Open Journal of Nursing, 2013, 3, 404-413 OJN
http://dx.doi.org/10.4236/ojn.2013.35055 Published Online September 2013 (http://www.scirp.org/journal/ojn/)
Cultural models of female breasts and breast cancer
among Korean women
Eunyoung E. Suh
Seoul National University College of Nursing and Research Institute of Nursing Science, Seoul, South Korea
Received 9 August 2013; revised 1 September 2013; accepted 10 September 2013
Copyright © 2013 Eunyoung E. Suh. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Although a great many qualitative descriptions of the
experience of having breast cancer exist, they over-
whelmingly represent experiences of women in West-
ern cultures and are based on assumptions that stem
from Western individualism. This study explores and
describes cultural models shared by a group of
non-Western women, South Koreans, in reference to
female breasts and breast cancer. The hermeneutic
phenomenology-grounded qualitative study was
conducted with 40 Korean women, between 23 and
81 years of age, half of whom were breast cancer sur-
vivors. The analysis elicited two cultural models, both
characterized in terms of physical relationships to
others (as opposed to the woman’s individual or in-
dependent view of her body): a breast-feeding mother
to a child and an attrac ti ve w ife to a husband. Female
breasts are interpreted as a medium that connects
women to roles as mothers and wives. Breast cancer
can lead women to detach from their previous rela-
tional and role-oriented identities. Cultural traditions,
cultural concepts, and culture-related health beliefs
in Korea are interwoven deeply in the women’s sto-
ries about breasts, as a gendered organ, and its dis-
ease. The findings suggest that understanding in-
digenous cultural models should precede any suppor-
tive breast cancer care for women from non-Western
cultural backgrounds.
Keywords: Breast Cancer; Cultural; Korean; Qualitative;
Phenomenology
1. INTRODUCTION
Cultural models are defined as the shared perspectives or
cognitive schemas through which members of a par-
ticular culture understand and interpret their realities [1].
People who share identical cultural models tend to con-
struct their realities and interpret them in similar ways.
Illuminating and deciphering cultural models thus offers
a profound understanding of human motives and be-
haviors [2,3].
Breast cancer, as the most common female cancer, is
estimated to affect over 1.38 million women according
to the 2008 GLOBOCAN of the World Health Or-
ganization [4]. As the incidence and survivability of
breast cancer have increased, so has the number of
survivors, which exacerbates its profound ramifications
in women’s lives [5-12]. Women’s lives are described as
“being in suspense” [13] and “scattered into an
unforeseen swirl” [14] when they are told that they have
breast cancer. Women feel that their previous routines
have been greatly changed [7,15] and experience phy-
sical and emotional turmoil as they undergo cancer
treatments such as mass excision surgery, chemotherapy,
and/or radiation therapy [16-18].
Even after cancer treatment, a woman must deal with
the fact that her symbol of womanhood is deformed or
removed [19,20] and her sexuality may have changed
due to chemotherapy and hormonal treatment [21-23].
Despite the ordeal of the illness trajectory, women live
out their lives with breast cancer by being “against all
odds” [7], finding meaning in their experiences [6], and
looking for spiritual equilibrium [24,25]. In addition,
women interpret and reconstruct their experiences of
breast cancer as positive drivers of personal growth [26]
or as opportunities for enlightenment and transference
[5,11,12]. A meta-synthesis of 30 qualitative research
reports of women’s lives with breast cancer focused on
the impact of breast cancer on “self” [27]. Through the
experiences of breast cancer diagnosis and its treatment,
women obtained an “awareness of their own mortality”,
lived with “an uncertain certainty”, validated attached
relationships around them, and ultimately redefined
themselves [27].
Although great numbers of qualitative descriptions of
women’s lives with breast cancer exist, they mainly

E. Suh / Open Journal of Nursing 3 (2013) 404-413 405
represent experiences of women in Western cultures [28]
and most assumptions of the reports stem from Western
individualism. The physical deformation due to the
surgery is often regarded as the changes in body image and
sexuality at an individual level [19,29]. The meanings of
the experience of breast cancer diagnosis and treatment are
also often analysed in a link of “self” [27] or within the
individual context [30]. Unlike an experience that is valued
and interpreted based on each individual’s reference points
in individualistic culture, a person in a collectivistic culture
will often define herself as a part of her group, and holds a
view of “self” according to the norms and traditions of that
group [31]. Therefore, cultural models of female breasts
and breast cancer of women in non-individualistic cultures
may differ from those of Western cultures.
Some reports of the significance of female breasts and
the experiences of breast cancer for women in non-
Western cultures provide a glimpse of the need for a
deeper examination of cultural models among those wo-
men. No Korean-American women used words related to
“body image” or “sexuality” when asked to express their
symbolic meanings for female breasts and breast cancer,
according to the cited excerpts [32]. Arab-American
women did not express concerns of “altered body image”
or “loss of their body part” when relating their ex-
periences with breast cancer. Instead, they spoke of
breast cancer as “fate” and of their priorities and value of
their roles in the family [33]. The importance of religion,
the beliefs of fatalism, and the significance of their
families and the completion of women’s roles in the
family were found in the reports with women from Arab
[33], Chinese [34], Pakistani [35,36], South Korean [32,
37], and Hong Kong Chinese families [15]. This study
therefore explored and aimed to describe cultural models
shared by a group of non-Western women, South Kor-
eans, in regard to female breasts and breast cancer. Such
descriptions are expected to expand the understanding of
how meanings and interpretations of certain experiences
are shaped by cultural models or cognitive schema.
2. METHODOLOGICAL BASIS
This qualitative study was philosophically inspired by
hermeneutic phenomenology from Heidegger, Gadamer,
and Ricoeur [38]. In their hermeneutic phenomenology,
the understanding of a person or an individual’s behavior
occurs in the context of the world that the person lives in
(“being-in-the-world”); truth is temporally determined in
accordance with the historical and cultural context of the
present knowledge [39]. Especially (according to
Gadamer and Ricoeur), text, as an object of interpretive
analysis, is not only a written document, but also a
meaningful action that opens up the existential world of
the nature of human experience, thus permits textual
multiplicity and textual plurality [39,40]. This study also
followed American phenomenological methodology, in
which descriptions of participants’ “situated” experi-
ences are themselves weighted [41]. Understanding and
explanation of their cultural model were articulated here
through the researcher’s engagement and interpretation
of interview transcripts [39,40].
2.1. Participants
In this qualitative study, interviews with 40 Korean
women, including twenty breast cancer survivors and
twenty healthy women, were analyzed and interpreted.
The interviews with healthy Korean women were
adapted from a larger grounded-theory study on breast
cancer screening behaviors among Korean immigrant
women [42]. The interviews with breast cancer sur-
vivors were conducted based on the tentative analysis of
the earlier interviews with healthy women to expand the
horizons of the phenomena under investigation. Par-
ticipants with histories of breast cancer were the subjects
of a completed intervention study [43]; they joined in
this qualitative study based on their interest in par-
ticipation. Participants’ ages ranged from 23 to 81 years.
They were mostly married and educated beyond high
school (Table 1). Women who reported their socio-
economic status as middle comprised more than half of
the participants. Only two of the healthy women and six
of the breast cancer survivors denied any religious
beliefs. All women with breast cancer had histories of
mass removal surgery, and all but two received
chemotherapy along with the surgery (Table 1).
2.2. Procedures
The institutional review board (IRB) of the university
where the researcher was affiliated approved the study.
Korean women were approached and recruited using a
theoretical and convenient sampling technique. Healthy
Korean women were recruited through Korean com-
munity churches and social groups in Philadelphia, USA,
and breast cancer survivors through a university cancer
center in Seoul, Korea. The possible influences of the
geographical and time-point differences in data collection
between the healthy women and the breast cancer
survivors were taken into account in the interpretive
analysis. Upon agreeing to participate in the study, each
subject joined in an individual interview with the
researcher in a quiet and comfortable place that the
participant chose, such as at their home, a restaurant, or
a meeting room in a cancer center.
Although it was called an “interview,” the data
collection proceeded through conversation between
each participant and the researcher, rather than just
asking questions of the participants, to refrain from
creating a hierarchical relationship [44]. The semi-
constructed questionnaires provided the contents and

E. Suh / Open Journal of Nursing 3 (2013) 404-413
406
Table 1. Demographic characteristics of the study participants.
Healthy Women
(n = 20)
Breast Cancer
Survivors
(n = 20)
Age Range (Mean) 23 - 81 (47.75) 26 - 63 (45.55)
Married 12 16
Marital Status
Not Married 8 4
≤Middle School 5 2
High-School 4 4 Education
≥College 11 14
High 3 2
Middle 12 14
Scioeconomic
Status
Low 5 4
Yes 18 14
Religion
No 2 6
Yes - 20
Surgery
No - 0
Yes - 18
Chemotherapy
No - 2
directions of the conversation between the researcher
and each participant. Those included: “what comes to
your mind when you think of female breasts and breast
cancer?”, “tell me any episode or memory you have in
reference to female breasts and breast cancer,” “tell me
any episode or story related to female breasts in your
family norms, customs, social relations.” The breast
cancer survivors were also asked: “tell me what it is like
being diagnosed and living with breast cancer”, and “tell
me any stories of how your life changed or situated by
the ordeal of breast cancer”. The interviews lasted an
hour to 2 hours in Korean until the participants
expressed their completion of disclosure of their stories
and thoughts on the given topics. All interviews were
recorded on a digital voice recorder; all participants
agreed to being recorded.
2.3. Data Analysis
All recorded interviews, which were conducted in Ko-
rean, were transcribed into verbatim transcripts. First
level coding, in which meaningful words, expressions, or
sentences are coded as units of analysis, was done in
Korean in order not to lose any particular Korean ex-
pressions or culturally coloured verbatim. Bilingual con-
stant comparative translation between Korean and Eng-
lish came from categorical/axial levels of coding [45].
The MAXQDA© software program for qualitative data
analysis was used for data management and reorganiza-
tion. Parts of the conversations were translated into Eng-
lish by two bilingual translators to present as exemplars
in this article. In Korean, the first person pronouns, “I”
or “my”, are not used in conversation unless it is neces-
sary to make meanings accurate, therefore, first person
pronouns were added in the quoted excerpts with paren-
thesis for sound English grammar.
The transcribed data were read many times and in-
terpreted by the researcher within the hermeneutic cir-
cle in which the interpretive dialogue between text and
the interpreter occurred and a “fusion of the horizons”
was reconstructed [46]. Three practical strategies for
interpretive analysis by Benner [47], thematic analysis,
exemplars, and paradigm cases, were applied in the
analysis. The thematic analysis was conducted through
careful reading of the text, recognition of patterns,
meanings, concepts in the text, and interpretation of in-
formation and themes within the given cultural and his-
torical context [48]. Several exemplars were selected to
elucidate the truth value of the findings. The paradigm
cases were explored and described to show how the
meanings of female breasts and breast cancer for Korean
women were constructed within their situational context
[49,41]. To establish the rigor of this study focusing on
credibility, transferability, and dependability, the deci-
sion trail was created and audited by team members of a
qualitative analysis group in which “events, influences,
and actions of the researcher” were recorded [50].
2.4. Ethical Consideration
The participants were introduced to the study’s purpose
and procedure upon their agreement to participate, and
informed of their freedom to withdraw from the study
anytime they wanted. All participants signed written
consent forms to participate in the study and for voice
recording. The recorded interviews were transcribed by
professional transcriptionists who did not know the indi-
vidual’s demographic profile. Any information in the
transcripts traceable back to the individual was switched
to anonymous symbols or pseudonyms by the researcher.
3. RESULTS
The thematic analysis findings are presented synchro-
nically according to the research topics although the
participants told their stories to the researcher diach-
ronically. The main theme elicited about female breasts
was “relating one to one’s relational world”, whereas
“detaching one from one’s usual world” was the main
theme for breast cancer discussions (Table 2). These
themes reflect participants’ way of perceiving their
bodies and illnesses within a context of relationships.

E. Suh / Open Journal of Nursing 3 (2013) 404-413 407
Table 2. The cultural models of female breasts and breast cancer from a thematic analysis.
Topics Main Themes Subthemes
1.1. Relating me to my roles for my husband and children
1.1.1. These connect me with my role as a mother of my children
1.1.2. These relate me to my role as my husband’s woman
The Female Breasts 1. Relating one to one’s
relational world 1.2. Taking the shared socioc ult ura l meanings for grante d
1.2.1. Not too big, not too small: the silhouette of the body
1.2.2. Covered, not get touched: the way of treating these
Breast Cancer 2. Detaching one from
one’s usual world
2.1. The aetiology: Against Sun-Li and forbearing Han inside
2.2. The experience: Unwanted engagement into an unfamiliar journey
2.3. The ramifications of breast cancer: Detaching me from my usual world
Details about the major themes and subthemes are
described with the quoted excerpts as exemplars; and a
paradigm case is presented.
3.1. Relating One to One’s Relational World:
Female Breasts
In conversations with Korean women in this study, they
mostly used the gender-neutral term meaning “chest”
(Ga-Seum) to indicate female breasts. Other Korean
words for either human female breasts, Yu-Bang (mean-
ing “milk room”), or Jeot (mammal’s breasts or breast
milk) were scarcely used. Every participant brought up
either her husband or children first and talked about her
roles for them, using female breasts as a medium. After
the thorough description of their husbands and children,
the participants turned the conversation to other various
episodes and stories they had experienced in reference to
female breasts, which reflected the sociocultural ways of
seeing, mentioning, and treating female breasts among
Korean people.
3.1.1. Relati ng Me to My Rol es for My Hu sband and
Children
The participants’ descriptions of female breasts were
reconstructed and interpreted as connectors to their roles
as mothers and wives. Women described female breasts
as objects that related a woman to her roles as a spouse
and as a mother of their children. One said, “They [fe-
male breasts] make (me) think of man and baby. You
provide milk to your baby to raise it. And you also use
them for satisfying your man” (woman, age 35). (Words
in parentheses were not spoken in Korean but added in
the scripts for sound English grammar.)
1) These connect me to my role as mother of my
children.
Instead of directly articulating the word for female
breasts, women often used the demonstrative pronoun,
these, to indicate their breasts. Many participants for the
first mentioned the image of breast feeding mother, the
memories of breast feeding, and their roles of being a
mother who breast fed their children.
Breasts remind (me) of feeding and raising children.
When (you) have a baby, (you) don’t care about shyness
or anything. (You) just feed them anywhere. The feeling
of connection with my babies when (I) fed them was so
fantastic. It is beyond description (woman, age 36).
Female breasts are for feeding children. Isn’t it a
mother’s obligation to feed (her) kids? Besides that, (I)
don’t have any thoughts about breasts (woman, age 77).
2) These relate me to my role as my husband’s
woman.
Following the schema of motherhood, the next pre-
vailing theme of female breasts incorporated a woman’s
role in relation to men, mostly to her husband, which
was being sexually attractive to him. To the participants,
breasts meant sexuality, which was recognized as part of
her role. A 33-year-old, college-graduate, married woman
told a story of how much she had struggled with her
“not-sexy-as-before” breasts—not according to her point
of view, but to her interpretation of her husband’s per-
spective.
(I was) never concerned about (my) breast size before
I got married. But after (I) started breast-feeding our son,
(my) breast shape changed. (It) is withered and sagged.
(I) feel sad seeing (my) breasts in a mirror because this
is not what a husband wants… A while ago, (I) asked
(my) husband if (I could) get breast cosmetic surgery. He
said (I) didn’t need to but I know he wanted (my) breasts
to have a sexier shape. When we went shopping, how-
ever, he is amazed by the pictures of sexy and voluptu-
ous women in magazine display on the shelves. (He)
looked at them carefully and said, “Wow, look at those
breasts, what a good figure!” or “What a sexy woman
(she) is!” (He) said (I) did not need to get cosmetic sur-
gery on (my) breasts. But as a wife, (I) know (he) wants
something sexier. (He) is just a man among other Ko-
rean men, you know (woman, age 33).
3.1.2. Taking the Shared Sociocultur al Meanings for
Granted
As women incorporated their husbands’ perspective to

E. Suh / Open Journal of Nursing 3 (2013) 404-413 408
understanding and interpretation of their breasts in pre-
vious descriptions, the participants also talked about
various kinds of sociocultural symbolic meanings of
female breasts in their everyday life. Especially in terms
of size and shape, and the way of treating women’s
breasts were told in detail reflecting the dominant social
desires toward female breasts within Korean culture.
1) Not too big, not too small: The silhouette of the
body
Many participants shared stories about the size of
breasts within a Korean sociocultural context. Inter-
estingly, even if sexuality in relation to breasts pre-
vailed in the participants’ perceptions, they preferred
breasts to be not too big or too small in size. Me-
dium-sized breasts created a socially appropriate
“silhouette of the body”, embodying what they identi-
fied as a sexy silhouette. Although sexiness was
brought up in relation to their husbands, sexiness in
this theme was rather an external symbolic view of
woman in general than that of the sexual object of her
husband.
Breasts make a woman’s exterior. In these days, a
man’s point of view is important for women. Breasts
create a (woman’s) look and a sexy appearance
(woman, age 20).
In the old days, (girls) tied up (their) breasts in order
not to be voluptuous. (We) were t oo shy to show our breast
lines... (Girls) who had bigger breasts than average felt
shy in those days… My friend has big breasts, so (sh e)
bent (her) shoulder to hide them and wanted to show
that (she) had normal size breasts. It was (her) handicap
having bigger breasts than average (woman, ag e 60).
Breasts remind (me) of (my) handicap. (My) breasts
are so small, such that when (I) was a high school stu-
dent, (I) was often embarrassed. (I) had a flat chest in
my school uniform compared with my friends. (I) put
some handkerchiefs in the bra to make (me) look good.
When (I) was young, we didn’t have bras like (we) have
now. That was kind of (my) handicap. As (you) know,
Koreans value proper size of breast s . Not too big, no t too
small (woman, age 54).
2) Covered, not get touched: The way of treating
these
With regard to the perception of their breasts, partici-
pants often told stories referring the traditional treat-
ments of breasts that they were taught. Evidently, the
discourse related to the female breast had seldom been
talked about in public, even in personal communications.
In addition to a taboo about discussing female organs,
breasts are supposed to be physically covered and se-
cured, neither to be shown nor touched. The participants’
identification of their bodies was evidently influenced by
the traditional notion of a chaste life for women in Ko-
rean culture.
When we were young, discipline for woman was hard.
(I) don’t think (I) ever talked about my body or breasts
with anyone. Especially, our mother strictly raised (her)
children. (She) said, “Women should keep your body
pure from men until you get married.” It was so strict.
(woman, age 77).
Even if a physician sees and touches (my) body as one
of (their) patients, how (I) interpret it is different. Being
touched and treated by someone who (I) don’t know well
makes (me) feel uncomfortable. (I) would go for female
doctors for (my) woman ’s exam. It is because that kind
of touching by a man could contaminate (my) virginal
purity (woman, age 23).
In the old days, wom en’s breasts had to be covered,
not shown…As our breasts grew in our teenage years,
(my) mother taught (me) not to show anyone and keep
(my) body untouched b y any man until I got married. So,
(I) just thought it was the rule… not showing (my) body
and not letting anyone touch (my) body (woman, age
81).
3.2. Detaching One from One’s Usual World:
The Cultural Model of Breast Cancer
According to participants’ descriptions, and similar to
what would be expected from the cultural model of
female breasts, breast cancer caused a change in inter-
personal and sociocultural relationships. All partici-
pants, including healthy women and breast cancer
survivors, mentioned the deformation or mutilation of
the breast and its effects in emotional, relational, and
functional aspects under the context of relationships.
For description purposes, the participants’ stories were
reconstructed in terms of etiology, personal experiences,
and ramifications of breast cancer.
3.2.1. Relati ng Me to My Rol es for My Hu sband and
Children
The participants’ beliefs about causes of breast cancer
showed a distinctive feature incorporating traditional
Korean health and illness beliefs, and a fatalistic per-
spective derived from the culture. Most participants im-
plied that life and critical life events were predetermined
by providential power or by one’s Pal-Ja (fate), to which
an individual should submit. Although they admitted that
their predestined fates were to get ill with breast cancer,
they presumed that either forbearing stresses or Han
(heartburning) or opposing Sun-Li (universal principles)
by disharmonizing with nature/others lead them to the
illness.
I think my having had too much stress caused my
cancer… As (you) know, we often say that “forbearing
Han inside causes disease” in our culture… For any

E. Suh / Open Journal of Nursing 3 (2013) 404-413 409
reason, accumulating stress and unresolved Han inside
caused it. So when I got diagnosed with breast cancer, I
cried and yelled at my husband that he caused it. He
causes me to feel stressed all the time (woman, age 47).
(I) think opposing natural principles caused my cancer.
When I had my son, I tied up my breasts after (I) gave
birth and got Yu-Jeot (a kind of breast inflammation).
Drying up (my) breast milk instead of feeding, I guess,
opposed the natural principles. Wh e n (I) manipulated
natural rules against Sun-Li, it became problematic and
eventually caused a cancer, (I) believe (woman , ag e 63).
3.2.2. The Experience: Unwanted Engagement into
an Unfamiliar Journey
The experiences of living with breast cancer were ex-
pressed by the survivors. Not surprisingly, all breast
cancer survivors had some kind of negative connotation
with their experience. Sorrow, fear, extreme difficulty,
suffering, unfamiliarity, and uncertainty emerged from
the narratives. In addition, many participants articulated
the experience as an unfamiliar journey, in which noth-
ing is certain or definite, and which seemed to be an
endless turmoil. Even 5 years after her treatment, one
said the experience of the cancer ordeal was still vivid,
and the fear of recurrence never diminished.
From the point of time when I heard my diagnosis
from my doctor, my whole world seemed to change. I
feel like all fear, sorrow, and despair came into my fam-
ily ever since, and the negative emotions and thoughts
need to be intentionally moved out of me, or they are
there forever. I feel like I began an endless, strange, and
lonely journey by myself… a few steps with my fam-
ily… but mostly by myself (woman , age 37).
3.2.3. The Ramifi cations of Breast Cancer: Detaching
Me fr om My Usual World
The breast cancer survivors’ perception of female
breasts, as a medium of the relations with their loved
ones, encourages both relational and social detachment
through the experience of breast deformation. It altered
their perceptions of their social roles of being mothers
and wives, and disengaged them from the social norms
of looking “normal” like other women. The survivor
participants were concerned over the loss of their former
roles, especially for their husbands. A woman’s percep-
tion of the lost breast signifies that she is no longer able
to fulfil her role as a sexual object of her husband. The
participants brought up the silhouette caused by breast
abscission. The participants’ point of view was external
and they integrated “womanly” appearance into their
perception, which was socially symbolized.
When my hair started falling off [because of chemo-
therapy], (my) husband and I cried together and we
started using different rooms ever since. (I) wear a wig
while he is home in order not to show him (my) bald
head. (I) take off the wig only when (I) am by myself. The
loss of my breast is irreversible, but the hairs will come
back. (I) do not want to show (my) deficiency to my be-
loved husband (woman, age 52).
3.3. Paradigm Case
B.S. is a 37-year-old Korean woman with two children,
aged 8 and 4. She met her husband in college and got
married when she was 28. She recalled her married life
had been busy raising kids, doing housekeeping, and
fulfilling the roles as a wife and a daughter-in-law in her
husband’s family. Being slender and weak since her
youth, she felt exhausted by raising kids and doing all
housekeeping by herself. She feels that she is always
tired. She thought her life was as it should be because
every woman lived a life similar to hers. As she has had
sickness on and off due to her heavy household work,
she ignored a lump in her left breast for a while; she
thought to herself that it felt strange to have very low
energy every day.
When she heard about her breast cancer from her
doctor, she was shocked and felt as if heaven had fallen
down on her. Since then, everything has changed. She
could not conduct her roles as a wife, a mother, and a
daughter-in-law as much as she had previously. She
thought that her internal stresses had finally burst out in
the form of breast cancer. She resented her husband and
others expecting too much of her all the time. The jour-
ney of undertaking the diagnosis and treatment of breast
cancer was difficult, rather lonely, painful, unorganized,
and uncertain. She felt that the entire cancer ordeal was
hers alone, despite support from her husband and rela-
tives. With a deformed breast and weakened body, B.S.
feels that she does only half of what others (husband,
kids, relatives, et al.) expect her to do. She feels de-
tached from her previous self, her close family, and even
from her husband.
4. DISCUSSION: INTERPRETIVE
REFLECTIONS
4.1. Cultural and Contextual World the Women
Live in
Korean women, as with women in many Asian countries
where women are in subservient positions, are raised
with social and cultural dispositions of “what it means to
be a woman in Korea”. The most dominant symbol of
the ideal woman in Korea is the Hyeon-Mo-Yang-Cheo
idealism that depicts a wise and sacrificial mother, and
submissive wife [51,52]. The idea of Hyeon-Mo-Yang-
Che originated from Confucian beliefs, which preordain
and limit a woman’s identity to being a mother or wife at

E. Suh / Open Journal of Nursing 3 (2013) 404-413 410
home rather than being an individual [52-54]. This im-
age is embedded in Korean cultural traditions, family
institutions, and the educational system and moulds the
image and social roles of Korean women.
Along with the aforementioned symbolization of the
Hyeon-Mo-Yang-Cheo, several Korean proverbs dis-
tinctly reflect the traditions of valuing man over woman
in ancient Korean culture. The two most common max-
ims are the Nam-Jonn-Yeo-Bi (man is precious and re-
spectful, women is vulgar and ignoble) and the Yeo-Pil-
Jong-Bu (wife must be submissive and obedient to her
husband) [51]. Unquestionably, women or associations
with what is female or feminine are less valuable than
men and what is seen as male. Female organs such as
breasts or female genitalia are usually considered some-
thing shameful, and need to be covered and secured
[55,56]. From this point of view, it is not difficult to en-
vision that maintaining breast health in this culture im-
plies a complicated and distinct context. The images
described by the participants reflect this Korean so-
ciocultural context in which a woman is situated rela-
tively normatively in a certain way, as it “should be”.
4.2. Living in the World with the Flow of Pure
Principles and Predetermined Fate
The word, Sun-Li, literally means “pure principles”. It
implies that there are universal principles on which crea-
tion must be based. The notion of Sun-Li originates from
Confucian beliefs, in which proper ways (Jeong-Do) to
be and to behave are considered natural [57]. Deviating
from the pure principles causes disharmony, resulting in
severe illnesses, such as breast cancer, according to the
participants’ conversations. Participants also brought up
their fate (Pal-Ja) often, referring one’s destiny or prede-
termined ways of living. Pal-Ja literally means “eight
characters”, which include a person’s time, date, month,
and year of his or her birth [58]. According to Korean
customs, a person’s date and time of birth are connected
to universal principles and they reveal his or her fate.
Participants believed in their predetermined fate; having
‘the life as it is’ is largely controlled by pure principles
and individual predestined fate.
4.3. The Cultural Models of Female Breasts and
Breast Cancer
In Korean dialects, three words, Yu-Bang, Jeot, and
Ga-Seum, indicate female breasts. Yu-Bang and Jeot
generally refer to female breasts as opposed to Ga-Seum,
which is a gender-neutral term meaning “chest”. The
Korean terms, Yu-Bang and Jeot, which originate from
the meaning of milk production, generally influences
women’s perception of breasts. The word, Yu-Bang, is
from Chinese: Yu means milk and Bang indicates a room
or space. Typically, the Chinese character, Yu, consists of
three parts, i.e., a hand, a son, and a flying swallow that
is believed as a messenger to bless the son. Yu, picto-
graphically implies handing a son blessed by a messen-
ger. Thus, the word Yu-Bang imposes the meaning of a
space for milk to raise a son. Although Yu-Bang is used
as a scientific term rather than in popular language, it is
generally acknowledged in Korean dialects. Conversely,
Jeot, is a Korean word, frequently used in popular lan-
guage, with two meanings; one indicates female breasts
and the other is milk. Both words indicate female breasts
in Korean various dialects. Yu-Bang and Jeot both imply
the idea of “feeding a baby with milk” within the words
themselves. As language is a symbolic representation of
the culture of people who use it [59], Korean words for
female breasts carry some of the symbolic meanings of
female breasts in Korean culture. This is clearly demon-
strated in the narratives of the cultural model of female
breasts among the participants.
Breast cancer implies the loss or deformation of a
breast, and can lead a woman to relational detachment
from her husband, and to social disconnection from the
norms of society. The loss or deformation of a breast is
therefore perceived as tragic because it devastates the
patient’s role as a woman. In addition, a woman with a
deformed breast may come to believe that she is no
longer like the others in the collectivistic Korean culture.
Unlikeness among the group members conveys disen-
gagement from the social bonding in the collectivistic
culture [31]. Therefore, the participants clearly articu-
lated that breast cancer created the sense of a “perceived
social death”.
5. CONCLUSIONS
In this hermeneutic phenomenology study, Korean
women’s cultural ways of perceiving, understanding, and
interpreting female breasts and breast cancer were inter-
pretively reconstructed and presented. The stories of
these 40 Korean women depicted cultural models of
breast-feeding mothers and women whose husbands see
them as attractive, in the contexts of these relationships
and the objectification of women’s bodies. Female
breasts are interpreted as an external medium that con-
nects women to their roles as mothers and wives. As
breast cancer often causes the deformation or mutilation
of this medium, it may lead women to detach from their
previous relational and role-oriented identities. Cultural
tradition, cultural concepts, and culture-related health
beliefs of Korea were interwoven deeply in the women’s
stories in reference to female breasts and breast cancer.
This study illustrates the ramification of breast cancer
in the lives of women whose ways of interpreting the
world are constructed within a non-Western sociocultural

E. Suh / Open Journal of Nursing 3 (2013) 404-413 411
context. Although its limitations correspond to criticisms
of applicability and consistency for interpretive studies,
the cultural models of Korean women presented here
coherently depict a lived manifestation of relational and
collective self in the given context [60]. Understanding
the indigenous cultural model of seeing, understanding,
and interpreting the journey with breast cancer should
precede any supportive breast cancer care for women
with non-Western cultural backgrounds.
6. ACKNOWLEDGEMENTS
This work was supported by the Korea Research Foundation (KRF)
grant funded by the Korea government (MEST) (No. 331-2008-1-
E00401).
REFERENCES
[1] Strauss, C. (1992) Models and motives. In: D’Andrade,
R. and Strauss, C., Eds., Human Motives and Cultural
Models, Cambridge University Press, New York, 1-20.
doi:10.1017/CBO9781139166515.002
[2] D’Andrade, R. (1992) Schemas and motivation. In:
D’Andrade R. and Strauss, C., Eds., Human Motives and
Cultural Models, Cambridge University Press, New York,
23-44. doi:10.1017/CBO9781139166515.003
[3] Strauss, C. and Quinn, N. (1997) A cognitive theory of
cultural meaning. Cambridge University Press, New
York.
[4] Ferlay, J., Shin, H.R., Bray, F., Forman, D., Mathers,
C.D. and Parkin, D. (2010) GLOBOCAN 2008, Cancer
incidence and mortality worldwide. IARC Cancer Base
No. 10, International Agency for Research on Cancer,
Lyon.
[5] Arman, M. and Rehnsfeldt, A. (2002) Living with breast
cancer—A challenge to expansive and creative forces.
European Journal of Cancer Care, 11, 290-296.
doi:10.1046/j.1365-2354.2002.00318.x
[6] Coward, D.D. and Kahn, D.L. (2005) Transcending
breast cancer: Making meaning from diagnosis and treat-
ment. Journal of Holistic Nursing, 23, 264-283.
doi:10.1177/0898010105277649
[7] Elmir, R., Jackson, D., Beale, B. and Schmied, V. (2010)
Against all odds: Australian women’s experiences of re-
covery from breast cancer. Journal of Clinical Nursing,
19, 2531-2538. doi:10.1111/j.1365-2702.2010.03196.x
[8] Manuel, J.C., Burwell, S.R., Crawford, S.L., Lawrence,
R.H., Farmer, D.F., Hege, A., et al. (2007) Younger
women’s perceptions of coping with breast cancer. Can-
cer Nursing, 30, 85-94.
doi:10.1097/01.NCC.0000265001.72064.dd
[9] Rosedale, M. (2009) Survivor loneliness of women fol-
lowing breast cancer. Oncology Nursing Forum, 36, 175-
183. doi:10.1188/09.ONF.175-183
[10] Sealy, P.A. (2012) Autoethnography: Reflective journal-
ing and meditation to cope with life-threatening breast
cancer. Clinical Journal of Oncology Nursing, 16, 38-41.
doi:10.1188/12.CJON.38-41
[11] Shaha, M. and Bauer-Wu, S. (2009) Early adulthood
uprooted: Transitoriness in young women with breast
cancer. Cancer Nursing, 32, 246-255.
[12] Taylor, E.J. (2000) Transformation of tragedy among
women surviving breast cancer. Oncology Nursing Fo-
rum, 27, 781-788.
[13] Drageset, S., Lindstrøm, T.C., Giske, T. and Underlid, K.
(2011) Being in suspense: Women’s experiences await-
ing breast cancer surgery. Journal of Advanced Nursing,
67, 1941-1951. doi:10.1111/j.1365-2648.2011.05638.x
[14] Suh, E.E., Park, Y.H. and Kim, S. (2008) The patients’
experiences of the diagnosis and pre-treatment period of
breast cancer. Journal of Korean Academy of Funda-
mental Nursing, 15, 495-503.
[15] Simpson, P. (2005) Hong Kong families and breast can-
cer: Beliefs and adaptation strategies. Psycho-Oncology,
14, 671-683. doi:10.1002/pon.893
[16] Coyne, E. and Borbasi, S. (2009) Living the experience
of breast cancer treatment: The younger women’s per-
spective. Australian Journal of Advanced Nursing, 26,
6-13.
[17] Nizamli, F., Anoosheh, M. and Mohammadi, E. (2011)
Experiences of Syrian women with breast cancer regard-
ing chemotherapy: A qualitative study. Nursing & Health
Sciences, 13, 481-487.
doi:10.1111/j.1442-2018.2011.00644.x
[18] Rosedale, M. and Fu, M.R. (2010) Confronting the un-
expected: Temporal, situational, and attributive dimen-
sions of distressing symptom experience for breast can-
cer survivors. Oncology Nursing Forum, 37, E28-E33.
doi:10.1188/10.ONF.E28-E33
[19] Helms, R.L., O’Hea, E.L. and Corso, M. (2008) Body
image issues in women with breast cancer. Psychology,
Health & Medicine, 13, 313-325.
doi:10.1080/13548500701405509
[20] Frith, H., Harcourt, D. and Fussell, A. (2007) Anticipat-
ing an altered appearance: Women undergoing chemo-
therapy treatment for breast cancer. European Journal of
Oncology Nursing, 11, 385-391.
doi:10.1016/j.ejon.2007.03.002
[21] Klaeson, K., Sandell, K. and Berterö, C.M. (2011) To
feel like an outsider: Focus group discussions regarding
the influence on sexuality caused by breast cancer treat-
ment. European Journal of Cancer Care, 20, 728-737.
doi:10.1111/j.1365-2354.2011.01239.x
[22] Ussher, J.M., Perz, J. and Gilbert E. (2012) Changes to
sexual well-being and intimacy after breast cancer. Can-
cer Nursing, 35, 456-465.
doi:10.1097/NCC.0b013e3182395401
[23] Wilmoth, M.C. (2001) The aftermath of breast cancer:
An altered sexual self. Cancer Nursing, 24, 278-286.
doi:10.1097/00002820-200108000-00006
[24] Coward, D.D. and Kahn, D.L. (2004) Resolution of
spiritual disequilibrium by women newly diagnosed with
breast cancer. Oncology Nursing Forum, 31, E24-E31.
doi:10.1188/04.ONF.E24-E31
[25] Swinton, J., Bain, V., Ingram, S. and Heys, S.D. (2011)

E. Suh / Open Journal of Nursing 3 (2013) 404-413 412
Moving inwards, moving outwards, moving upwards:
The role of spirituality during the early stages of breast
cancer. European Journal of Cancer Care, 20, 640-652.
doi:10.1111/j.1365-2354.2011.01260.x
[26] Horgan, O., Holcombe, C. and Salmon, P. (2011) Ex-
periencing positive change after a diagnosis of breast
cancer: A grounded theory analysis. Psycho-Oncology,
20, 1116-1125. doi:10.1002/pon.1825
[27] Berterö, C. and Wilmoth, M.C. (2007) Breast cancer
diagnosis and its treatment affecting the self: A meta-
synthesis. Cancer Nursing, 30, 194-204.
doi:10.1097/01.NCC.0000270707.80037.4c
[28] Howard, A.F., Balneaves, L.G. and Bottorff, J.L. (2007)
Ethnocultural women’s experiences of breast cancer: A
qualitative meta-study. Cancer Nursing, 30, E27-E35.
doi:10.1097/01.NCC.0000281737.33232.3c
[29] Sheppard, L.A. and Ely S. (2008) Breast cancer and
sexuality. The Breast Journal, 14, 176-181.
doi:10.1111/j.1524-4741.2007.00550.x
[30] Degner, L.F., Hack, T., O’Neil, J. and Kristjanson, L.J.
(2003) A new approach to eliciting meaning in the con-
text of breast cancer. Cancer Nursing, 26, 169-178.
doi:10.1097/00002820-200306000-00001
[31] Triandis, H. (1995) Individualism and collectivism.
Westview Press, New York.
[32] Lee, E.E., Tripp-Reimer,T., Miller, A.M., Sadler, G.R.
and Lee, S. (2007) Korean American women’s beliefs
about breast and cervical cancer and associated symbolic
meanings. Oncology Nursing Forum, 34, 713-720.
doi:10.1188/07.ONF.713-720
[33] Obeidat, R.F., Lally, R.M. and Dickerson, S.S. (2012)
Arab American women’s lived experience with early-
stage breast cancer diagnosis and surgical treatment.
Cancer Nursing, 35, 302-311.
doi:10.1097/NCC.0b013e318231db09
[34] Leung, P.P.Y. and Chan, C.L.W. (2010) Utilizing East-
ern spirituality in clinical practice: A qualitative study of
Chinese women with breast cancer. Smith College Stud-
ies in Social Work, 80, 159-183.
doi:10.1080/00377317.2010.483673
[35] Banning, M., Hafeez, H., Faisal, S., Hassan, M. and
Zafar, A. (2009) The impact of culture and sociological
and psychological issues on Muslim patients with breast
cancer in Pakistan. Cancer Nursing, 32, 317-324.
doi:10.1097/NCC.0b013e31819b240f
[36] Banning, M., Hassan, M., Faisal, S. and Hafeez, H. (2010)
Cultural interrelationships and the lived experience of
Pakistani breast cancer patients. European Journal of
Oncology Nursing, 14, 304-309.
[37] Lim, J.W., Baik, O.M. and Ashing-Giwa, K.T. (2012)
Cultural health beliefs and health behaviors in Asian
American breast cancer survivors: A mixed-methods ap-
proach. Oncology Nursing Forum, 39, 388-397.
doi:10.1188/12.ONF.388-397
[38] Ormiston, G.L. and Schrift, A.D. (1990) The hermeneu-
tic tradition: From Ast to Ricoeur. State University of
New York Press, Albany.
[39] Geanellos, R. (1998) Hermeneutic philosophy. Part I:
implications of its use as methodology in interpretive
nursing research. Nursing Inquiry, 5, 154-163.
doi:10.1046/j.1440-1800.1998.530154.x
[40] Ricoeur, P. (1971) The model of the text: Meaningful
action considered as a text. Social Research, 38, 529-
562.
[41] Caelli, K. (2000) The changing face of phenomenologi-
cal research: Traditional and American phenomenology
in nursing. Qualitative Health Research, 10, 366-377.
doi:10.1177/104973200129118507
[42] Suh, E.E. (2008) The sociocultural context of breast can-
cer screening among Korean immigrant women. Cancer
Nursing, 31, E1-E10.
doi:10.1097/01.NCC.0000305742.56829.fc
[43] Suh, E.E. (2012) The effect of P6 acupressure and nurse-
provided counseling on chemotherapy-induced nausea
and vomiting in patients with breast cancer. Oncology
Nursing Forum, 39, E1-E9. doi:10.1188/12.ONF.E1-E9
[44] Walters, A.J. (1994) An interpretive study of the clinical
practice of critical care nurses. Contemporary Nurse, 3,
21-25. doi: 10.5172/conu.3.1.21
[45] Suh. E.E., Kagan, S.H. and Strumpf, N.E. (2009) Cul-
tural competence in qualitative interview methods with
Asian Americans. Journal of Transcultural Nursing, 20,
194-201. doi:10.1177/1043659608330059
[46] Koch, T. (1995) Interpretive approaches in nursing re-
search: The influence of Husserl and Heidegger. Journal
of Advanced Nursing, 21, 827-836.
doi:10.1046/j.1365-2648.1995.21050827.x
[47] Benner, P. (1985) Quality of life: A phenomenological
perspective on explanation, prediction, and understand-
ing in nursing science. Advances in Nursing Science, 8,
1-14.
[48] Boyatzis, R.E. (1998) Transforming qualitative informa-
tion: Thematic analysis and code development. Sage
publication, Thousand Oaks.
[49] Leonard, V.W. (1989) A Heideggerian phenomenologic
perspective on the concept of the person. Advances in
Nursing Science, 11, 40-55.
[50] Koch, T. (1994) Establishing rigour in qualitative re-
search: The decision trail. Journal of Advanced Nursing,
19, 976-986.doi:10.1111/j.1365-2648.1994.tb01177.x
[51] Cho, H.J. (1988) Women and men of Korea. Munhak and
Gisung, Seoul.
[52] Sim, Y., Jeong, J. and Yun, J. (2000) Mo-Seong-Ui
Dam-Non-GwaHyeon-Sil (Discourse and reality of mo-
therhood). Nanam, Seoul.
[53] Kim, E.H. (1998) The social reality of Korean American
women: Toward crashing with the Confucian ideology.
In: Song, Y.I. and Moon, A., Eds., Korean American
Women from Tradition to Modern Feminism, Praeger,
Westport, 23-33.
[54] Cho, H.J. (1998) Reflection on modernism and feminism:
Women and men of Korea II. TtoHanauiMunhwa, Seoul.
[55] Kramer, E.J., Ivey, S.L. and Ying, Y.W. (1999) Immi-
grant women’s health: Problems and solutions. Jossey-
Bass, San Francisco.

E. Suh / Open Journal of Nursing 3 (2013) 404-413 413
[56] Song, Y.I. and Moon, A. (1998) Korean American
women: From tradition to modern feminism. Praeger,
Westport.
[57] Geum, J. (2003) Hyeon-Dae-Han-Gug-Yu-Gyo-WaJeon-
Tong (Modern Korean Confucianism and tradition).
Seoul National University Press, Seoul.
[58] Im, H. (2002) Sa-Ju-Pal-Ja (Four pillars and fate). Samho
Media, Seoul.
[59] Duranti, A. (1997) Linguistic anthropology. Cambridge
University Press, New York.
doi: 10.1017/CBO9780511810190
[60] Sedikides, C. and Brewer, M.B. (2001) Individual self,
relational self, collective self. Psychology Press, Phila-
delphia.