Research Literature Review Breast Cancer in USA Essay

Introduction Breast cancer continues to be an important focus of attention for medical professionals, policy-makers and general public in the US. The high incidence of the disease and its devastating, in many cases, fatal, outcomes rivet the attention of the professional public. Studies identified for this literature review are for the most part practically oriented, in the sense that they deal with topics that are of primary importance in detecting, treating, and preventing breast cancer. Thus, two sources deal with the programs aimed at women education in the US concerning breast cancer, and two others cover the research into environmental causes of breast cancer. The problem of treatment options for breast cancer is also considered. Education Programs In the US where the population is extremely diverse, creation of special education programs targeting various population groups in accordance with their status is of special importance. Armando Valdez, Kakoli Banerjee, Lynn Ackerson, and Maria Fernandez in their article â€Å"Multimedia breast cancer education intervention for low-income Latinas† outline a special program aimed at the segment of women including Latino women. The problem with detection and early treatment of cancer among Latino women is connected to the fact that Latina women’s screening rate is considerably lower the required government standards and the rate for other ethnic groups. The researchers arrive at the conclusion that, given the availability of subsidized mammograms for poor Latina women, the main deterrent for improvement in the screening rate is lack of knowledge about cancer risks and treatment options. Complicated level of education materials prepared for the target group by the American Cancer Society was identified as an important factor blocking the access of Latina women to adequate information as materials presented often required a superior level of reading skills and the materials were not prepared in Spanish. The paper reports â€Å"the results of a multimedia breast cancer education intervention, tailored to the needs of low-education, low-income Latinas, and attempt to document specific changes in women’s knowledge, attitudes and intentions toward mammography screening† (Valdez et al., 2002). Using the Breast Cancer Multimedia Kiosk including instructional videos exposing the target group to the dangers of breast cancer, the authors were able to conclude that interactive multimedia technologies are an effective tool in raising awareness of cancer risks among low-income women. Although the women had some prior knowledge of cancer (â€Å"the majority of baseline study participants (over 80%) knew age and family history as risk factors†), the post-exposure assessment revealed a significant increase in knowledge after the program. Krystal Ngoc-Thy Luong and Jenny K. Yi in â€Å"Apartment-Based Breast Cancer Education Program for Low Income Vietnamese American Women† evaluate a similar program targeting a different ethnic group. As in the case with Latina women, breast cancer is the leading cause of death in this subgroup. Although Asian/Pacific Islander American, or APIA, women have a lower incidence rate of breast cancer (102.0 per 100,000 versus 140.8 per 100,000 for White American women), exposure to Western lifestyle tends to push these rates up. In addition, APIA women tend to be younger when diagnosed with breast cancer than other categories. The study aimed â€Å"to develop, implement, and evaluate the effect of an apartment-based breast cancer educational program for the hard to reach low income Vietnamese women† (Luong, Yi, 2005). The program was designed to be based on apartment visits as it provided a convenient way to reach women, covering neighbourhoods with high concentration of Vietnamese families in Houston. The intervention was carried out by two educators who delivered 20 educational sessions over the period of 3 months that provided the Vietnamese women with information concerning screening, recommendations and referrals to screening. Women were supplied with promotional materials including printed educational information and videos. Measurement of the knowledge levels through telephone surveys concerning breast cancer issues demonstrated that they were â€Å"significantly higher in the intervention group after receiving education about breast cancer when compared to women in the control group† (Luong, Yi, 2005). The researchers drew the conclusion that an apartment-based program has many advantages as compared to other ones because it addresses women in comfortable home settings, giving them a chance to relax and open up more to the conversation with the educator. Environmental Hazards and Breast Cancer Another important direction of research concerns the impact of pollutants and other environmental factors on incidence of breast cancer in women. Thus, Peggy Reynolds, Susan E. Hurley, Robert B. Gunier, Sauda Yerabati, Thu Quach, and Andrew Hertz in â€Å"Residential Proximity to Agricultural Pesticide Use and Incidence of Breast Cancer in California, 1988-1997† evaluate the connection between the facts that California is the most important agricultural state and also demonstrates the highest breast cancer rates in the US. The purpose of the study was formulated as desire to find out â€Å"whether California breast cancer rates were elevated in areas with recent high agricultural pesticide use† (Reynolds et al., 2005). The research was based on the assessment of 176,302 invasive breast cancer cases including â€Å"70,968,598 person-years of observation† (Reynolds et al., 2005). Using Poisson regression analyses, the authors were not able to find a consistent link between living close to the areas of pesticide distribution and having breast cancer. The upshot of the study was that breast cancer was hardly driven by pesticide use, but was more closely related to various social factors such as socioeconomic status. Julia Green Brody and Ruthann A. Rudel in â€Å"Environmental pollutants and breast cancer† address a wider ranger of substances that can lead to breast tumors. The proliferation of breast cancer in North America has caused the need to look for more sources of this disease, examining a wider range of factors. The study covers â€Å"chemicals that may be breast carcinogens, promote growth of breast cells and hormonally sensitive tumors, or affect mammary gland development and susceptibility† (Brody, Rudel, 2003). The researchers identify already known breast cancer risk factors including reproductive factors, exposure to pharmaceutical hormones, diet, ionizing radiation, socioeconomic status and posited the need to identify more factors. Thus, the scholars point to the need to further investigate the risk associated with occupational hazards including exposure â€Å"to the mammary carcinogens benzene, PAHs, and certain organic solvents† (Brody, Rudel, 2003). For instance, speaking of organic solvents, one study identified a connection between breast cancer rates in Danish women and their exposure to these substances in the workplace. The research, after examining 7,802 women with cancer diagnosis, registered a 20-66% rise in breast cancer risk for women who have been employed in occupations that envisaged active exposure to organic solvents. Other studies demonstrated increased risk of breast cancer development for women employed in the chemical industry, textile manufacturing, or nuclear power plants. The authors conclude by saying that more research is needed in the area, but the literature available so far clearly indicates that the link exists between cancer rates and environmental factors. Treatment Options Finally, another issue which has been identified to inspire researchers is the availability of treatment options for cancer and choice between various alternatives. Kathleen B. Donaghy in â€Å"Fostering Sound Medical Treatment Decision Making: A Focusing on Treatment Choices for Breast Cancer† explores this problem. Invoking the decision-making theory, the author evaluates the potential for adequate decision-making in patients struck with this shocking diagnosis. Donaghy (2003) believes that hasty decisions concerning treatment options made on insufficient information are often regretted by the patient later on. As common deterrents that prevent responsible decision-making she identifies five key points: 1.) cognitive overload 2.) failure to fully comprehend treatment options 3.) inability or refusal to process information in the presence of a denial defense 4.) hurried presentation of information by the physician 5.) self-imposed time constraints to get decisions made. (Donaghy, 2003) The article identifies the key strategies that can be employed by the physician to help the patient in the choice, such as providing maximal possible information to guide the patient’s decisions, improving communication, framing information in an appropriate format, obtaining informed consent etc. Using the decision theory to define decision-making as a choice between status quo and other alternatives shed light on patient values that can be involved in decisions regarding breast surgery. Conclusion The pervasiveness of breast cancer in the US makes research related to the issue highly topical. Examination of causes including environmental factors can help craft governmental policies that will prevent the spread of the deadly disease. On the other hand, developing policies aimed at early detection and effective treatment can be instrumental in curbing the death rate from breast cancer. In this light, creation of programs specifically tailored to the needs of individual groups can be an effective solution. Finally, research oriented toward helping the patient make the best decision concerning treatment options will be an important prerequisite of effective treatment programs. References Ackerson, L., Banerjee, K., Fernandez, M., & Valdez, A. (2002). A Multimedia Breast Cancer Education Intervention for Low-Income Latinas. Journal of Community Health 27(1), 33+. Retrieved April 14, 2006, from http://www.questia.com/PM.qst?a=o&d=5000714747 Brody, J.G., & Rudel, R.A. (2003). Environmental Pollutants and Breast Cancer. Environmental Health Perspectives 111(8), 1007+. http://www.questia.com/PM.qst?a=o&d=5002005585 Donaghy, K.B. (2003). Fostering Sound Medical Treatment Decision Making: A Focusing on Treatment Choices for Breast Cancer. Annals of the American Psychotherapy Association 6(4), 6+. Retrieved April 14, 2006, from http://www.questia.com/PM.qst?a=o&d=5002578878 Gunier, G.M., Hertz, A., Hurley, S.E., Quach, T., Reynolds, P., et al. (2005). Residential Proximity to Agricultural Pesticide Use and Incidence of Breast Cancer in California, 1988-1997. Environmental Health Perspectives 113(8), 993+. Retrieved April 14, 2006, from http://www.questia.com/PM.qst?a=o&d=5010885312 Ngoc-Thy Luong, K., & Yi, J.K. (2005). Apartment-Based Breast Cancer Education Program for Low Income Vietnamese American Women. Journal of Community Health 30(5), 2005, 345+. Retrieved April 14, 2006, from http://www.questia.com/PM.qst?a=o&d=5011756419