Using qualitative methods to elicit recall of a critical time period

The period during and after puberty seems to be important for breast cancer initiation. Because experiences during that time are likely to be influenced by a woman's cultural background, we conducted a pilot study among Hispanic and Caucasian women to elicit their memories of early life events. These data were used to design culture-specific questionnaire modules for the retrospective assessment of peripubertal breast cancer risk factors, using specific strategies to trigger accurate recall. Study subjects were volunteer breast cancer survivors or relatives of survivors. In carrying out this work, we took methods from the social sciences and applied them to a research question in chronic disease epidemiology. We found both qualitative and quantitative differences in recall of peripubertal exposures and experiences between Hispanic and Caucasian subjects. Our preliminary data indicate that in contrast to Caucasian women, Hispanic women consider the church rather than school a touchstone for recalling past events. Under the domain "body development," Hispanic women are more likely to mention menstruation than Caucasian women but less likely to recall changes in body hair and breast development. Caucasian women cited team sports as an important physical activity during the peripubertal period, whereas Hispanic women listed more sedentary games and housework as the main activities. Results of our pilot study support the view that to enhance the validity of retrospective data on peripubertal breast cancer risk factors, it is important to take account of cultural differences. Our experience using qualitative methods to elicit data of this kind in the context of a larger epidemiologic research effort suggests that such innovative approaches are valuable.