Asian American adults to inform strategies for CVH promotion in this at‐risk population. Methods and Results Using data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) cohort study, multinomial and multivariable logistic regression were used to evaluate associations of participant social network size and density, proportion of network who are kin or South Asian ethnicity and reported health of participant's identified social network members (“alters”), with participant CVH and presence of coronary artery calcium. The 699 MASALA participants included were mean age 59.2 (SD, 9.2) years and 42.9% women. After adjustment, a 1‐person larger social network size was associated with 13% higher odds of ideal CVH (odds ratio [OR], 1.13; 95% CI, 1.01–1.27). Reporting an alter with high blood pressure was associated with lower odds of ideal CVH (OR, 0.51; 95% CI, 0.29–0.88), and reporting an alter with high cholesterol was associated with lower odds of ideal CVH (OR, 0.54; 95% CI, 0.30–0.94). Conclusions Social network characteristics are associated with CVH in South Asian American adults. Engaging social networks may help promote CVH in this population.