Cultural Aspects of Cancer

Selected and compiled by Jacquelyn Coughlan, M.S., M.L.S.

Abbe, M., Simon, C., Angiolillo, A., Ruccione, K., & Kodish, E. D. (2006). A survey of language barriers from the perspective of pediatric oncologists, interpreters, and parents. Pediatric Blood and Cancer, 47(6), 819-824.

Adelman, J. D. (1983). Staff awareness of Hispanic health beliefs that affect patient compliance with cancer treatment. Progress in Clinical and Biological Research, 121, 85-86.

Adonis, C. (1978). French cultural attitudes towards cancer. Cancer Nursing, 1(2), 111-113.
Ahmad, F., Cameron, J. I., & Stewart, D. E. (2005). A tailored intervention to promote breast cancer screening among South Asian immigrant women. Social Science & Medicine, 60(3), 575-586.
Alfiere, M., Syombathy, V., & Munet-Vilaro, F. (2001). The challenge of providing culturally competent cancer care. Cancer Practice, 9(2), 62-65.
Almuzaini, A. S., Salek, M. S., et al. (1998). The attitude of health care professionals toward the availability of hospice services for cancer patients and carers in Saudi Arabia. Palliative Medicine, 12(5), 365-373.
Angwafo, F.F. (1998). Migration and prostate cancer: an international perspective. Journal of the National Medical Association 90(Suppl. 11), S720-S730.
Arruda, E. N., Larson, P. J., et al. (1992). Comfort: Immigrant Hispanic cancer patients' views. Cancer Nursing, 15(6), 387-394.
Ashing, K. T., Padilla, G., et al. (2003). Understanding the breast cancer experience of Asian American women. Psycho-Oncology, 12(1), 38-58.
Azaiza, F. and M. Cohen. (2006). Health beliefs and rates of breast cancer screening among Arab women. Journal of Women's Health, 15(5), 520-530.
Baron-Epel, O., Granot, M., Badarna, S., & Avrami, S. (2004). Perceptions of breast cancer among Arab Israeli women. Women & Health, 40(2), 101-116.
Barroso, J., McMillan, S., & Meyer, J. (2000). Comparison between African-American and white women in their beliefs about breast cancer and their health locus of control. Cancer Nursing, 23(4), 268-276.
Becker, S. A. (2006). Talking circles: Northern Plains tribes American Indian women's views of cancer as a health issue. Public Health Nursing, 23(1), 27-36.
Behbakht, K., Lynch, A., Teal, S., Degeest, K., & Massad, S. (2004). Social and cultural barriers to Papanicolaou screening in an urban population. Obstetrics and Gynecology, 104(6), 1355-1361.
Bener, A., Alwash, R., Miller, C. J., Denic, S., & Dunn, E. V. (2001). Knowledge, attitudes, and practices related to breast cancer screening: A survey of Arabic women. Journal of Cancer Education, 16(4), 215-220.
Bener, A., Honein, G., Carter, A. O., et al . (2002). The determinants of breast cancer screening behavior: A focus group study of women in the United Arab Emirates. Oncology Nursing Forum, 29(9), E91-98.
Bhagat, R., & Hilton, B. A., et al. (1999). South Asian women's views on the causes of breast cancer: Images and explanations. Patient Education and Counseling, 37(3), 243-254.
Bird, J. A., McPhee, S. J., et al. (1998). Opening pathways to cancer screening for Vietnamese-American women: Lay health workers hold a key. Preventive Medicine, 27(6), 821-829.
Borrayo, E. A. & Jenkins, S. R (2001). Feeling indecent; breast cancer screening resistance in Mexican-descent women. Journal of Health Psychology, 6(5), 537-549.
Boyle, D. M. (1998). The cultural context of dying from cancer. International Journal of Palliative Nursing, 4(2), 70-83.
Brusamolino, E., & Surbone, A. (1997). Telling the truth to the patient with cancer: A cross-cultural dialogue. Annals of the New York Academy of Sciences, 809, 411-421.
Burhansstipanov, L. & Hollow, W. (2001). Native American cultural aspects of oncology nursing care. Seminars in Oncology Nursing, 17(3), 206-219.
Butow, P. N., Tattersall, M. H., & Goldstein, D. (1997). Communication with cancer patients in culturally diverse societies. Annals of the New York Academy of Sciences, 809, 317-329.
Canales, S., Ganz, P. A., & Coscarelli, C. A. (1995). Translation and validation of a quality of life instrument for Hispanic American cancer patients: Methodological considerations. Quality of Life Research, 4(1), 3-11.
Carpenter, V., & Colwell, B. (1995). Cancer knowledge, self-efficacy, and cancer screening behaviors among Mexican-American women. Journal of Cancer Education, 10(4), 217-222.
Chan, A. K. (1993). Transcultural health care for Chinese oncology patients. In R. Masi & L. L. Mensah (Eds.), Health and cultures: Programs, services and care (pp. 121-130). Buffalo: Mosaic Press
Changrani, J. & Gany, F. (2005). Paan and Gutka in the United States: An emerging threat. Journal of Immigrant Health, 7(2), 103-108.
Changrani, J., Gany, F. M., Cruz, G., Kerr, R., & Katz, R. (2006). Paan and gutka use in the United States: A pilot study in Bangladeshi and Indian-Gujarati immigrants in New York City. Journal of Immigrant and Refugee Studies, 4(1), 99-109.
Chavez, L. R., Hubbell, F., Allan, H. F., et al. (1995). Understanding knowledge and attitudes about breast cancer: A cultural analysis. Archives of Family Medicine, 4(2), 145-152.
Chiu, L. (2000). Transcending breast cancer, transcending death; A Taiwanese population. Nursing Science Quarterly, 13(1), 64-72.
Chiu, L., Balneaves, L., Barroetavena, M. C., Doll, R., & Leis, A. (2006). Use of complementary and alternative medicine by Chinese individuals living with cancer in British Columbia. Journal of Complementary and Integrative Medicine, 3(1), art. no. 2.
Cho, J. K., Kim, K., & Yu, E. (1998). Knowledge and beliefs about the association between diet and cancer among Korean immigrants in the U.S.A. Journal of Korean Society for Health Education, 15(1), 133-149.
Choe, J. H., Chan, N., Do, H. H., Woodall, E., et al. (2005). Hepatitis B and liver cancer beliefs among Korean immigrants in Western Washington. Cancer, 104(S12), 2955-2958.
Choudhry, U. K., Srivastava, R., & Fitch, M. I. (1998). Breast cancer detection practices of South Asian women: Knowledge, attitudes and beliefs. Oncology Nursing Forum, 25(10), 1693-1701.
Cohen, M. & Azaiza, F. (2005). Early breast cancer detection practices, health beliefs, and cancer worries in Jewish and Arab women. Preventive Medicine, 41(5-6), 852-858.
Collins, D., Villagran, M.M., & Sparks, L. (2008). Crossing borders, crossing cultures: Barriers to communication about cancer prevention and treatment along the U.S./Mexico border. Patient Education and Counseling, 71(3), 333-339.
Coreil, J., Wilke, J., & Pintado, I. (2004). Cultural models of illness and recovery in breast cancer support groups. Qualitative Health Research, 14(7), 905-923.
Cui, Y., Shu, X.-O., Gao, Y., Wen, W., Ruan, Z.-X., Jin, F., & Zheng, W. (2004). Use of complementary and alternative medicine by Chinese women with breast cancer. Breast Cancer Research and Treatment, 85(3), 263-270.
Davies, B., Deveau, E., deVeber, B., et al. (1998). Experiences of mothers in five countries whose child died of cancer. Cancer Nursing, 21(5), 301-311.

Davis, A. (1996). Ethics and ethnicity: End-of-life decisions in four ethnic groups of cancer patients. Medicine and Law, 15(3), 429-432.

Delbar, V. (1999). From the desert: Transcultural aspects of cancer nursing care in Israel. Cancer Nursing, 22(1), 45-51.
DelVecchio Good, M. J., et al. (1990). American oncology and the discourse on hope. Culture, Medicine, Psychiatry, 14(1), 59-79.
Domino, G. & Lin, J. (1991). Images of cancer: China and the United States. Journal of Psychosocial Oncology, 9(3), 67-78.
Ell, K. O., Mantell, J. E., et al. (1988). Socioculturally sensitive intervention for patients with cancer. Journal of Psychosocial Oncology, 6(3/4), 141-155.
Elwyn, T. S., Fetters, M. D., Gorenflo, D. W., & Tsuda, T. (1998). Cancer disclosure in Japan: Historical comparisons, current practices. Social Science & Medicine, 46(9), 1151-1163.
Emami, A. & Tishelman, C. (2004). Reflections on cancer in the context of women's health: Focus group discussions with Iranian immigrant women in Sweden. Women & Health, 39(4), 75-96.
Frank, G., Blackhall, L. J., Murphy, S. T., et al. (2002). Ambiguity and hope: Disclosure preferences of less acculturated elderly Mexican Americans concerning terminal cancer--a case story. Cambridge Quarterly of Healthcare Ethics, 11(2), 117-126.
Frank-Stromborg, M. & Olsen, S. J. (1993). Cancer prevention in minority populations: Cultural implications for health care professionals. St. Louis: Mosby.
Gany, F. M., Herrera, A. P., Avallone, M., & Changrani, J. (2006). Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: A focus group approach. Ethnicity and Health, 11(1), 19-39.
Ghavamzadeh, A., & Bahar, B. (1997). Communication with the cancer patient in Iran: Information and truth. Annals of the New York Academy of Sciences, 809, 261-265.
Gongal, R., Vaidya, P., Jha, R., Rajbhandary, O., & Watson, M. (2006). Informing patients about cancer in Nepal: What do people prefer? Palliative Medicine, 20(4), 471-476.

Granda-Cameron, C. (1999). The experience of having cancer in Latin America. Cancer Nursing, 22(1), 51-57.

Gregg, J., & Curry, R. H. (1994). Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: The implications for a cancer screening program. Social Science & Medicine, 39(4), 519-26.
Grossarth-Maticek, R., Siegrist, J., et al. (1982). Interpersonal repression as a predictor of cancer. Social Science and Medicine, 16(4), 493-498.

Guidry, J. J., & Walker, V. D. (1999). Assessing cultural sensitivity in printed cancer materials. Cancer Practice, 7(6), 291-296.

Gullatte, M. M. (1999). A nurse's guide to breast cancer. Breast health and culture: Issues for nursing practice. Georgia Nursing, 59(1), 18, 25-27.
Higuchi, N. (1992). The patient's right to know of a cancer diagnosis: A comparison of Japanese paternalism and American self-determination. Washburn Law Journal, 31(3), 455-473.
Hilton, L. W. (1999). The Robert Tiffany Lectureship: Vital signs at the millennium: Becoming more than we are. Cancer Nursing, 22(1), 6-16.
Hodge, F. S., Fredericks, L., et al. (1996). American Indian women's talking circle: A cervical cancer screening and prevention project. Cancer, 78(Suppl. 7), 1592-1597.
Holroyd, E., Twinn, S. F., & Shia, A. T. Y. (2001). Chinese women's experiences and images of the Pap smear examination. Cancer Nursing, 24(1), 68-75.
Huang, X., Butow, P., Meiser, B., Goldstein, D. (1999). Attitudes and information needs of Chinese migrant cancer patients and their relatives. Australian and New Zealand Journal of Medicine, 29(2), 207-213.
Intercultural Cancer Council - ICC. (2007). Pocket guide. Order information for Cultural competence in cancer care: A health care professional's passport, $6.00 per one to nine copies with a $3.00 shipping cost.  Retrieved January 21, 2009 from
Jackson, J. C., Do, H., Chitnarong, K., Tu, S., Marchand, A., Hislop, G., et al. (2002). Development of cervical cancer control interventions for Chinese immigrants. Journal of Immigrant Health, 4(3), 147-157.
Jackson, L. (1994). Cancer education and screening for Asian-Americans. Journal of the American Academy of Physician Assistants, 7(10), 693-699.
Jadalla, A., & Sharaya, H. (1998). A Jordanian view about cancer knowledge and attitudes. Cancer Nursing, 32(4), 269-273.
Jenkins, C. N. H., & Kagawa-Singer, M. (1994). Cancer. In N. W. S. Zane, D. Takeuchi, & K. N. J. Young (Eds.), Confronting critical health issues of Asians and Pacific Islander Americans (pp. 105-147). Thousand Oaks, CA: Sage.
Johnson, J. L., Bottorff, J. L., Balneaves, L. G., Grewal, S., Bhagat, R., Hilton, B. A., et al. (1999). South Asian womens' views on the causes of breast cancer: Images and explanations. Patient Education and Counseling, 37(3), 243-254.
Johnston, S. C. & Spilka, B. (1991). Coping with breast cancer: The roles of the clergy and faith. Journal of Religion and Health, 30(1), 21-33.
Juarez, G., Ferrell, B., & Borneman, T. (1999). Cultural considerations in education for cancer pain management. Journal of Cancer Education, 14(3), 168-173.
Kagawa-Singer, M. (1997). Addressing issues for early detection and screening in ethnic populations. Oncology Nursing Forum, 24(10), 1705-1711.
Kagawa-Singer, M. (1987). Cultural & ethnic perspectives of cancer nursing: Hispanics and Japanese-Americans. Oncology Nursing Forum, 14(3), 59-65.
Kagawa-Singer, M. (1996). Cultural systems related to cancer. In S. Baird, R. McCorkle, & M. Grant (Eds.), Cancer nursing (2nd ed., pp. 38-52). Philadelphia: Saunders.
Kagawa-Singer, M., & Wellisch, D. K. (2003). Breast cancer patients' perceptions of their husbands’ support in a cross-cultural context. Psycho-oncology, 12(1), 24-37.
Kagawa-Singer, M., Wellisch, D. K., & Durvasula, R. (1997). Impact of breast cancer on Asian American and Anglo American women. Culture, Medicine and Psychiatry, 21(4), 449-480.
Kakai, H., Maskarinec, G., Shumay, D. M., Tatsumura, Y., & Tasaki, K. (2003). Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: An exploratory study with correspondence analysis. Social Science & Medicine, 56(4), 851-862.

Kaufert, J. M. (1999). Cultural mediation in cancer diagnosis and end of life decision-making: Experience of Aboriginal patients in Canada. Anthropology & Medicine, 6(3), 405-421.

Kaufman, Z., Shpitz, B., et al. (1995). Mastectomy as the preferred treatment for breast cancer among new immigrants from the former Soviet Union. Journal of Surgical Oncology, 60(3), 168-173.

Kaur, J. S. (1999). Native women and cancer. Health Care for Women International, 20(5), 445-453.

Kelly, A.W., Fores, C.M., et al. (1996). A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community. Mayo Clinic Proceedings, 71(5), 437-444.
Koval, A. E., Riganti, A. A., & Foley, K. L. (2006). CAPRELA (Cancer prevention for Latinas): Findings of a pilot study in Winston-Salem, Forsyth County. North Carolina Medical Journal, 67(1), 9-15.
Leavitt, M., Martinson, I. M., Liu, C., et al. (1999). Common themes and ethnic differences in family caregiving the first year after diagnosis of childhood cancer: Part II. Journal of Pediatric Nursing: Nursing Care of Children and Families, 14(2), 110-122.
Lee, M. C. (2000). Knowledge, barriers, and motivators related to cervical cancer screening among Korean-American women: A focus group approach. Cancer Nursing, 23(3), 168-175.
Lee, M. M., Lin, S. S., Wrensch, M. R., Adler, S. R., & Eisenberg, D. (2000). Alternative therapies used by women with breast cancer in four ethnic populations. Journal of the National Cancer Institute, 92(1), 42-47.
Li, S., Chou, J. L. (1997). Communication with the cancer patient in China. Annals of the New York Academy of Sciences, 809, 243-248.
Lin, C.-C., Wang, P., Lai, Y.-L., et al. (2000). Identifying attitudinal barriers to family management of cancer pain in palliative care in Taiwan. Palliative Medicine,14(6), 463-470.
Little, D. (2001). Breast cancer in Asian women. Ethnomed. Retrieved December 3, 2008 from
Liu, J. E., Mok, E., & Wong, T. (2005). Perceptions of Chinese cancer patients and the favorable and unfavorable words conveyed by their social support providers. Cancer Nursing, 28(5), 348-354.

Liu, J. M., Lin, W. C., Chen, Y. M., Wu, H. W., Yao, N. S., Chen, L. T. & Whang-Peng, J. (1999).The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre. Journal of Medicine and Ethics, 25(4), 309-314.

Long, S. (1982). Curable cancers and fatal ulcers. Attitudes toward cancer in Japan. Social Science & Medicine, 16(24), 2101-2108.
Mahloch, J., Jackson, J. C., et al. (1999). Bridging cultures through the development of a cervical cancer screening video for Cambodian women in the United States. Journal of Cancer Education, 14(2), 109-114.
Malik, I. A., & Qureshi, A. F. (1997). Communications with cancer patients: Experiences in Pakistan. Annals of the New York Academy of Sciences, 809, 300-308.
Mark, N., & Roberts, L. (1994). Ethnosensitive techniques in the treatment of the Hasidic patient with cancer. Cancer Practice, 2(3), 202-208.
Martin, B. A., & Belcher, J. V. (1986). Influence of cultural background on nurses' attitudes and care of the oncology patient... in Africa and in Midwest America. Cancer Nursing, 9(5), 230-237.
Martinson, I. M., Leavitt, M., Liu, C., et al. (1999). Comparison of Chinese and Caucasian families caregiving to children with cancer at home: Part I. Journal of Pediatric Nursing: Nursing Care of Children and Families, 14(2), 99-109.
McKinley, E. D., Garret, J. M., Evans, A. T., et al. (1996). Differences in end-of-life decision making among black and white ambulatory cancer patients. Journal of Internal Medicine, 11(11), 651-656.
McNeil, C. (1990). Culture: The impact on health care. Journal of Cancer Education, 5(1), 13-16.
McPhee, S. J., Stewart, S., Brock, K. C., et al. (1997). Factors associated with breast and cervical cancer screening practices among Vietnamese American women. Cancer Detection and Prevention, 21(6), 510-521.
Michielutte, R., Harp, P. C., et al. (1994). Cultural issues in the development of cancer control programs for American Indian populations. Journal of Health Care for the Poor and Underserved, 5(4), 280-296.
Mitchell, J. L. (1996). Cross-cultural issues in the disclosure of cancer. Cancer Practice, 6(3), 153-160.
Mok, E. (2001). Empowerment of cancer patients: From a Chinese perspective. Nursing Ethics, 8(1), 69-76.
Montbriand, M. J. (1998). Abandoning biomedicine for alternate therapies: Oncology patients' stories. Cancer Nursing, 21(1), 36-45.
Morales, E. (1994). Meaning of touch to hospitalized Puerto Ricans with cancer. Cancer Nursing, 17(6), 464-469.
Munet-Vilaro, F. (2004). Delivery of culturally competent care to children with cancer and their families - The Latino experience. Journal of Pediatric Oncology Nursing, 21(3), 155-159.
Murray, S. A., Grant, E., Grant, A., et al. (2003). Dying from cancer in developed and developing countries: Lessons from two qualitative interview studies of patients and their carers. British Medical Journal, 326(7385), 368.
Navon, L. (1999). Cultural views of cancer around the world. Cancer Nursing, 22(1), 39-45.
Nielson, B. B., McMillan, S., et al. (1992). Instruments that measure beliefs about cancer from a cultural perspective. Cancer Nursing, 15(2), 109-115.
Ong, K. J., Back, M. F., Lu, J. J., et al. (2002). Cultural attitudes to cancer management in traditional South-East Asian patients. Australasian Radiology, 46(4), 370-4.
Owens, B. & Dirksen, S. R. (2004). Review and critique of the literature of complementary and alternative therapy use among Hispanic/Latino women with breast cancer. Clinical Journal of Oncology Nursing, 8(2), 151-156.
Paisley, J. A., Haines, J., Greenberg, M., et al. (2002). An examination of cancer risk beliefs among adults from Toronto's Somali, Chinese, Russian and Spanish-speaking communities. Canadian Journal of Public Health, 93(2), 138-41.
Perez-Stable, E. J., et al. (1992). Misconceptions about cancer among Latinos and Anglos. JAMA - Journal of the American Medical Association, 268(22), 3219-3223.
Pfeffer, N. & Moynihan, C. (1996). Ethnicity and health benefits with respect to cancer: A critical review of methodology. The British Journal of Cancer, 74(Suppl. 29), S66.
Rajaram, S. S., & Rashidi, A. (1999). Asian-Islamic women and breast cancer screening: A socio-cultural analysis. Women & Health, 28(3), 45-58.
Remennick, L. (2003). "I have no time for potential troubles": Russian immigrant women and breast cancer screening in Israel. Journal of Immigrant Health, 5(4), 153.
Rose, T.A. (2007). The special needs of adult trans-cultural cancer patients. Canadian Journal of Medical Radiation Technology, 38(2), 10-16. 
Sawyer, J. E. & Eaton, L. (1992). Gastric cancer in the Korean-American: Cultural implications. Oncology Nursing Forum, 19(4), 619-623.
Simon, C.E. (2006). Breast cancer screening: Cultural beliefs and diverse populations. Health and Social Work, 31(1), 36-43.
Simon, R. J. (1986). Refugee women and their daughters: A comparison of Soviet, Vietnamese, and native-born American families. In C. L. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement countries (pp. 157-172). Washington, DC: Hemisphere.
Soyannwo, A. & Amanor-Boadu, S. D. (2001). Management of cancer pain--a survey of current practice in West Africa. Nigerian Postgraduate Medical Journal, 8(4), 175-178.
Sparks, L. & Mittapalli, K. (2004). To know or not to know: The case of communication by and with older adult Russians diagnosed with cancer. Journal of Cross-Cultural Gerontology, 19(4), 383-403.
Sparreboom, A., Cox, M. C., Acharya, M. R., & Figg, W. D. (2004). Herbal remedies in the United States: Potential adverse interactions with anticancer agents. Journal of Clinical Oncology, 22(12), 2489-2503.
Struthers, R. & Eschiti, V. S. (2004). The experience of indigenous traditional healing and cancer. Integrative Cancer Therapies, 3(1), 13-23.
Surbone, A. (2006). Cultural aspects of communication in cancer care. Recent Results in Cancer Research. 168(9), 91-104.
Surbone, A. (2008). Cultural aspects of communication in cancer care. Supportive Care in Cancer, 16(3), 235-240.
Takashi, Y. (1990). Informing a patient of malignant illness: Commentary from a cross-cultural viewpoint. Death Studies, 14(1), 83-91.
Tam, A. K., Padilla, G., Tejero, J., & Kagawa-Singer, M. (2003). Understanding the breast cancer experience of Asian American women. Psycho-oncology, 12(1), 38-58.
Tang, S. T. (2000). Meanings of dying at home for Chinese patients in Taiwan with terminal cancer: A literature review. Cancer Nursing, 23(5), 367-370.
Tang, T. S., Solomon, L., et al. (1999). The role of cultural variables in breast self-examination and cervical cancer screening behavior in young Asian women living in the United States. Journal of Behavioral Medicine, 22(5), 419-436.
Thibodeaux, A.G. (2007). Cultural influences on family management of children with cancer. Journal of Pediatric Oncology Nursing, 24(4), 227-233.
Thomas, V., Richardson, A., et al. (2000). The efficacy of bilingual health advocacy in ethnic minority patients with cancer. Nursing Standard, 14(26), 32-33.
Torrecillas, L. (1997). Communication of the cancer diagnosis to Mexican patients. Attitudes of physicians and patients. Annals of the New York Academy of Sciences, 809, 188-196.
Tovey, P., Chatwin, J., & Ahmad, S. (2005). Toward an understanding of decision making on complementary and alternative medicine use in poorer countries: The case of cancer care in Pakistan. Integrative Cancer Therapies, 4(3), 236-241.
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Wellisch, D., Kagawa-Singer, M., et al. (1999). An exploratory study of social support: A cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. Psycho-Oncology, 8(3), 207-219.
Wong, R., Sagar, C. M., & Sagar, S. M. (2001). Integration of Chinese medicine into supportive cancer care: A modern role for an ancient tradition. Cancer Treatment Reviews, 27(4), 235-246.
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Yi, J. K. & Luong, K. N. (2005). Apartment-based breast cancer education program for low income Vietnamese American women. Journal of Community Health, 30(5), 345-353.
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©Jacquelyn Coughlan, March 2009 ( citations)