Research Topics: Breast Cancer Management

BREAST CANCER MANAGEMENT

Breast cancer is the second most common cancer in the world and the most common cancer in women, accounting for 18% of all female malignancies (Bickley, 2003). Breast cancer appears to have reached epidemic levels. Talk to any group of people anywhere in the UK and they all seem to have some experience of it–someone in their family, a friend, a neighbor or work colleague. And it is not just a vague impression that this is the case, there are hard statistics to back it up. Every year around 39 000 women and between 200 and 300 men are diagnosed with breast cancer in the UK. Government figures show that the number of people who develop breast cancer every year has increased by 70 per cent since 1971, and by 15 per cent in the ten years to 2000. It is by far the most common form of cancer in women and the most common cause of cancer death in women (Ogden, 2004).   SOCIAL LIFE Although one in eight women will eventually develop breast cancer, it is important to note that this is a cumulative lifetime risk that increases with age. More than three fourths of breast cancer cases occur in women 50 years or older; more than half in women older than the age 65. For women between the ages of 35 and 55 without major risk factors, the chance of developing breast cancer is approximately 2.5% (Bickley, 2003). Breast cancer risk factors include family history, menstrual history, pregnancy and breast conditions and diseases. Breast cancer appears long after the organ finishes its development. Age is associated with the location of the tumors. The area of the breast where the cancer originated was more central in the older patient population studied (Janssens, 1999). Researchers believe the increasing mortality rates in this group reflect changes in various risk factors, such as delayed childbearing, that occurred early in the century (Newman, 1997).             Asian women have traditionally had low breast cancer rates. But at present, invasive breast cancer cases have grown significantly among Japanese and Chinese women, and especially among South Asians and Koreans. Researchers suspect that Asians’ breast cancer rates have risen as immigrant women have adopted elements of a Western lifestyle, especially having fewer children and delaying having children until later in life (Ogden, 2004).   PSYCHOLOGY The presence of cancer in a family produces not only physical but also mental and social problems, which are impossible for the family to cope with alone. There is a demand on the part of the nurse for sympathetic understanding and support in building and maintaining morale of the patient and his or her family.             Friends and relatives can be a major source of support, but face their own difficulties. They have to provide emotional support, physical care and help in making decisions about treatment. Many of the observations about the impact of cancer are as true for them as for the patient. Their response to the illness depends on things such as their relationship to the patient, the stage of the disease and their own personalities (Ogden, 2004).   PAIN MANAGEMENT Cancer of the breast is generally not painful, though a vague discomfort may sometimes be present. Many, if not most, ailments of the body cause pain and this includes breast cancer. Cancer pain syndromes can result from the progression of the disease or from efforts to cure or control the disease (Kozier & Erb, 2004).             When talking of cancer pain management, what usually comes to mind are morphine, codeine, music therapy, prayer, and even radiation therapy. At an ever-increasing rate, cancer patients are meeting their pain management needs by using these and other noninvasive procedures. Some of these therapies have very sound science behind them while others rely on the patient’s belief system to offer noticeable effects. However, all of these pain remedies have been shown to help some people dispel cancer pain and achieve a more desirable quality of life (Platner, 2002).   DIAGNOSIS Tremendous emotional upheaval is common after being diagnosed with cancer. Many cancer patients experience feelings disbelief, shock, fear, and anger. They may also feel overwhelmed by the girth of information about their cancer and their treatment options, by the decisions they are required to make, and by the sudden changes in their lives. It takes time to accept and understand the diagnosis. As overwhelming and painful as a diagnosis of cancer is initially, many cancer survivors say that their struggle against cancer gave them an opportunity to re-evaluate their lives and to find strengths and abilities that they hadn’t known they possessed (Ogden, 2004).   TREATMENT Surgery, radiotherapy, and chemotherapeutic agents are the major modalities used to treat patients with cancer, though various biologic therapies are beginning to have a significant impact. The basic problem is to make available drugs (natural products or synthetics) that kill cancer cells effectively but are not excessively toxic to normal cells. The table below lists seven major classes of compounds that have been widely used in the treatment of cancer: Class of Compound Example Site of Action Treatment Use Alkylating agents Melphalan Alkalytes DNA and other molecules Myeloma Antimetabolites <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify"> Purine antagonists</li> </ul>   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify"> Pyrimidine antagonists</li> </ul>   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify"> Folate antagonists</li> </ul>   Mercaptopurine     Fluorouracil     Methotrexate   Converted to a “fraudulent” nucleotide and inhibits purine synthesis Converted to a “fraudulent” nucleotide and inhibits thymidylate synthetase Inhibits dihydrofolate reductase   Acute myelocytic leukemia   Colorectal cancer     Choriocarcinoma Antitumor antibiotics Doxorubicin Intercalates in DNA and stabilizes the DNA-topoisomerase II complex Hodgkin’s disease Other agents Cisplatin   Hydroxyurea Causes strand breakage in DNA Inhibits ribonucleotide reductase Carcinoma of the lung Chronic myelocytic leukemia Plant compounds Vinblastine Binds tubulin and inhibits microtubule formation Kaposi’s sarcoma Sex hormones Estrogens Block effects of androgens in prostatic tumors Cancer of the prostate Corticosteroids Prednisone Inhibits proliferation of lymphocytes Myeloma Source: Harper’s Biochemistry, page 806             Insofar as unrestrained cell division is a feature that typifies many malignant tumors, many of these agents are used because they inhibit DNA synthesis. For this reason, they are also likely to damage normal tissues whose cells divide continuously – e.g. bone marrow (Murray, et al, 2000).             Current cancer treatments – “cut, burn, poison” – are recognized as crude and painful. Promising new methods focus on delivering anticancer drugs precisely to the cancer (via monoclonal antibodies that respond to one type of protein on a cancer cell) and on increasing the immune system’s ability to fend off cancer (Marieb 2004).   PROGNOSIS The prognosis for women with a type of breast cancer is very good. When treated early (stages 0 or I), 10-year survival rates are reported to be more than 96%. Recurrence of the disease tends to be greater in women whose tumors are of high nuclear grade and show evidence of comedo architectural pattern, making it particularly imperative that women diagnosed with ductal breast cancer in this stage receive close clinical follow-up with routine mammography (Watson, 2001).   PREVENTION Cancer prevention is defined as the reduction of cancer mortality by reducing the incidence of cancer. This can be accomplished by avoiding a carcinogen or altering its metabolism; pursuing lifestyle or dietary practices that modify cancer-causing factors or genetic predispositions; and/or medical intervention to successfully treat precancerous lesions. Preventive health care is more dynamic than health maintenance because it requires the individual to enhance his or her health status actively, rather than maintain the status quo. The three levels of prevention are primary, secondary, and tertiary (Black, et al, 2001). Primary prevention consists of health promotion activities that are focused on protecting against the occurrence of cancer. It includes teaching patients about healthy lifestyle behaviors. The most consistent finding, over decades of research, is the strong association between cigarette smoking and cancers of many kinds. Not smoking, or giving up, is the single most effective strategy to prevent cancer (Marieb, 2004). Other examples of modifiable cancer risk factors that are open to primary prevention include alcohol consumption, physical inactivity, and being overweight. Based on current evidence, it is now thought that avoiding excessive alcohol consumption, being physically active, and maintaining recommended body weight may all contribute to reductions in risk of certain cancers; however, compared with tobacco exposure, the strength of the effect is modest or small, and therefore the strength of evidence is often weaker (Robbins, 1998). Other lifestyle and environmental factors known to affect cancer risk include certain sexual and reproductive practices, the use of exogenous estrogens, exposure to ionizing radiation and ultraviolet radiation, certain occupational and chemical exposures, and infectious agents (Ogden, 2004). Secondary prevention refers to health behaviors that promote early detection, early treatment, and limited disability. For example, genetic testing for high-risk individuals, with enhanced surveillance or prophylactic surgery for those who test positive, is already available for certain types of cancer, including breast cancers. Cervical cytology testing (using the Pap test) leads to the identification and excision of precancerous lesions. Over time, such testing has been followed by a dramatic reduction of cervical cancer incidence and mortality (Black, et al, 2001). Tertiary prevention is directed toward rehabilitation after a disease or condition already exists to minimize disability and help the person to live productively with limitations. Tertiary prevention is used when disability is permanent and irreversible. This type of prevention is aimed at minimizing disease progression effects and disability.   EDUCATION In the absence of screening programs as in the case of poorer countries, primary prevention should take place through health education. By informing women on the early warning signs of reproductive cancers and encouraging them to seek medical examinations and treatment, women would not have to die needlessly. The NHS Cancer Plan, published in September 2000, sets out the first ever comprehensive strategy to tackle the disease. It is the first time any government has drawn up a major program of action linking prevention, diagnosis, treatment, care and research. The NHS Cancer Plan Progress Report released in March 2005 substantial progress has been made in meeting the Plan’s targets. The thirty-four cancer networks which have been established have achieved important improvements in delivering cancer services across England. These are mostly for educating people about breast cancer how they can possibly avoid it. In addition to the NHS Cancer Plan, the Department has launched other initiatives to improve cancer services, including a tobacco advertising ban and a strengthening of the partnership between the NHS and the voluntary sector (National Audit Office, 2005).   ASSESSMENT The assessment and evaluation of every woman presenting for a breast cancer screening program must begin with a complete patient history. Personal and family history is important in assessing each patient’s “risk profile.” Patients should be questioned about personal and family medical history in addition to undergoing a physical exam. Evaluating each patient’s individual risk factors is important, because breast cancer isn’t triggered by a specific virus or by a cause-and-effect association like smoking and lung cancer. Instead, breast cancer seems to develop when a combination of many different events creates circumstances that cause or encourage cancer tumors to grow (Newman, 1997). REFERENCES   Breast Cancer Campaign, Retrieved from: www.breastcancercampaign.org Bickley, L. and Szilagyi, P. (2003). Bates’ Guide to Physical Examination and History Taking 8th Edition. Lippincott Williams and Wilkins. Black, J.M., Hawks, J.H. & Keene, A.M. (2001), Medical-surgical nursing: Clinical Management for Positive Outcomes 6th edition. W.B. Saunders. Ganong, W. (2001). Review of Medical Physiology 20th Edition. McGraw-Hill. Guyton, A. and Hall, J. (2000). Textbook of Medical Physiology 10th Edition. Harcourt Asia Pte Ltd. Janssens, J.P. (1999). Risk Implications for Research and Dietary Guidelines for Children. Nutrition Today. Kozier, B. and Erb, G. (2004). Fundamentals of Nursing: Concepts, Process, and Practice 7th Edition. Pearson Education Inc. Marieb, E. (2004). Essentials of Human Anatomy and Physiology 7th Edition. Pearson Education Inc. Murray, R.K., Granner, D.K., Mayes, P.A. & Rodwell, V.W. (2000). Harper’s Biochemistry 25th Edition. McGraw-Hill. Newman, J. (1997). Early Detection Techniques in Breast Cancer Management. Radiologic Technology. Ogden, J. (2004). Understanding Breast Cancer, Wiley. Platner, T. (2002). Cancer Pain Management Alternatives, Radiologic Technology. Potter, P. and Perry, A. (2004). Fundamentals of Nursing. Mosby. Robbins, S.L. (1998). Pathologic Basis of Disease, W.B.Saunders Company. The NHS Cancer Plan: A Progress Report.  (2005). Retrieved from: http://www.nao.org.uk/pn/04-05/0405343.htm Watson, L. (2001). Breast Cancer: Diagnosis, Treatment and Prognosis, Radiologic Technology.   Credit:ivythesis.typepad.com

BREAST CANCER MANAGEMENT

Breast cancer is the second most common cancer in the world and the most common cancer in women, accounting for 18% of all fem...

Is Breast self examination an effective Strategy in the early detection of breast cancer ?

Description of Essay Topic             It has been reported that breast cancer is not just one disease, but several, and can be found in a precancerous state or which might be developed into invasive cancer if left untreated, and as a cancer which has not yet spread, or after it has spread to other organs. Breast lumps are common in women in all ages, but in younger women, they are usually non-malignant. Men can also get breast cancer, although in rare occasions (2004). A number of causes of breast cancer can be identified including, age risk factors, genetics, race, hormonal activity, lifestyle and dietary causes, such as increase in intake of fatty foods and obesity, alcohol intake, and environmental causes. As such, 13% of women have a lifetime risk of developing invasive breast cancer, while approximately 2,030 men in the United States will develop invasive breast cancer (2007).             Due to increasing risks of both genders to acquire breast cancer, it is emphasized that one’s most effective strategy against breast cancer is early detection. With early detection, some female cancers, such as breast cancer can be cured or put into remission, the temporary but sometimes long-term disappearance of symptoms. Chances of surviving breast cancer are greatly increased by early detection because deaths from breast cancer result not from the localized tumor in the breast but from metastasis or the spread of cancer beyond its primary site to the blood and lymph systems (2000). In this regard, annual mammograms and breast examinations by a medical professional, monthly breast self-examinations are the most effective tools in early detection (2000). As such, it can be deduced that with the help of breast self-examination, early prevention, detection and treatment can be attained. Outline of Essay Topic <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Introduction</li> </ul> -          Brief information in breast cancer -          Statistics on breast cancer -          Aim and purpose of the paper   ·         Description of Breast Cancer -          Types of breast cancer -          Different causes of breast cancer   ·         Diagnosis of Breast Cancer -          Symptoms of breast cancer ·         Issues in the Increase of Incidences and Deaths due to Breast Cancer -          Socioeconomic factors, race, ethnicity, culture -          Costs of treatment -          Lack of understanding and knowledge of the disease -          Lack of medical facilities for screening, detection, prevention and treatment -          Debate on efficacy of treatment methods: breast self-exam vs. mammography   ·         Strategies for Detection of Breast Cancer -          Steps of breast self-examination or BSE -          Other techniques for breast examination: Mammography, clinical breast exam -          Implications for early detection of breast cancer   ·         Strategies for Prevention of Breast Cancer -          Education -          Information -          Symposia, open forums, conventions   ·         Strategies for Treatment of Breast Cancer -          Role of medical and healthcare practitioners, and social workers -          Role of family and peers -          Methods for Treatment: Surgery, chemotherapy, lifestyle modification   ·         Conclusion Brief Descriptions of 10 Articles   1) (2005). Advancing Social Workers’ Responsiveness to Health Disparities: The Case of Breast Cancer Screening. Health and Social Work Type of Article: Research study Article Source: Questia Media America Article Description: The purpose of the study is to provide information for public health workers to customize breast cancer health promotion programs that are age-and culturally responsive in order to eliminate disparities in breast cancer screening and mortality. It intends to indicate that mammography is a precursor of a woman’s actual screening utilization behavior that encompasses predisposing, reinforcing and enabling factors to pursue breast health care. In addition, the study indicates that levels of income, health insurance, sources of information and education, age, religion, and race are the factors believed by the authors of the study to influence breast cancer detection and treatment. The role of the social workers and medical practitioners are crucial in this sense, as they are the ones responsible for the dissipation of information regarding the disease, thus, must be able to have effective and appropriate programs that would not only focus on the disease of clients, but on their personal preference, religion, socioeconomic status, and education as well.   2)  (2003). Breast Cancer Screening. The Medical Journal of Australia Type of Article: Review article Article Source: Australian Health Review Article Description: It has been indicated in the article that breast cancer among women in Australia is considered the most common cause of cancer death. Screening tests, such as Mammographic screening and breast self-examination are the best strategies recommended for the early detection of breast cancers. However, such screening tests are being challenged regarding its efficacy of disease detection, along with the role of primary care providers. As such, along with screening tests, public health initiatives such as “breast awareness” for women of all ages must be implemented at all levels.   3)  (2006). Knowledge of Breast Cancer and Its Early Detection Measures among Rural Women in Akinyele Local Government Area, Ibadan, Nigeria. BMC Cancer Type of Article: Research article Article Source: BioMed Central Article Description: Breast cancer is the commonest form of cancer in Nigeria, wherein national breast cancer screening programs are not available and access to knowledge and detection measures are inadequate. This study aimed at evaluating the level of knowledge and early detection measures of breast cancer among the rural women of Nigeria. Results of the study suggest that significant lack of knowledge of the disease itself and its detection, prevention, and treatment were observed among the rural women of Nigeria. The lack of active national breast screening programs in Nigeria can also indicate the increase in the incidences of breast cancer in the country. However, the leading source of information regarding breast cancer was healthcare workers, along with elders, neighbors and friends.   4)  (2006). Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care. The Breast Journal Type of Article: Review article Article Source: PubMed Central Article Description: The article aims to develop evidence-based, economically feasible, and culturally appropriate guidelines to be used in nations with limited healthcare resources, in order to improve breast cancer early detection and access to care. The target population of such guidelines is the women in limited-resource countries, the women with signs and symptoms of breast disease, and the women with breast cancer in limited-resource countries. Different interventions for early detection of breast cancer in low-income countries and provision of healthcare were considered by the article, including public education and breast cancer awareness, clinical breast examination and breast self-examination training, and imaging-based screening programs.   5) (2006). Knowledge, Attitudes and Perceptions about Breast Cancer and Breast Cancer Screening among Hispanic Women Residing in South Central Pennsylvania. Journal of Community Health Type of Article: Research article Article Source: Questia Media America Article Description: The article aims to assess cultural factors that significantly influence breast cancer screening behaviors of Hispanic women residing in the area and to determine strategies that health professionals can use to increase these women’s responses to breast cancer campaigns. Results of the study indicate that cultural factors, such as the family and cultural pride significantly influence the prevention of the disease. In addition, the study indicates that fear of death associated with the disease was most evident with the responses of the participants in general, thus, the support of one’s family is crucial in the process. As such, the study concluded that health professionals must be able to consider cultural factors in accordance to the views, perceptions, opinions, detection, and prevention of breast cancer among Hispanic women in the area specified.   6)  (2006). An Innovative Community-Based Intervention for African-American Women with Breast Cancer: The Witness Project [R]. Health and Social Work Type of Article: Review article Article Source: Questian Media America Article Description: The Witness Project (WP) serves as a response to the high mortality rate of African American women with breast cancer living in Arkansas, and was designed to reach out to low-income and rural women in a way that is culturally relevant to increase awareness and participation in breast cancer screening. The community-based cancer screening program is grounded in the deep spiritual roots of the participants and uses affirmation to increase their belief in their ability to seek action to save their lives. The program involves self-help, spirituality, and peer education, which are programs that could help provide support for African American women with breast cancer outside of the more traditional hospital-run support groups.   7) (2005). Pain and Discomfort Associated with Mammography among Urban Low-Income African-American Women. Journal of Community Health Type of Article: Research study Article Source: Article Description: Mammography screening involves tight compression, which presents discomfort or pain for women. Such discomfort can hinder women from further screening, thus, leading to delayed detection and treatment that could entirely lead to death. Factors for breast cancer screening in low-income women in the urban African-American population were considered, including sociodemographic factors, psychosocial factors, health and healthcare related factors, and breast-cancer related factors. The article assumed that the pain and discomfort associated with mammography screening influences a woman’s intention to undergo further cancer screening. Based on the findings, effective interpersonal communication and techniques for controlling the rate and degree of compression may address the pain associated with the process.   8) (2005). Augmented, Pulsating Tactile Feedback Facilitates Simulator Training of Clinical Breast Examinations. Human Factors Type of Article: Research study Article Source: Questia Media America Article Description: This article points out that certain inconsistencies can be derived at using the Clinical Breast Examination process due to disparities and differences in the skills of detecting breast lumps. As such, three breast models were utilized in the experiment for training and effective detection of breast lumps in the clinical setting. The study concluded that the use of the dynamic breast model yielded more desirable results, as greater skill improvement has been observed than do conventional clinical breast examination training models. Such information can be used for future applications and study on Clinical Breast Examination techniques.      9) (2006). Breast Self-Examination. Journal of Obstetricians and Gynaecologists of Canada Type of Article: Review article Article Source: The Society of Obstetricians and Gynaecologists of Canada Medical Online Article Description: This article emphasizes that programs that encourage breast self-examination would be unlikely to reduce mortality from breast cancer, and may only increase chances of having a benign breast biopsy. Some studies indicated in the article stressed that breast self-examination programs do not guarantee decrease in breast cancer mortality. Although such methods can be helpful it would take a lot of time, effort, and money in teaching women how to provide themselves with self-help. Seeking professional medical help when changes are felt is the best way to address symptoms of breast cancer.   10) (2006). The Challenge of Early Breast Cancer Detection among Immigrant and Minority Women in Multicultural Societies. The Breast Journal Type of Article: Research article Article Source: The Fred Hutchinson Cancer Research Center Article Description: The article presented the different barriers experienced by women from traditional cultures in preventive health and breast care. The sociodemography, culture, and multiple roles of women in low-income societies have somehow hindered the room for health preventive concerns, such as breast self-examination, which does not indicate the ignorance of individuals, but indicates the reflection of social and economic disadvantage augmented by negative emotional reactions to cancer. Barriers to early detection of breast cancer include structural barriers such as lack of access to preventive services, lack of transportation, and lack of time due to child care; organizational barriers such as the influence of religion, language, and gender; psychological barriers including fear, fatalism, and denial; and sociocultural barriers.         Appendices: Copy of Abstracts of Each Article   Article 1:(2005). Advancing Social Workers’ Responsiveness to Health Disparities: The Case of Breast Cancer Screening. Health and Social Work Abstract: As members of health and public health teams, social workers can provide leadership in addressing disparities in breast cancer screening and mortality rates. With their professional training in the ecological framework and their concern for equitable, accessible, and culturally respectful and responsive health care, social workers can help communities understand why breast cancer is a public health concern, why the incidence and mortality trends of this disease have fluctuated during the past 25 years, and why their impact has not been shared uniformly by all women. The incidence of breast cancer for all women increases with age and is highest among white women; however, mortality rates are highest among older African American women (2001). Although the National Cancer Institute and other medical organizations agree that women age 50 and older should undergo routine mammography every one to two years (1995;  1997), estimates of breast cancer screening utilization show that participation in mammography screening is typically lowest among groups of women with whom social workers often work; that is, older, low-income, rural, and racially and culturally diverse women ( 1998;1997;1999). Studies have investigated a variety of factors predictive of women’s decisions about breast cancer screening, including socioeconomic factors, and to a lesser extent, psychological and cultural variables. Findings generally suggest that older and ethnic minority women, women with inadequate insurance coverage and no regular source of medical care, women who are less educated, women who live in medically underserved areas, and women who report strong religious values, attitudes, and beliefs about breast cancer, are less likely to obtain breast cancer screening and are at greater risk of dying from breast cancer than are white women who are younger, educated, have health insurance and access to medical care, and who do not express strong beliefs about breast cancer (1999;  1998;  2000; 1994). Furthermore, these and other studies corroborate the need for health promotion to be tailored to pertinent socioeconomic, psychological, interpersonal, and cultural factors to encourage women’s optimal utilization of mammography and adherence to screening mammography guidelines (1998; 1997; 1999; 1998). Hence, the purpose of this study is to provide the grist for public health social workers to customize breast cancer health promotion programs that are age- and culturally responsive and that will help eliminate disparities in breast cancer screening and mortality.     Article 2: (2003). Breast Cancer Screening. The Medical Journal of Australia Abstract: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify"> Achieving and maintaining a high rate of attendance for screening and two-yearly re-screening is essential for the success of the Breast Screen Australia program. A low participation rate will result in fewer breast cancer-related deaths being prevented. </li> <li class="MsoNormal" style="text-align: justify"> Results of two recent large randomized trials do not show that a systematic approach to breast self-examination finds breast cancers early or impacts on survival. </li> <li class="MsoNormal" style="text-align: justify"> “Breast awareness” and the prompt reporting of breast symptoms are important early detection messages for women of all ages. </li> <li class="MsoNormal" style="text-align: justify"> General practitioners have a key role in the promotion and provision of information about effective public-health initiatives for the early detection of breast cancer. </li> </ul>     Article 3:  (2006). Knowledge of Breast Cancer and Its Early Detection Measures among Rural Women in Akinyele Local Government Area, Ibadan, Nigeria. BMC Cance Abstract: Background Breast cancer is the commonest cancer among women in Nigeria and globally. In Nigeria, late presentations of breast cancer cases have also been consistent for three decades. In an environment where there is no established national screening program for breast cancer, it is pertinent to assess the knowledge of breast cancer and its early detection measures. The objective of this study therefore, was to assess rural women’s level of knowledge of breast cancer and its early detection measures. Methods The knowledge of various aspects of breast cancer; etiology, early warning signs, treatment modes and early detection measures; was assessed among women in two randomly selected health districts in Akinyele Local Government in Ibadan. The assessment was performed with the use of a self-structured validated questionnaire administered by trained interviewers to 420 women randomly selected from the two health districts. The various aspects of facts about breast cancer were scored and added together to determine respondents’ level of knowledge Results The mean score of knowledge of breast cancer was 55.4 SD 5.4 (range of scores obtainable was 26–78), while the mean score for knowledge of early detection of breast cancer was 24.8 SD 2.3 (range of scores obtainable was 12–36). The leading source of information about breast cancer was “elders, neighbors and friends” and 63(15.4%) acknowledged this source, while only 18 (4.4%) respondents acknowledged health workers as source. Only 54 (13.3%) claimed to have heard about breast self- examination (BSE) however, and the leading source of information about BSE were health workers. Nine (2.2%) of respondents claimed this source. Conclusion This study revealed that respondents lacked knowledge of vital issues about breast cancer and early detection measures. It also revealed that health workers were not forthcoming with information to the public thereby constituting a challenge to community health nurses and other health workers, to provide vital information to the public.   Article 4:  (2006). Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care. The Breast Journal Abstract: GUIDELINE OBJECTIVE(S) To develop evidence-based, economically feasible, and culturally appropriate guidelines that can be used in nations with limited health care resources to improve breast cancer early detection and access to care TARGET POPULATION <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="text-align: justify"> Asymptomatic women in limited-resource countries </li> <li class="MsoNormal" style="text-align: justify"> Women in limited-resource countries with signs and symptoms of breast disease </li> <li class="MsoNormal" style="text-align: justify"> Women in limited-resource countries with breast cancer </li> </ul> INTERVENTIONS AND PRACTICES CONSIDERED <li class="MsoNormal" style="text-align: justify"> Public education to increase breast cancer awareness, especially awareness about breast cancer survivability </li> <li class="MsoNormal" style="text-align: justify"> Tailored approaches to increase breast cancer awareness that are targeted to specific audiences and that take into account culture, religion, and other factors </li> <li class="MsoNormal" style="text-align: justify"> Clinical breast examination (CBE) training for detecting symptomatic (palpable) breast cancer </li> <li class="MsoNormal" style="text-align: justify"> Opportunistic CBE </li> <li class="MsoNormal" style="text-align: justify"> Breast self examination training </li> <li class="MsoNormal" style="text-align: justify"> Mammography and other imaging-based screening programs for detecting asymptomatic (non-palpable) breast cancer) </li> MAJOR OUTCOMES CONSIDERED <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="text-align: justify"> Tumor size at diagnosis </li> <li class="MsoNormal" style="text-align: justify"> Tumor stage at diagnosis </li> <li class="MsoNormal" style="text-align: justify"> Rates of advanced disease </li> <li class="MsoNormal" style="text-align: justify"> Breast cancer morbidity and mortality rates </li> <li class="MsoNormal" style="text-align: justify"> Breast cancer survival rates </li> </ul>   Article 5:(2006). Knowledge, Attitudes and Perceptions about Breast Cancer and Breast Cancer Screening among Hispanic Women Residing in South Central Pennsylvania. Journal of Community Health Abstract: Breast cancer is a public health issue of great proportions. An estimated 215,990 new breast cancer cases were projected to occur in the United States in 2004. (1) Although, the incidence rates of breast cancer have increased since 1980, in the last few years the incidence rates have only increased among women 50 years and older. The American Cancer Society (ACS) also estimated that 40,110 U.S. women would die from breast cancer in 2004, accounting for about 14.7 percent of cancer deaths among women. Still, mortality rates have declined since 1990 due to earlier detection and improved treatment. (1) In the US from 1996-2000, the annual age-adjusted incidence rates for breast cancer were 140.8 per 100,000 among White women and 89.9 per 100,000 among Hispanic women. (1) During the same period, the annual age-adjusted mortality rate for breast cancer deaths was 27.2 per 100,000 among White women compared to 17.9 per 100,000 among Hispanic women. Despite the fact that Hispanic women have lower incidence rates for breast cancer and breast cancer deaths than Non-Hispanic women, breast cancer is the number one cancer diagnosed among Hispanic women. (2) In addition, breast cancer is frequently diagnosed at a later stage among Hispanic women than in Non-Hispanic women. (2,4) Breast cancer deaths can be reduced significantly if the tumor is discovered at an early stage. In order to detect breast cancer at an early stage, the ACS (1) recommends guidelines for annual mammogram, annual clinical breast examination, and breast self-examination. In the year 2000, while 57 percent of White women, forty and older, reported having had a mammography within the last year, only 48 percent of Hispanic women reported having had a mammography during the same period. Similarly, 72 and 63 percent of White and Hispanic women, respectively, reported that they had a mammography within the past two years. (1) Data collected by the National Center for Health Statistics (5) showed that 79 percent of women age 45 to 64 have had a clinical breast exam within the last two years. Among Hispanic women in the same age bracket, the percentage was sixty-three. Thus, health professionals (i.e., health care providers, health educators) must effectively promote the recommendations regarding annual mammogram, annual clinical breast examination, and breast self-examination among Hispanic women. Several studies have shown a significant relationship between breast cancer screening and health insurance, access to health care, and sociodemographics among Hispanic women with low rate of breast cancer screening. (6,8) Other studies have shown that awareness and knowledge about breast cancer, acculturation, cultural beliefs and traditions, family support, language, and anxiety about cancer influence breast cancer screening among this group. (9,12) Thus, the results of studies on what influence breast cancer screening among this group have not been consistent across the literature. While Hispanics share many cultural characteristics, when the Hispanic subgroups are compared to each other, they are culturally and socially diverse. The cultural and social diversity among Hispanics might help explain the different results reported in the literature. The purpose of this investigation was to assess the knowledge, attitudes, and perceptions about breast cancer, and screening behaviors among Hispanic women residing in south-central Pennsylvania. In addition, the authors wanted to assess cultural factors that significantly influence this group’s breast cancer screening behaviors and to determine strategies that health professionals can use to increase these women’s responses to breast cancer campaigns.   Article 6:  (2006). An Innovative Community-Based Intervention for African-American Women with Breast Cancer: The Witness Project [R]. Health and Social Work Abstract: Overall, the incidence rates of breast cancer among women have continually increased since 1980 (2005). Despite advances made in the prevention, diagnosis, and treatment of breast cancer over the past several decades, there continues to be a major disparity in breast cancer morbidity and mortality between African American and white women. ACS estimated that 211,240 U.S. women would be diagnosed with breast cancer in 2005 and 40,410 would die from the disease. African American women have a lower incidence of breast cancer than white American women (119.9 per 100,000 compared with 141.7 per 100,000), but a higher mortality rate (35.4 per 100,000 compared with 26.4 per 100,000) (ACS). There are a variety of reasons postulated to explain the lower incidence yet higher mortality rate of breast cancer in African American women, including less access to health care, lack of health insurance, lower socioeconomic status, communication barriers, and perceptions among this population that cancer is fatal (2004; 2003;  2003).   Article 7: (2005). Pain and Discomfort Associated with Mammography among Urban Low-Income African-American Women. Journal of Community Health, Abstract: An estimated 211,300 new cases and 39,800 deaths from breast cancer will occur among U.S. women in 2003, (1) making it the most commonly diagnosed cancer and the second leading cause of cancer death among women. There is an unequal distribution of breast cancer mortality by race/ethnicity. Although the incidence among African-American women is lower when compared to white women, African-American women experience higher mortality. (1) Regular mammography screening can decrease breast cancer mortality by approximately 26% in women ages 50-74 years. (2) Despite potential benefits, the majority of women do not receive regular screening. (3) African-American women have lower rates of screening when compared to white women, (4) making non-compliance with recommendations a particular problem within this ethnic group.   To obtain a good image of the breast, mammography involves a tight compression, (5) which is uncomfortable for many women. Research shows that a substantial proportion of women experience some level of pain or discomfort during mannnography. (6,7) Reported rates of mammography-related pain vary from 0.2% to 62%. (8) Estimates encompassing discomfort tend to be much higher, with rates as high as 90%. (5) Discomfort can deter women from future screening. (9) This, in turn, can lead to delayed breast cancer diagnoses and worse prognoses. It  is important for providers to understand characteristics of patients reporting higher levels  of pain or discomfort. These women may be at higher risk of non-compliance and therefore may need special care when screened. In order to understand variability in the pain experience, researchers have investigated factors associated with pain, including psychosocial characteristics, health-related problems including cystic or lumpy breasts, (10,11) and external factors including amount of breast compression, friendliness and sensitivity of mammography technicians, and facility atmosphere and procedures. (5) Associations between pain expectations, coping strategies, and experienced pain have also been explored. Women not anticipating painful experiences and those having effective strategies to reduce pain report less pain during mammography. (6,12) Screening at regular intervals is essential in order for mammography to be successful. Identifying factors associated with repeat screening is crucial for breast cancer screening programs. Several studies have found that women who experience pain or discomfort during the mammogram are more likely to state that they would not come back when compared to women who did not report discomfort. (5,13,14) Much of the literature investigating factors associated with pain during mammography, as well as how this pain influences adherence to recommended screening guidelines, has been conducted within predominantly white, highly educated communities. Few studies have investigated whether the association between factors related to pain and discomfort seen within these settings will hold across diverse populations. (14,15) The current investigation examined the correlates of pain and discomfort associated with mammography within a low-income, African-American population. Four types of influences on reported pain or discomfort were investigated including: sociodemographic (e.g., gender, age), psychosocial (e.g., depressive symptoms, social support, church attendance), health and healthcare-related (e.g., access to care, health and chronic conditions) and breast cancer -related (e.g., knowledge of mammography) factors. In addition to reports of any pain or discomfort, the  reasons for pain or discomfort were also explored. The association between pain and discomfort and intention to repeat screening was also assessed. It was hypothesized that the experience of pain and discomfort during mammography within a low-income African-American population will influence a woman’s intention to return for breast cancer screening.       Article 8:  (2005). Augmented, Pulsating Tactile Feedback Facilitates Simulator Training of Clinical Breast Examinations. Human Factors   Abstract: Each year breast cancer kills 40,000 women in the United States, with approximately 211,240 new cases estimated for 2005 (2005). Fortunately, if tumors are treated before reaching 2.0 cm in maximum diameter, the 5-year survival rate exceeds 98%. Because of high breast cancer mortality rates worldwide, research has focused on early detection as one possible means of saving lives. A clinical breast exam (CBE) is a common component of many breast cancer screening protocols, often used as a complement to mammography. To conduct a CBE, a health care professional methodically palpates the patient’s breast, pressing the tissue against the patient’s rib cage with his or her finger pads, feeling for tissue irregularities. The critical skill in this exam is tactile perception, the elicitation and perception of nonuniform pressures across the finger pad surface resulting from the variable stiffness of the underlying material. The potential benefit of CBE is currently limited by sensitivity ranges of 39% to 59% ( 2001). This limited sensitivity may be caused by inadequate training or training procedures. Many physicians self-report low CBE confidence and skill levels, possibly because they never received formal training or validated their CBE skills (1985;  1995;1993). Forty-three percent of residents, faculty, and nurse practitioners lack confidence in their CBE skills (1993), and most surveyed physicians acknowledge a need to increase their CBE competence ( 2001). Practitioners may underutilize CBE if they do not feel proficient (1998). Training tactile skills is difficult for several reasons. Tasks such as distinguishing tumors from normal breast tissue nodularity demand discrimination of subtle differences. Consistent task performance requires the simultaneous application of multiple skills, which include maintaining a precisely controlled pressure, moving with a consistent frequency and duration, and visualizing the three-dimensional tissue volume. Although 0.2- to 1.0-cm lumps are palpable (  1982; 1974), small, deep tumors are initially very difficult to find without gradual learning and practice, advancing from larger to smaller tumors. Training can substantially improve performance, and effective training tools can improve training success (1990; 1991;1980). Current training approaches emphasize a thorough search pattern, adequate pressure, proper finger positioning, and the ability to discriminate a solid mass from normal breast tissue, including normal, potentially confusing structures within the breast, such as milk ducts (2001; 1982). These skills are typically introduced with live patient volunteers, artificial breast models, and training videos. The tactile discrimination skills can be trained with simulators, live patients with benign breast tumors, or both. Breast model training can provide a 44% to 66% skill improvement (1990;1999;1980) and allow trainees to detect tumors as small as 2 or 3 mm in diameter (1976; 1982). One consistent limitation of CBE breast model training research, however, is the increase in false positives after training, which suggests that breast model training may increase a health care practitioner’s willingness to diagnose more breast anomalies as tumors (1990; 1991;1998). Current CBE breast model training techniques, developed in the late 1970s and 1980s, emphasize realistic stimulus representation. Much of this work is reported in a series of nine papers published by  (1976; 1982;1977), a team that founded the Mammatech Corporation to provide the medical community with low-cost breast models resulting from the research. The team initially emphasized training procedures for discrimination, feedback, and attaining a fixed performance criterion (1980) and later focused on performance proficiency and maintenance improvement (1982). This research led to the development of the current static CBE breast models, which are flattened silicone hemispheres embedded with five hard lumps (i.e., artificial tumors) and covered with an opaque, flexible skin. The trainee palpates the breast model to discover the lumps. After the search is completed, the gel may be turned over and a cloth backing removed to reveal the position of the lumps within the translucent silicone. (2001) noted the recent reverse trend toward using low-fidelity simulators, such as these silicone breast models, to train complex skills. They suggested that these somewhat less sophisticated displays do well in representing the knowledge, skills, and attitudes to be trained as well as facilitating transfer of training. Breast models made of rubber-like materials can avoid the technical limitations of mechanical resolution, update rate, and repeatability associated with haptic displays based on programmable force-feedback devices. Developers of haptic simulators seeking greater device flexibility, generality, and programmability have recently focused on developing electromechanical devices that simulate palpated tissue or the interaction between tissue and a surgical instrument. Such simulators are being developed for laproscopic surgery ( 2000), spinal needle biopsy (2001), endoscopic sinus surgery (1996), epidural anesthesia (1996), and prostate cancer exams (1999). Much of this research has focused on the realistic and efficient modeling of the mechanics and dynamics of soft tissues and tool-tissue interaction (1999; 2000). Combining the realism of the low-fidelity, rubber-like materials with the flexibility of the electromechanical instrumentation could lead to training simulators that provide relatively natural haptic feedback while incorporating a wide variety of programmable stimuli conditions. To explore this design opportunity, we developed a clinical breast exam training device that presents lumps by inflating one or more balloons embedded in a breast -shaped silicone matrix ( 2001). This approach provides the advantage of facilitating extended practice by allowing the position of active lumps to be reconfigured between trials. While developing the model, we observed that oscillating the water pressure in the balloons seemed to help trainees localize and detect subtle lumps. The pulsation, which relies on the training device’s unique design, is a novel form of augmented task feedback. This feedback may simplify high-difficulty tasks by allowing the trainee to focus on the perception subtask rather than the judgment subtask. Current training procedures with a CBE training device are easily modified to incorporate the augmented, pulsating feedback. Training with both the static and dynamic training devices begins by presenting one or more stimuli (a silicone breast with one or more lumps) to the trainee. The trainee palpates the breast model, searching for and reporting the location of each suspected lump. After each trial, the trainer provides postperformance feedback to the trainee, explaining whether or not a tumor was present at a designated location. With traditional CBE training devices, this procedure may be repeated just once or twice before the trainee memorizes the fixed positions of the tumors, after which the trainee gains little benefit from the postperformance feedback. The dynamic training device, however, allows the procedure to be repeated indefinitely because each lump may be independently activated, offering a new configuration of lumps to trainees and allowing valuable postperformance feedback to aid and speed skill acquisition. When the trainee misses a lump, the dynamic training device can also provide augmented feedback by oscillating the water pressure in the lumps. Providing this feedback directly after a trial with a missed lump helps the trainee locate the missed lump and identify the previously hidden stimulus. Previous research suggests that this additional feedback provided on missed trials is likely to improve training effectiveness. Various researchers have demonstrated, for example, that frequent feedback quickly improves performance and consistency (1989; 1989; 1989). Feedback that is customized to the trainee’s needs, such as providing frequent feedback when a task is first introduced and then reducing its frequency as the trainee becomes more competent, also increases its effectiveness and supports long-term retention (1996). An interesting aspect of the pulsating feedback is that it is not realistic. It is a caricature of the realistic stimulus presentation, using exaggeration to direct the trainee’s attention toward specific aspects of the perceptual stimuli. Nevertheless, the dynamic breast model’s augmented haptic presentation may help the trainee to develop critical discrimination skills necessary in the real task environment. The following experiment compares the training effectiveness of the feedback facilitated by the dynamic and static training devices. A between-subjects experimental design was chosen to balance the clinical relevance and benchmarking provided by the well-known static training device and the novel capabilities of the dynamic training device. To emphasize the effect of the feedback rather than the effect of the testing device (static or dynamic), care was taken to ensure that training conditions presented by the two devices were as similar as possible, although this somewhat limited the full capabilities of the dynamic simulator. For example, the testing involved only 5 of the 15 lumps available in the dynamic model, matching as well as possible the stimuli presented by the static model. Also, the experimental protocol suggested that several static models were available. To do this, the static model was discreetly rotated to change the absolute lump positions, and the model remained hidden from sight between tests. Although these measures limited the participants’ opportunity to memorize the static model’s lump positions, no advantage was provided to the dynamic trainees to compensate for how static trainees could have learned the tumor locations. The experimental objective was to determine whether providing the additional feedback facilitated by the dynamic training device, in particular the pulsating lump feedback, would improve clinical breast exam training effectiveness for medical students.   Article 9:(2006). Breast Self-Examination. Journal of Obstetricians and Gynaecologists of Canada   Abstract: Objective: To examine the value of teaching regular breast self-examination (BSE).   Outcome: Reduction of benign biopsy rates.   Benefits: To provide better advice for women about the risks and benefits of BSE, and to ensure that women who choose to practice BSE are taught to perform it proficiently.   Summary Statement: Routine teaching of BSE does not reduce mortality and likely increases benign biopsy rates.   Recommendations: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"></ul> <li class="MsoNormal" style="text-align: justify"> Breast self-examination should not be routinely taught to women. </li> <li class="MsoNormal" style="text-align: justify"> A full discussion of breast self-examination, including risks, should be provided for the woman who requests it. </li> <li class="MsoNormal" style="text-align: justify"> If a woman makes an informed decision to practice BSE, care providers should ensure she is taught the skills and that she performs self-examination proficiently. </li>   Validation: This committee opinion was developed by the Breast Disease Committee of the Society of Obstetricians and Gynaecologists of Canada. It was approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.    Sponsors: The Society of Obstetricians and Gynaecologists of Canada    (2006). The Challenge of Early Breast Cancer Detection among Immigrant and Minority Women in Multicultural Societies. The Breast Journal,   Abstract:             A sociological view of the barriers experienced by women from traditional cultures, both in their native countries and as immigrants and minorities in multicultural western societies, in preventive health care generally and in breast screening specifically, is essential not only to understand patters of late-stage diagnosis, but also to design successful interventions and programs. Breast cancer is a unique disease, as its name ties together a multisymbolic organ of the female anatomy and a potentially fatal affliction, the treatment of which commonly is a body-mutilating procedure (masectomy). Because of its special nature, breast cancer is shrouded in fears, myths, and connotations reaching far beyond the objective clinical understanding of the disease. Many women do not use available breast-screening services and present with advanced symptoms. To help women detect and treat breast cancer early, health care providers and policymakers should try to understand their predicaments and the factors influencing their decisions. Structural barriers include such socioeconomic factors as poor health insurance, distance to medical facilities, and inability to take time off from work, while organizational barriers include difficulty in navigating complex health care systems and interacting with medical staff. Psychological and sociocultural barriers include poor health motivation, denial of personal risk, fatalism, mistrust of cancer treatments, and the fear of becoming a burden on family members. These barriers can often preclude proactive breast screening or rapid response to symptoms, even when breast cancer awareness is rather high. Moreover, in may traditional societies, especially Muslim ones, women’s decisions and actions are controlled by men, and men may be unaware of or disapprove of breast screening. This article discusses several approaches to lowering the described barriers, including specially tailoring educational programs that dispel cancer myths, involving men in breast cancer detection efforts, implementing cultural competence training for mainstream health care providers, and recruiting minority health care professionals to enable better outreach to their coethnics.                Credit:ivythesis.typepad.com

Is Breast self examination an effective Strategy in the early detection of breast cancer ?

Description of Essay Topic It has been reported that breast cancer is not just one disease, but several, and can be found in ...