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Introduction
Breast cancer is a disease in which cells in the breast grow out of control - different kinds
of breast cancer depend on the cells within the breast that turn into cancer (Centers for Disease
Control). In the United States, it is the most common cancer in women for all races and
ethnicities and the second most common cause of death from cancer for African American
women in particular (CDC, 2013). In 2011, Californias breast cancer incidence rate accounted
for about 48% of new cases for all types of cancers (California Cancer Facts and Figures, 2014).
The California Department of Public Health stated that, for the year of 2012, the county of Los
Angeles had the highest rate of incidence for female breast cancer for the whole state of
California. The high incidence and morbidity rates are caused by little to no education about the
particular cancer itself and lack of awareness in the community. Because the community plays a
big role in disparity awareness, the female African American population has a significantly
increased rate of mortality because of breast cancer. In 2010, the California Cancer Registry
claimed that African American women had a rate of 33.0 deaths per 100,000 women in
California with the runner up being Non-Hispanic White women at 23.9 deaths per 100,000.
Incidence, specifically in the African American community, is shown that one in nine
African-American women in the US will be diagnosed with breast cancer in her lifetime.
African-Americans have a higher incidence rate than Caucasians before the age of 45. Although
now, the incidence rates for Caucasians and African Americans are becoming similar. For
PROBLEM JUSTIFICATION - BREAST CANCER
African Americans, the median age that is diagnosed is 58 years old whereas Caucasians are
In terms of mortality, there are many factors that show African-Americans have a higher
mortality rate than Caucasians. Those factors vary from getting diagnosed at different stages,
obesity and comorbidities, and response to treatment. Even before the age of 45, mortality rates
are even higher in African Americans than Caucasians. In 2013, approximately 6,080 deaths
Breast cancer is the most common cancer among women in the United States, after skin
cancer. When it comes to surviving breast cancer, Black women tend to have poorer survival
rates than women from other racial and ethnic groups in the United States. African American
women are more likely than other racial/ethnic groups to be diagnosed at later stages and have
the lowest survival at each state of diagnosis. They are also more likely to be diagnosed with
triple negative breast cancer, an aggressive subtype that is linked to poorer survival (American
Cancer Society). Studies have also found that they often have aggressive tumors with a poorer
chance of recovery. According to recent research, the overall 5-year relative survival rate for
breast cancer diagnosed in 2008-2012 among African American women was 81%, compared to
92% among white women; this difference may be attributed to both later stage at diagnosis and
poorer-stage-specific survival among black women (Susan G. Komen, 2016). There are many
reasons why African American tend to have poorer survival rates compared to other ethnicities
including white women. One risk factor is that African American women tend to be more
overweight and obese compared to white women. Women of some races/ethnicities are also more
PROBLEM JUSTIFICATION - BREAST CANCER
likely than others to have low income, delay in diagnosis, delay in treatment and lack of follow
up. This hold true especially with African American women who have a low SES.
Social Consequences
In the case that these African American women choose to opt out of regular breast cancer
screenings, they put themselves at high risk for late detection of lumps and abnormalities. One
study performed by Dr. Janice Phillips seeked to describe African American womens
experiences of being at high risk for breast cancer. Several themes were found including: life-
changing experience, relationships: fears, support, and concerns, healthcare experience, raising
awareness, and strong faith (Phillips, 2011). Upon their diagnosis of having breast cancer or
being at high risk, these African American women faced similar experiences including: finding
ways to communicate with spouse/significant other, family and friends; high costs of treating
breast cancer; quality of their relationships with healthcare provider; educating their loved ones
about breast cancer; and turning to their faith as a major source of strength to cope with
Currently there are two best practices used for early detection of breast cancer in women
who have no signs or symptoms of the disease: high quality screening mammogram and clinical
breast examinations. Our program will aim to promote breast cancer screening amongst African
American women. We plan to discuss the benefits, as well as the risks, of each type of screening.
Mammography
A mammogram is an x-ray picture of the breast. The breast is placed on a clear plastic
plate and another plate firmly presses the breast to flatten it while the X-ray is being taken
(Centers for Disease Control). There are two types of mammograms: screening and diagnostic.
PROBLEM JUSTIFICATION - BREAST CANCER
Screening mammogram involves two x-ray pictures of each breast, making it possible to detect
check for breast cancer after a lump or other sign/symptom has been found. It can also be used to
evaluate changes found during a screening mammogram or to view breast tissue when it is
mammography is beneficial for early detection of breast cancer by allowing the patient to start
treatment earlier before the cancer spreads. Results from randomized clinical trials and other
studies show that screening mammography can help reduce the number of deaths from breast
advanced practice nurses, physicians, and general practice nurses. These examinations can be
done before, during, or after the teaching of breast examination sessions. Clinical breast
examinations also take family history into account. Visual inspection of the breast area is
included in the examination, as well as palpation to the breast area for any lumps or
abnormalities. This solution is a better alternative to the breast self examination (BSE) because a
medical professional is performing the examinations instead of the patient. This can help with
early detection, accuracy and provide patients with a more in depth screening (National Cancer
Institute).
Lumps can also be discovered by self examination, however, patients may find benign
lumps and assume it to be cancerous. According to the National Breast Cancer Coalition, 8 out of
10 lumps are not cancerous. Performing a breast self examination has not been found to lower
the risk of breast cancer, but being familiar with how ones breasts look and feel can help the
individual to notice symptoms such as lumps, pain, or changes in size (CDC, 2016). Breast self
examination (BSE) is a method developed for the specific purpose of searching for cancer. A
woman uses her hands to inspect her breasts and the surrounding areas for unusual lumps and
shape changes. This is done regularly with the purpose of screening and detecting breast cancer
as early as possible. For the past few decades, many organizations have recommended that
woman age 20 and older perform a BSE each month. Many organizations have spent resources
on shower cards, educational programs, and videos to teach women how to perform BSE. Many
nurses and physicians also take the time to teach their patients. In one study, only 7.6% of breast
cancer patients who had practiced BSE on a regular basis actually found their breast cancers
while performing BSE. According to research, there is no evidence that suggests BSE are the
best way in detecting early cancer or have a better chance of survival, but they can help women
know what is normal for them so they can report any changes to their healthcare provider
The high incidence of breast cancer in African American women in the United States
alone is reason enough to find a way to eradicate all possible risk factors for the disease. The first
step towards a means to an end is education. Education is the key towards preventing and
catching breast cancer early on, especially in the local Los Angeles County with its large African
American community. Catching cancer and getting early treatment are crucial factors to a higher
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chance of survival and better quality of life. Educating these women on the importance of getting
regular mammograms, clinical breast exams, and how to conduct a self breast examination, as
well as, bringing awareness about the locally provided services, could do wonders in decreasing
References
American Cancer Society. (2015).Breast Cancer Rates Rising Among African American Women.
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cancer-rates-rising-among-african-american-women
California Breast Cancer Mapping Project: Identifying Areas of Concern in California. (2012,
California Cancer Facts and Figures 2014. (2014, February ). Retrieved September 6, 2016,
from http://www.ccrcal.org/pdf/reports/acs_2014.pdf
Centers for Disease Control and Prevention. (2016). Breast Cancer Statistics. Retrieved
Centers for Disease Control and Prevention. (2016). What is a Mammogram?. Retrieved
https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm
Centers for Disease Control and Prevention. (2016). What is Breast Cancer Screening?.
https://www.cdc.gov/cancer/breast/basic_info/screening.htm
Los Angeles: Indicators: Breast cancer incidence rate: County: Los Angeles. (2016, August ).
module=Indicators&controller=index&action=view&indicatorId=180&localeId=256
http://www.cancer.gov/types/breast/patient/breast-screening-pdq
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National Cancer Institute. (2016). Mammograms. How are screening and diagnostic
http://www.cancer.gov/types/breast/mammograms-fact-sheet#r1
National Cancer Institute. (2016). Mammograms. What are the benefits and potential
http://www.cancer.gov/types/breast/mammograms-fact-sheet#r1
Phillips, J., & Cohen, M. (2011). The meaning of breast cancer risk for african american