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California State University, Long Beach

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Problem Justification - Breast Cancer


PROBLEM JUSTIFICATION - BREAST CANCER

Introduction

Identify the health problem

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.

Target Population/Population of Interest

Incidence and Prevalence

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

diagnosed at the age of 62 (Susan G. Komen, 2016).

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

were presumed to happen among African Americans (Susan G. Komen, 2016).

Impact of the Problem

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

diagnosis (Phillips, 2011).

Solutions to the Problem

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

malignant tumors and microcalcifications (indication of breast cancer). Diagnostic mammograms

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

difficult to obtain a screening mammogram (National Cancer Institute). Screening

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

cancer among women ages 40 to 74 (National Cancer Institute).

Clinical Breast Examinations

Clinical breast examinations are typically performed by health professionals such as

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).

One other solution - Breast Self Examinations


PROBLEM JUSTIFICATION - BREAST CANCER

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

(National Breast Cancer Coalition, 2011).

Validate the Need/Conclusion

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
PROBLEM JUSTIFICATION - BREAST CANCER

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

the mortality rate due to breast cancer.

References

American Cancer Society. (2015).Breast Cancer Rates Rising Among African American Women.
PROBLEM JUSTIFICATION - BREAST CANCER

Retrieved September 7, 2016. http://www.cancer.org/cancer/news/news/report-breast-

cancer-rates-rising-among-african-american-women

California Breast Cancer Mapping Project: Identifying Areas of Concern in California. (2012,

November ). Retrieved September 7, 2016, from California Environmental Health

Tracking Program, CDPH, http://www.cehtp.org/file/cbcmp_report_final_pdf

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

September 06, 2016, from https://www.cdc.gov/cancer/breast/statistics/index.htm

Centers for Disease Control and Prevention. (2016). What is a Mammogram?. Retrieved

September 3, 2016 from

https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm

Centers for Disease Control and Prevention. (2016). What is Breast Cancer Screening?.

Retrieved September 3, 2016 from

https://www.cdc.gov/cancer/breast/basic_info/screening.htm

Los Angeles: Indicators: Breast cancer incidence rate: County: Los Angeles. (2016, August ).

Retrieved September 7, 2016, from http://www.thinkhealthla.org/index.php?

module=Indicators&controller=index&action=view&indicatorId=180&localeId=256

National Breast Cancer Coalition. (2011). Breast Self-Exam: Position Statement.


Retrieved September 1, 2016, from http://www.breastcancerdeadline2020.org/breast-
cancer-information/breast-cancer-information-and-positions/bse-position.pdf
National Cancer Institute. (2016). Breast Cancer Screening-Patient Version. Clinical

breast exam (CBE). Retrieved September 3, 2016 from

http://www.cancer.gov/types/breast/patient/breast-screening-pdq
PROBLEM JUSTIFICATION - BREAST CANCER

National Cancer Institute. (2016). Mammograms. How are screening and diagnostic

mammograms different? Retrieved September 3, 2016 from

http://www.cancer.gov/types/breast/mammograms-fact-sheet#r1

National Cancer Institute. (2016). Mammograms. What are the benefits and potential

harms of screening mammograms? Retrieved September 3, 2016 from

http://www.cancer.gov/types/breast/mammograms-fact-sheet#r1

Phillips, J., & Cohen, M. (2011). The meaning of breast cancer risk for african american

women. Journal of Nursing Scholarship, 43(3), 239-247.

Susan G. Komen. (2016). Black/African-Americans & Breast Cancer. Retrieved

September 7, 2016 from http://komensandiego.org/blackafrican-americans-breast-cancer/

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