Health Promotion Activities surveillance

for African American women

with Breast Cancer

Liberty UniversityAdvanced Physiology and Pathophysiology

Final Project PresentationFunmilayo Whitaker

NUR - 506

http://www.cdc.org

Breast Cancer is…

A disease in which abnormal breast cells grow at an alarming rate. The type of breast cancer you have depends on which breast cells turn cancerous. Breast cancer, like other cancers, can spread and eventfully kill – if not detected early enough.

Breast cancer is the first most common cancer in women of all races, however African American women bear a larger burden from the disease than any other race.

Pathophysiology… Various types of breast cancer have been identified

based on their histologic characteristics and growth patterns. The main component of the breast are lobules (milk-producing glands) and ducts(milk passages that connect the lobules and the nipple). In general breast cancer arise from the epithelial lining of the ducts(duct carcinoma). Breast cancer may be invasive or in situ. Most breast cancer arise from the ducts are invasive.

The natural history of breast cancer varies considerably from patient to patient. Cancer growth rate can range from slow to rapid. Factors that affect cancer prognosis are size, axillary node involvement, tumor differentiation, DNA content and estrogen and progesterone receptor status. ( Lewis et. al. 2004)

Population Characteristics

http://www.healthypeople.gov//document/thml/volume/

03cancer.htm

African American women are more likely to die of breast and colon cancers than are women of any other race.

African Americans are about 34% more likely to die of cancer than are whites.

BRCA Statistics… Cancer exacts a higher toll in African Americans than in

whites.  The mortality is higher across virtually all tumor types and stages.   In breast cancer, more African American women present with advanced disease.  Even in patients with similar stages of disease at presentation, survival is worse for African Americans.   Only 76 percent of African American women diagnosed with breast cancer survive compared to 90 percent of white women.

More cancers are diagnosed in African American adults -722 new cases per 100,000-compared to 665 new cases in whites.  Male African Americans share the heaviest burden in this disparity in incidence.  Cancer mortality also is higher in African Americans, where 237 per 100,000 will die compared to 190 Caucasians.  Although cancer mortality has generally decreased, the age-adjusted morality rate is 36% higher in African American males than in white males.

http://www.hopkinskimmelcancercenter.org/index.cfm/cID/471?CFID=7255723&CFTOKEN=54473558

Breast Cancer Incidence

American Cancer Society (2007-2008). Cancer Fact & Figures for American (pp

110

115

120

125

130

135

Incidence

AfricanAmericanwomen,118.3 per100,000WhiteAmericanwomen,132.5 per100,000

The incidence rates for White American women is higher than African American women. The incidence of breast cancer has risen steadily since 1950 and is leveling off at about 110 cases per 100,000 women.

http://www.omhrc.gov/templates/content.aspx?

ID=2826

Breast Cancer Mortality

0

5

10

15

20

25

30

35

Mortality

AfricanAmericanwomen,33.8 per100,000WhiteAmericanwomen,25.0 per100,000

The death rate for African American women is much higher than that of White American.

American Cancer Society (2007-2008). Cancer Fact & Figures for American American

Breast Cancer Prevalence

The 5 year survival rate for 1996 – 2002

was 77 % for African American women

and 90% for White American women.

www.cancer.gov

Breast Cancer Morbidity

DepressionPainNausea/vomitingHair lossFatigueOral complications

www.cdc.gov/cancer

Breast Cancer Risk Factors

Age

Personal history with breast cancer

Family History

Genetic Predisposition

Socioeconomic status

Geographical variation

Healthy People 2010 findings on Breast Cancer

in African American Women

African Americans have a higher death rate from breast cancer despite having a mammography screening rate that is nearly the same as white women.

Http://www.healthypeople.gov/document/html/uih_2.htm

African American Women often forego vital treatment…

A new study finds that nearly one in four African American women with late stage breast cancer refuse chemotherapy and radiation therapies. Published in the July 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society , the study indicates that more efforts are needed to ensure that all women with breast cancer receive appropriate care.

Http://www.sciencecentric.com/news/article.php?q=09052248-african-american-women-

...

Goals

Two goals set forward:

The first is to help persons of all ages increase life expectancy and improve their quality of life.

The second goal is to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

http://www.askew.fsu.edu/current/masters/actionreport/sp2004/Josette%20Sykes%20%20Eliminating%20Health%20Disparities%20among%20African.pdf

According to the US Census Bureau, Top 10 states with the largest African American population.

New York, California, Texas, Georgia, Florida, North Carolina, Illinois, Michigan, Maryland and Virginia.

www.cdc.gov/cancer

Breast Cancer Geographical Differences

Examples of Evidenced base efforts

Primary - Education/teaching/communicationTo increase knowledge/awareness of breast cancerTo educate medical community.

Secondary – Screenings/ MammographyEarly detection of breast cancerPrompt diagnosis of breast cancer

Tertiary – Treatment/Clinical researchTreatment optionsClinical ResearchRehabilitation/Survivorship programs.

Primary Level resources/efforts

CDC/Cancer.org/Alabama REACH/Susan G. Komen/Sisters Network, Inc.

Breast Cancer Continuing Medical Education This new program educates clinicians to be culturally

sensitive and to provide appropriate and timely information to African American women regarding breast cancer.

The need for training healthcare professional in communication strategies which is designed to engage patient in medical decisions and reduce disparities is evident in all stages of the cancer continuum.

http://www.cdc.gov/cancer/nbccedp/cme.htm

Primary Level resources/efforts through

Cancer.org CancerPlan.org enables State and Community Cancer

Control Planners to share resources and tools to effectively develop, implement, and evaluate Comprehensive Cancer Control (CCC) Plans.

http://www.cancerplan.org/portal/server.pt/space=communityPage8

Primary Level resources/efforts

Alabama (REACH) Susan G. Komen/Sisters Inc.

Program

The university of Alabama at Birmingham Breast and Cervical Cancer Coalition involved a variety of community-based, religious, grassroots, and health care organizations that serve the underserved populations.

Designed to reduce disparities in breast cancer education/awareness and outcome between African American and white women through the use of community advisors.

Susan G. Komen/Sisters Study Inc. reaching out to provide breast cancer awareness and education to African-American community.

http://www.healthierus.gov/steps/summit/prevportfolio/programs/cancer.htm

Community Education & Awareness Programs

Secondary Level resources/efforts

CDC(NBCCEDP)/USDHHS(WISEWOMAN)

CDC provides low-income, uninsured, and underserved women access to timely, high-quality screening and diagnostic services, to detect breast and cervical cancer at the earliest stages, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

In 1993 Congress established WISEWOMAN program. Well integrated screening and evaluation program for women across the nation. A preventive program as an opportunity to offer low income African American women additional screening services.

http://www.hhs.gov/asl/testify/t020425.htmlhttp://www.cdc.gov/cancer/nbccedp/about.htm

Intervention Program Failure

Although the NBCCEDP Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from this program or other sources, there remains a substantial need for services for this historically underserved population.

Community demographics influence the ability to reach minority women, although more than half of all women screened through the program are non-white. Most African American women felt mammograms were unpleasant and very uncomfortable.

Mammography are still underused by many African-American women and those who immigrated to the United States within the past 10 years.

Still many African women do not participate in screening programs because of high cost, lack of the program awareness, fear of breast cancer, and the concern about being used as “guinea pigs”.

http://ww.cdc.gov/cancer/nbccedp/about.htm

Secondary Levelintervention Program

SuccessSecondary Level Program Success:

Since 1991, the NBCCEDP has served more than 2.7 million women, provided more than 6.5 million screening examinations, and diagnosed more than 26,000 breast cancers, 88,000 precursor cervical lesions, and 1,700 cervical cancers.

In 2004, the NBCCEDP 1) screened 391,968 women for breast cancer using mammography, 2) found 3,970 breast cancers, and 3) screened 12.6% of all American women eligible to participate in the NBCCEDP for breast cancer.

http://ww.cdc.gov/cancer/nbccedp/about.htm

Tertiary resources/efforts

Over the past five years, Susan G. Komen for the Cure Affiliates - working with local organizations to help fund breast cancer survivorship screening, treatment and clinical research programs over the past five years, and have awarded more than $160 million in needs-based community grants.

Sisters Network Inc. a national African-American survivor advocate organization that has provided health awareness rehabilitation program and clinical trial support to thousands of women in the African-American community since its inception in 1994.

http://wwwcms.komen/publicPloicy/AccesstoQualityCare/index.htmhttp://theoncologist.alphamedpress.org/cgi/content/full/10/1/1

Tertiary Level Program resources/efforts Success

Since its inception in 1982, Susan G. Komen foundation have awarded more than 1,000 breast cancer research grants totaling more than $180 million. They remain the nation's largest private provider of funds for breast cancer research and community outreach programs

In addition to funding breast cancer research, Komen and their Domestic Affiliate Network fund non-duplicative, community-based grants that translate the findings from research into breast health education and seek to enhance the availability of breast cancer screening and treatment for the medically underserved.

The survivorship advocates, social networks, and church-based support groups appears to be quite valuable in achieving their goals. Especially Sisters Network supporting thousands of African-American breast cancer survivors.

http://www.cms.komen/publicPloicy/AccesstoQualityCare/index.htmhttp://theoncologist.alphamedpress.org/cgi/content/full/10/1/1

Tertiary Level Program resources/efforts failure

Current budgetary climate leading states to reduce or eliminate funding for important treatment program. This is because medical care expenses for cancer patients and survivors add up to over $60 billion annually, above 5% of all dollars spent on health care in the U.S.

Socioeconomic factors, low income, lack of knowledge about cancer treatment and lack of medical insurance for post-treatment.

Geographical variation, African-American women in the rural areas have less access and knowledge about these programs.

Fatalistic beliefs – cancer is inevitable/untreatable.

Program reach less than 20 percent of eligible women due to funding constraints.

External locus of control

http://www.plan2003.cancer.gov/inbrief/highlights.htm

Effect of Exercise on Breast Cancer Patients

and Survivors

Physical exercise has been identified as a potential intervention to improve quality of life in women with breast cancer. Exercise is an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients and survivors.

http://www.cmaj.ca/cgi/content/full/175/1/34

A Solution/Resolution to Address Concerns and Level of Prevention

Support Breast Cancer Legislation –

Target changes toward passage of Breast Cancer Treatment Act, which will secure Medical coverage for low income, uninsured women through a federal screening program – “Access to quality care for all”

The main goal is to achieve a longstanding commitment to advancing uncompromised evidence-based medicine and training consumers to strive toward system change. (This must include meaningful access to evidence based interventions that study environmental factors that are believed to contribute to breast cancer.) The health care system must have methods for measuring what is and is not working in order for quality of care to continuously improve. Re-Evaluation!!!

Retrieved from: http:// www.natlbcc.org

Potential Social Primary Implications and Solution

Integrated low literacy Cancer Education program for the AA community.

• Patient literacy influences access to curial information about the right healthcare, where it involves following instructions for care, taking meds and comprehending information related to information give

• Education and material resources will help to increase knowledge and awareness among AA

Retrieved from: http:// www.cdc.gov.

Lesson Learned – Early Prevention works, it’s much

cheaper and save lives!

What we don’t want is advanced stage of breast cancerAfrican-American women present with stage IV cancers at the rate of 6.5%, while White African women present at a rate of 3.6%

African-American women are more likely to be diagnosed at later stages of the disease, making the cancer more difficult to treat resulting in worse prognosis.

http://www.utoronto.ca/ois/SIA/2007/Breast%20Cancer/Breast%20Cancer.pdf.

Funmilayo Whitaker ‘s future Plan As

Advanced Practice Nurse…

Patients and families, who cope with cancer, face many challenges.  The more patients know about their cancer and its treatment, the more equipped they are to actively participate in their care.   So, creating many services and programs will help them during this time.

This program will involve planning, developing, and implementing cancer awareness activities with lay and professional African Americans to reduce cancer incidence and mortality rates, increase survival rates, address risk behaviors, and improve screening use and early detection rates within the U.S. Black American community

Set up educational parties, or “home health parties “ to promote breast health awareness and screening for this group.

The hostesses for parties can be recruited through patients, referring agencies, and health clinics in the community, as well as flyers and invitations distributed or posted at health fairs, beauty and nail salons, sporting events, churches, and community organizations. The hostesses serve as “connectors” or informal community leaders not only known to the targeted women but also assisting by participating in a word-of-mouth campaign to communicate the importance of messages relayed at the events

Educational Parties as a Strategy to Promote

Breast Health Awareness and Screening in Underserved Female Populations

The APN developed a draft lesson plan for the project to include presenters and recognized the hostess, review purpose of the party, conducted ice-breaker activities, and used three gaming strategies to increase participants’ knowledge related to prevention and early detection of breast cancer.

The plan incorporated a demonstration of breast self-examination by the APN or RN facilitator, encouraged participant palpation of breast models, and announced an opportunity to schedule appointments with hospitals or health clinics for screening services. Time was built into the format of the 60- to 90-minute program for participant evaluation, networking, and refreshment.

What we don’t want to see happen…

Dear future Advanced Practice nurses! The following pictures speak for themselves Early intervention is the answer! See next five

slides (please hold on to your seats!).

Advanced Breast Cancer (stages III and IV)

http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00003.JPG.

Advanced Breast Cancer (stages III and IV)

http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00151.JPG

Advanced Breast Cancer (stages III and IV)

http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00106.JPG

Advanced Breast Cancer (stages III and IV)

http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00640.JPG.

Advanced Breast Cancer (stages III and IV

http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00007.JPG

Current Debate on screening

Ambassador Nancy G. Brinker, founding chair of Susan G. Komen for the Cure, will address the controversy over new federal breast cancer screening recommendations.

Brinker, a breast cancer survivor, will challenge the just-released guidelines by the U.S. Preventive Services Task Force that suggest self breast examinations and annual mammograms for women in their 40s are unnecessary. She will also discuss the need to improve screening procedures, especially in vulnerable populations.

http://www.newscom.com/cgi-bin/prnh/20080917/NPCLOGO)

Interpreting the U.S. Preventive Services Task Force Breast Cancer

Screening Recommendations for the General Population

What are the new recommendations from the U.S. Preventive Services Task Force (USPSTF)?

• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. (grade C recommendation)

• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. (grade B recommendation)

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (grade I statement)

• The USPSTF recommends against teaching breast self-examination (BSE). (grade D recommendation)

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older (grade I statement)

www.acog.org/from_home/Misc/uspstfInterpretation.cfm

References

Adams, M. L. (2007). The African American Breast Cancer Outreach Project: Partnering With Communities. Family & Community Health. 2007:30 (1): S85 – S95. Retrieved November 15, 2009 from http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=692001.

American Cancer Society. Cancer Facts & Figures for African Americans 2007-2008. Atlanta: American Cancer Society: 2007 Retrieved November 12, 2009 from, http://www.cancer.org/downloads/STT/CAFF2007AAacspdf2007.p

Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program. (2007). Retrieved November 12, 2009, from http://www.cdc.gov/cancer/nbccedp/about.htm

Chilton, J.A. DrPh, Jones, L.A. PhD (2001). Impact of Breast Cancer on African American Women: Priority Areas for Research Within the Next Decade. American Journal of Public Health. Retrieved November 11, 2009 from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1447112/

ReferencesCornelius LJ, Smith PL, Simpson GM. What factors hinder women of color

from obtaining preventive health care? American Journal of Public Health. 2002:92(4):530–534.

Kinney AY, Emery G, Dudley W, Croyle RT. Screening behaviors among African American women at high risk for breast cancer: do beliefs about God matter? Oncology Nursing Forum. 2002;29(5):835–843.

Lewis et al (2004). Medical Surgical Nursing. Assessment and Management of Clinical Problems. 6th Edition, Mosby: St Louis.

McNeely, M.L, et al (2006). Effect of exercise of breast cancer patients and Survivors: A Systematic review and meta-analysis. CMAJ, Retrieved November 11, 2009 from http://www.cmaj.ca/cgi/content/full/175/1/34

Rochman, S. (2006). African American Women and Breast Cancer. Dr. Susan Love Research Foundation. Retrieved November 12, 2009, from

http://www.drsusanloveresearchfoundation.org/pdfs/african_american_bc.pdf

References

Russell, K.M., Parkins, S. M., Zollinger, T. W. and Champion, V. L. (2006). Sociocultural context of mammography screening use. Oncology Nursing Forum, 33 (1) 105-112.

Spurlock, W.R. & Cullins, L. S. (2006). Cancer fatalism and breast cancer screening in African American women. The ABNF Journal, 17 (1) 38-43.

Sykes, R. J. (2003). Eliminating health disparities among African American women with breast cancer: An Analysis of Options. Retrieved November 12, 2009 from http://askew.fsu.edu/current/masters/actionreport/sp2004/Josette%20Sykes%20%20Eliminating%20Health%20Disparities%20among%20African.pdf