Cultures, subcultures and late presentation with breast cancer.

BACKGROUND There has been an increased recognition of the importance of socio-cultural factors affecting late presentation in breast cancer. Socio-culturally mediated symbolic meanings, attached to " breasts" might importantly affect understandings of breast cancer in connection with late presentation. OBJECTIVE To explore symbolic meanings of " breasts" which might affect late presentation, as observed by the practitioners of complementary, alternative and religious (CAM) healing who worked with women with breast cancer in the Boston area, USA. METHOD We conducted semi-structured interviews with 46 CAM practitioners who worked with approximately 70 CAM modalities. The interviews were entered into the database and analysed using thematic approach. RESULTS The CAM practitioners observed that late presentation is related to two symbolic meanings of " breasts". Firstly, " breasts" are a symbol of maternity and consequently some women delayed seeking medical help because such understanding affected their perceived capacity to take care of their families. Secondly, among White American women " breasts" are related to the culturally highly relevant concept of " beauty", but among African American women " beauty" is equated with " health". Such understandings lead to very different reasons for late presentation, different illness experiences and require different psycho-social intervention to support women. DISCUSSION AND CONCLUSION In planning and designing effective health promotion strategies and appropriate supportive care strategies for women coming from different cultural and sub-cultural backgrounds it is important to carefully examine concepts affecting late presentation in all their different social and (sub-)cultural settings.