Reducing the Incidence of Breast Cancer Fatality

Reducing the Incidence of Breast Cancer FatalityA Look at the Nurse’s Role in Reducing the Incidence of Breast Cancer FatalityAs many advances are made each day in the world of medicine, breast cancer still remains high on the list of deadly diseases. With over 40,000 deaths as a result of breast cancer in 2005 for the United States, there is an urgent need for nurses to actively decrease breast cancer fatality through educating their client’s about associated risk factors, modifications of risk factors, and methods of screening. Due to the absence of one full-proof cure, it is the nurse’s job to holistically treat their client to ensure the highest rate of prevention, and ultimately survival. A nurse has several opportunities to spread awareness about risk factors associated with breast cancer. Besides scheduled appointments in the office, she can talk with clients at clinics, and everyday people at health fairs. The purpose is to get as much awareness out about breast cancer to as many people possible.There are two categories of risk factors associated with breast cancer, modifiable and non-modifiable. The modifiable risk factors are those an individual has control over, and can change. The non-modifiable risk factors are uncontrollable, and cannot be changed. First, the main known risk factors of breast cancer are age and female gender, both of which are non-modifiable (Dell, 2005). For women, the estrogen levels in the body seem to be the most significant determination of breast cancer development. As Dell (2005) states in her article “Spread the Word About Breast Cancer”, a woman who has an early menarche, early ovulation, and/or late menopause has increased levels of estrogen in her body. The last major non-modifiable risk factor is the presence of two known gene mutations, BRCA1 and BRCA2. In an article on BRCA gene mutations by Wainberg and Husted, the authors state that a female with one of these gene mutations has a 60-85% chance of developing breast cancer by the age of 70 (Wainberg & Husted, 2004). Lastly, the modifiable risk factors fall in line with an overall unhealthy lifestyle. A study done by Malin and fellow authors found that women with a high caloric intake, high Body Mass Index, and a low exercise/activity level were at a largely increased risk of being diagnosed with breast cancer (Malin, Mathews, Shu, Cai, Dai, Jin, et. al., 2005).The next crucial step for a nurse is to assess their client’s awareness of ways to modify any controllable risk factors pertaining to them. According to Dell (2005), “although the optimal frequency, duration, and timing of physical activity haven’t been determined…researchers have seen an 18% decrease in risk with 1 ½ to 2 ½ hours of brisk walking weekly” (¶8). Patients should be encouraged to be as active as their lifestyle allows, and only perform the kinds of exercise their body can handle. Dell (2005) comments on a Nurse’s Health Study found women who gained more than 45 lbs after the age of 18, “had a 40% higher risk of breast cancer after menopause than women who gained less than 5 lbs” (¶9). According to Dell (2005), the association with fat and breast cancer is that adipose tissue produces estrogen, thus higher densities of adipose tissue means higher risk and severity of breast cancer. Patients should be encouraged to eat an assortment of foods based on the food pyramid, and a good resource to point patients towards is www.mypyramid.gov. Other unhealthy lifestyle habits should be addressed at this point such as smoking and alcohol consumption. Although there are no direct correlations between the use of cigarettes and breast cancer, the American Cancer Society has stated that, “consuming one or more alcoholic beverages a day increases the risk” (Dell, 2005, ¶12).The use of Breast Self-examinations (BSE) is way for women to become aware of the usual nature of their breast tissue through palpation, and could lead to an early detection of abnormal feeling tissue. The risk with this form of exam is the ability to feel something that is not actually cancer and become stressed out, and to miss the cancer all together because it is no large enough or the area was not palpated correctly. For those reasons, mammography using X-rays and computer-aided detection/diagnosis is the first line of defense for early prevention. Breast ultrasounds can also be used to “…distinguish cysts from solid masses and benign from malignant lesions” (Dell, 2005, ¶21). Other forms of screening such as full-field digital mammography, which is a high tech version of traditional mammography, and breast magnetic resonance imaging, a machine which can detect breast cancer in women with dense breast tissue, are very expensive and should only be used when needed (Dell, 2005).One other area of importance for a nurse is sensitivity to the various cultures and socioeconomic groups they will treat. In the melting pot of America, we have a wide blend of cultures, ethnicities, and socioeconomic classes. An assessment of Lucas County, Ohio by Rahman, Mohamed, and Digman (2003) amongst underinsured and uninsured women found that early detection programs are scarce. Also, Rahman and fellow authors (2003) found that the women’s cultural background and economic status played a large role in whether they were screened for breast cancer, and what they decided to do as a result of diagnosis. It is important to respect a person’s cultural beliefs associated with breast disease, and still make prevention services readily available to the population no regardless of their monetary worth.An estimated 211,240 women and 1,690 men diagnosed with breast cancer in 2005 (Dell, 2006). Dell (2006) states that the numbers of deaths related to breast cancer are declining “due to greater awareness, detection of more tumors early when they’re still small, and wider use of better treatments” (¶2). Due to the absence of a definitive cure, our strongest weapon to fight breast cancer is prevention through early detection and treatment. As stated in the Australian Nursing Journal (2006), nurses are health professionals in a “diverse nation” and it is our responsibility to be sensitive and knowledgeable when it comes to teaching other cultures about breast cancer and the lifestyle modifications needed to prevent it.Intervention 1: Properly educating clients about the risk factors associated with breast cancer.1. Disadvantage 1: Cultural differences in the way breast cancer and its associated risk factors are viewed.America has made leaps and bounds in education and prevention material for breast cancer, but unfortunately this does not mean all cultures are benefiting. One major problem posed is the failure of the medical system to effectively educate the populations of people who reside in the many cultural enclaves in America. According to researchers Rahman, Mohamed, and Dignan (2003), a cultural enclave is a group of people from the same culture who mostly socialize with their culture only. This poses not only a possible communication barrier, but an interpretation barrier as well. The marvelous modifications the American culture has recommended (i.e. exercise, fruits/vegetables, chemo prevention, and antiestrogen) may seem strange and even harmful to other cultures who are not able to understand the mountains of technically worded research on breast cancer risk factors and prevention. Rahman, Mohamed, and Dignan explore an example of the effects of cultural enclaves on breast cancer education stating, “an aggregate data from 1993-1997 demonstrates that the death rate of breast cancer among African American women is 11% higher than among white women” (Rahman, Mohamed, and Dignan, 2003). The mortality rate amongst the woman in America should be decreasing proportionately, not one cultural group over another. This tells healthcare professionals there is still more research and attention needed regarding factors such as the social, cultural and economical issues surrounding breast cancer and its associated risk factors (Rahman, Mohamed, and Dignan, 2003).Disadvantage 2: Knowledge deficits in regards to medical vs. lifestyle risk factors.As devastating breast cancer is, there is some hope for at risk women and men. Several studies have been conducted searching out the best breast cancer prevention methods and in the department of modifiable risk factors the common knowledge is healthy lifestyle behaviors such as exercise, good nutrition, smoking cessation, and stress reduction. According to Madlensky, Vierkant, Vachon, Pankratz, Cerhari, and Vadaparampi (2005) there are also medical measures that high-risk people can take (those with significant familial history or carriers of the BRCA1 or BRCA 2 genes), such as prophylactic removal of breasts, chemoprevention with antiestrogenic agents. In a society with advanced medical solutions to problems, it appears more attention is being paid to medical modification of risk factors than lifestyle modifications. As Madlensky, Vierkant, Vachon, Pankratz, Cerhari, and Vadaparampil state in their research of low, moderate, and high-risk groups of women, “women with strong familial histories are more likely to undertake medical but not lifestyle preventative behaviors” (Madlensky, Vierkant, Vachon, Pankratz, Cerhari, and Vadaparampil, 2005). As not only a nurse, but an American, this is concerning. Are medical prevention methods the only being encouraged by healthcare professionals, or do Americans see radical medical treatments as an easier method of change over lifestyle changes? As the researchers of this study state, there is still a need for further research on these findings and what this means for not only the prevention methods recommended by healthcare professionals, but the prevention measures taken by patients (Madlensky, Vierkant, Vachon, Pankratz, Cerhari, and Vadaparampil, 2005).Intervention 2: Educating clients about the screening options available for breast cancer detection.Disadvantage 1: Inadequate insurance available to cover screening costs.Health insurance is a touchy issue that many people dread dealing with, but when it comes time to have a procedure done, or even a routine visit to the doctor paid for, it becomes clear how vital adequate health insurance is. So, what does this mean for breast cancer screening? Well, there is always the free Self-breast exam, which can be done in the privacy of your own home. You need nothing more than some water or lotion and your hands, right? Wrong. How will a patient know if they are feeling something abnormal, how do they know the most efficient method for palpating the breast tissue? As Dell states in her article “Spread the Word About Breast Cancer”, “if a woman chooses to perform a Breast Self Exam, she should learn the correct procedure from a knowledgeable healthcare professional who can also evaluate her technique” (Dell, 2006). If someone does not have health insurance, the chances of him or her going to a health professional for Self Breast Exam 101 are very slim. Other methods available are mammography, ultrasound, MRI, ductal lavage, or fine needle aspiration (Dell, 2006). All of these require a doctor’s visit, use of expensive equipment, and possible medication. In the end, no health insurance or inadequate health insurance will reduce a person’s chances of adequate screening options.Disadvantage 2: The effects of socioeconomic status on the way client’s view/understanding of screening procedures available.A common screening method used throughout the United States in the early detection of breast cancer is Mammography. A woman’s breast is put in between two flat portions of the machine and the tissue is assessed on a computer screen. Although this procedure is painless (unless your breasts are tender for various reasons making the procedure uncomfortable), it can be scary to a person who has never been around technical machinery or has not been properly educated about the procedure. A study conducted amongst low-income women in Ohio by Rahman, Mohamed, and Dignan (2003) found a population of women who identified mammography as a painful procedure, which proved to them the existence of a lack of proper education and misconception about breast cancer and mammography. Also, Rahman, Mohamed, and Dignan (2003) discovered only 55.1% had an actual breast exam inside a clinic prior to the study. Thus, if there are populations of women who are not adequately educated about screening methods, early prevention gets lost with an entire socioeconomic class.BibliographyDell, D. D. (2006). Spread the word about breast cancer. Holistic Nursing Practices, 20 (2), 55-62. Retrieved October 28, 2006 from Expanded Academic ASAP database.Fitzroy, N. (2006). Cultural awareness in breast cancer fight. Australian Nursing Journal, 13 (8), 33. Retrieved April 10, 2007 from Proquest.Malin, A., Matthews, C. E., Shu, X., Cai, H., Dai, Q., & Jin, F. (2005). Energy balance and breast cancer risk. Cancer Epidemiology, Biomarkers & Prevention, 14, 1496-1501. Retrieved on October 28, 2006 from Expanded Academic ASAP.Rahman, M. M., Mohamed, I., Digman, M. B. (2003). Assessment of perceptions related to breast cancer prevention and behavioral practices in medically undeserved women. Journal of Multicultural Nursing & Health, 9 (3), 30. Retrieved on April 10, 2007 from Proquest.Wainberg, S., Husted, J. (2004). Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Cancer Epidemiology, Biomarkers, and Prevention, 13, 1989-1995.