Epidemiology of Breast Cancer
For the master’s-prepared nurse, knowledge of epidemiology and its application to preventive screening guidelines is important in many clinical areas: administrative, education, and nurse practitioner fields. Consider that you are working in a clinic and need to order preventive screening for a patient for BREAST CANCER. (While this is a preventative measure, it also can be a diagnostic tool in other circumstances. For this assignment, the screening is a secondary prevention measure.)
Your screening methodology must come from the United States Preventive Services Task Force guidelines.https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/
Include the condition and type of screening are both identified and defined. Screening choice is one from the assignment directions.
Epidemiology of Condition
Include a correct definition of the condition and define the epidemiology of the condition in the United States, via three statistical terms. Include the correct mortality and related morbidity statistics in numerical format and address trends using terms such as increasing, larger or less, related disparities, and population rate comparison (race, sex, age, etc.).
Methodology
Incorporate the USPSTF guideline development methodology process into the methodology section of the paper.
Discuss the population for the screening guideline using age, sex or related characteristic and includes information on two risk factors addressed in the guideline methodology.
Justify the screening based on these risks using statistical rationale.
Explain and support the screening measures.
Guideline
Summarize the USPSTF guideline recommendation and include population characteristics, screening type, and interval.
Include most current recommendations.
Critical Analysis
Conduct a literature review of the guideline’s support and may include alternative studies found in more recent literature supporting or offering alternative views.
Cite four studies in the analysis.
Provide a summary conclusion of the screening guideline, general benefit to the individual, and why it is important.
Sample Paper
Breast Cancer
Breast cancer is a form of cancer that starts in the breast. It might start as a small lump and then spread to other cells and tissues. Cancer begins when the cells in the breast mutate and grow at an uncontrollable rate. Breast cancer can begin from any part of the breast and then spread. For example, it can start from breast lobules that make breast milk (Waks, 2019). The most common form of breast cancer begins in the duct, which transports milk to the nipple from the lobules. Cancer can also start in the lining of the blood and lymph vessels.
Epidemiology of Breast Cancer
Breast cancer is the most common form of cancer among US women. There were more than 281 550 new cases of cancer in 2021. Of these cases, ductal carcinoma accounts for about 15% of newly diagnosed cases. About 1 in 38 people die of breasts cancer, making the mortality rate 2.6%. There were about 43,600 cancer deaths in the US in 2021. The rate of breast cancer in the US is higher in Women compared to men (Momenimovahed, 2019). Studies indicate that about 12.9% of women in the US will be diagnosed with cancer in their lifetime. Besides, close to 4 million women in the US are cancer survivors and still living with cancer. Men also contract cancer but at much lower rates. The cases of men having breast cancer are about 3,000, accounting for less than 1% of all cases of breast cancer. Breast cancer has an ethnic perspective. The rate of breast cancer is higher among White women, compared to Blacks, Asians, and Hispanics. The risk of breast cancer in the US increased with age, up to 70. The average age at which women in US are at the most significant risk of breast cancer is 50 years.
Methodology
The USPSTF uses various strategies to develop breast cancer screening guidelines. The agency reviews the evidence-based data on the effectiveness of the current breast cancer screening tools in reducing breast cancer. It also uses surveillance data from healthcare facilities and community programs to identify risk factors contributing to breast cancer diagnosis and mortalities. In addition, USPSTF uses a critical analysis of current research studies on breast cancer screening, risk factors, morbidity, and mortalities to identify the best studies to incorporate in updating the breast cancer screening guidelines.
Guidelines
USPSTF recommends women aged 50 to 74 years be screened for breast cancer using mammography every two years. However, for women younger than this age, breast cancer screening is a personal decision. USPSTF also recommends clinicians assess women who have a family history of breast cancer for BRCA1 and 2 gene mutations using the proper risk assessment tool. Those women identified to be at a significant risk of breast cancer from the assessment should receive genetic counseling to understand their susceptibility to breast cancer. Genetic testing should be done after counseling. For those women who are determined to be at risk of contracting breast cancer, USPSTF recommends clinicians prescribe risk-reducing medication for 35 years and above. Such medications include Aromatase inhibitors, tamoxifen, and raloxifene. These medications are recommended for women at high risk of getting breast cancer and without any risk of adverse side effects from the medication. (Klarenbach et al., 2018).
Literature Review
Various studies have been conducted to assess the effectiveness of the USPSTF guidelines in the prevention and early diagnosis of breast cancer. Studies on breast cancer have led to a better understanding of its physiology and more effective screening tools (Waks, 2019). Studies indicate that the use of mammograms for periodic screening of breast cancer has led to the early detection of breast cancer, unlike before when it was detected at late stages (Sandler et al., 2021). This early diagnosis of breast cancer has significantly boosted less costly treatment and better outcomes in breast cancer management, thus reducing breast cancer mortalities.
However, other studies have indicated that mammograms are still not effective in detecting breast cancer, especially in women with thick breasts (Baron et al., 2018). There have been cases of false negative or false positive diagnosis in breast cancer screening using mammograms. These studies indicate reduced efficiency, accuracy, and reliability of mammograms, especially in the detection of small tumors. Other studies have suggested that mammograms should be complemented with other breast cancer screening tools such as ultrasound and breast MRI to increase accuracy (Caughran et al., 2018). Breast ultrasound has been shown to detect cancer, but its success rate is shallow.
Conclusion
The increasing prevalence of breast cancer especially among women continue to negatively impact public health and healthcare expenditure. However, the USPSTF guidelines for breast cancer screening have provided hope in addressing the problem of breast cancer. Adopting the guideline in healthcare has enabled early diagnosis of breast cancer and its risk factors, thus allowing early intervention. Early intervention translates to less costly care with increased chances of better incomes. However, increasing studies suggest mammograms have reduced reliability, especially in dense breast and early breast cancer stages. Therefore, there is a need to complement mammography with other evidence-based tools such as ultrasound and MRI.
References
Baron, R., Drucker, K., Lagdamen, L., Cannon, M., Mancini, C., & Fischer-Cartlidge, E. (2018). CE: breast cancer screening: a review of current guidelines. AJN The American Journal of Nursing, 118(7), 34-41. https://journals.lww.com/ajnonline/Abstract/2018/07000/CE__Breast_Cancer_Screening__A_Review_of_Current.24.aspx
Caughran, J., Braun, T. M., Breslin, T. M., Smith, D. R., Kreinbrink, J. L., Parish, G. K., … & Henry, N. L. (2018). The Effect of the 2009 USPSTF breast cancer screening recommendations on breast cancer in Michigan: A longitudinal study. The breast journal, 24(5), 730-737. https://doi.org/10.1111/tbj.13034
Klarenbach, S., Sims-Jones, N., Lewin, G., Singh, H., Thériault, G., Tonelli, M., … & Thombs, B. D. (2018). Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer. Cmaj, 190(49), E1441-E1451. https://www.cmaj.ca/content/190/49/E1441.short
Momenimovahed, Z., & Salehiniya, H. (2019). Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer: Targets and Therapy, 11, 151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462164/
Sandler, K. L., Haddad, D. N., Paulson, A. B., Osterman, T. J., Scott, C. C., Poulos, E. A., & Deppen, S. A. (2021). Women screened for breast cancer are dying from lung cancer: An opportunity to improve lung cancer screening in a mammography population. Journal of Medical Screening, 28(4), 488-493. https://doi.org/10.1177%2F09691413211013058
Waks, A. G., & Winer, E. P. (2019). Breast cancer treatment: a review. Jama, 321(3), 288-300. https://jamanetwork.com/journals/jama/article-abstract/2721183
