Reasons for Delayed Diagnosis of Breast Cancer - Assignment Example

? Perception of African-American Women Regarding Reasons of Delayed Diagnosis of Breast Cancer College of Health Sciences: PhD Program in Public Health- Epidemiology Specialization University ID Problem Statement Cancer influence millions of individuals across the world and is emerging as the second leading cause of death among African-Americans and Whites (Centers for Disease Control and Prevention: Leading causes of Death, 2011). The matter is of great concern as US Census Bureau approximates that in 2013 the population of African-Americans living in US will be 42 million, contributing to 13 percent of the total population (US Census Bureau, 2012). An early detection is considered to enhance the survival rate of the patient bringing back life to normalcy. Research displays a drastic decline in number of cancer patients. Transformation in cancer treatment is attributed to the new generation of targeted oral chemotherapy and to the progression in technology and medicine (Breast cancer incidence statistics, 2010 ). However, carcinogenesis is a complex, multistage process, involving more than one genetic change. Other epigenetic factors responsible for carcinogenesis encompass level of hormones in the body, exposure to carcinogens and tumor promoting agents. Such epigenetic factors do not produce cancer by themselves but enhances the likelihood of genetic mutation(s) resulting in cancer (Katzang et al., 2009). Breast cancer is one of the most common cancers prevailing in women across the world (American Cancer Society, Surveillance Research, 2011). Despite all the developments in cancer detection especially in case of breast cancer, African-American women suffer with the condition inexplicably and therefore breast cancer is becoming one of the leading causes of mortality in African-American women (American Cancer Society, Surveillance Research, 2011). Mammography is the screening procedure adopted for the detection of breast cancer. Mammogram detects tumors at their primitive stages to onset the treatment procedure. However, delay in undergoing the screening process may diminish the survival rate (Chatterjee, He, & Keating, 2013). A paucity of research exists to explain the perception of the underlying reasons of delayed diagnosis of breast cancer in African-American women. Research is desired to distinguish and confer the problems related to the breast cancer in this particular population. The study may serve as an aid to breast cancer research organizations. Significance Cancer is known as malignant neoplasm, the hallmark characteristic involves uncontrolled proliferation of cells. Under normal conditions cells grow, divide and die, but if genetic defect called mutation occurs, an abnormal DNA is formed leading to altered control machinery of the cells, responsible for bringing devastating consequences, or malignancy. Cancer cells in due course form a lump or mass called tumor, tumor cells do not have any repair mechanism for the damaged DNA and there is a constant proliferation of cells without displaying senescence. Some breast cancers are known as in situ as they are impounded within ducts (ductal carcinoma in situ or DCIS) or lobules (lobular carcinoma in situ or LCIS). DCIS accounted for 83 percent while LCIS accounted for 11 percent during 2004-2008. Most of the breast cancers are invasive or infiltering type. Detection through breast examination and imaging needs to be further confirmed by microscopic examination of breast tissue for definitive diagnosis (Breast Cancer Facts & Figures 2011-2012, American Cancer Society, Surveillance Research, 2011). Female breast cancer incidence (2004-2008) and mortality rates (2003-2007) by race/ ethnicity and state by American Cancer Society, Surveillance Research (2011) for Ohio, reveals that Non-Hispanic White women displayed the breast cancer incidence rate to be 119.4 while the mortality rate was 25.9; African American women displayed incidence rate as 120.7 while the mortality rate was 34.5. On the other hand Hispanic women displayed the incidence rate of breast cancer as 61.9 and the mortality rate was 14.9. Rates are per 100,000 (Breast Cancer Facts & Figures 2011-2012, American Cancer Society, Surveillance Research, 2011). Women in Ohio belonging Hispanic community displayed lesser incidence of breast cancer and also the low rate of mortality when compared to the Non-Hispanic White and African-American communities. African-American women displayed greater incidence of encountering breast cancer and also the rate of mortality is very high. Research reveals that black women are often diagnosed at later stages of the cancer condition, where cancer becomes difficult-to-treat. Background Selected articles to understand the delayed diagnosis among African-American women between the ages of 18-49, encompass the concentration of the issue related to breast cancer incidence in White women, especially a sharp decline between 2002 and 2003, is attributed to the drop in menopausal hormones usage (Ravdin et al., 2007). The research requires to rule out the reasons why the decline in the incidence of breast cancer was not reported in African American women who dropped the use of menopausal hormones. As a result breast cancer prevalence is not declining (DeSantis et al., 2011). To understand the prevalence it is essential to understand the period of 2005-2009 must be taken into consideration, the annual incidence of breast cancer rate was 4 percent less in African American women than the White women. On the other hand, African American women of less than 45 years old showed higher rate of prevalence of breast cancer than White women (Surveillance, Epidemiology and End Results (SEER) Program SEER*Stat Database: NAACCR Incidence - CiNA Analytic File, 1995-2009). Considering the importance of the issue, Dunn et al., (2010), addressed how breast cancer condition diagnosed in African American women is linked to poor prognosis, hormone receptor category as compared to the White women. As a result, premenopausal African American women potentially possess greater risk for triple negative (ER negative, PR negative and HER negative). Moreover African American women display basal-like breast cancer related to diminished survival. Phipps et al., (2011) tried to rule out the reasons associated with the enhanced prevalence rate of breast cancer incidence and revealed that the frequency of aggressive subtypes of breast cancer in African American women is attributed to early menarche, premature first pregnancy, birth to more than one child. Millikan et al., (2008), addressed the breast cancer mortality rate in African American women enhanced from 1975- 1992 (this period was followed by a decline which is attributed to the early detection of the breast cancer as well as treatment of the condition). Further, van Ravesteyn addressed that in 1980s the prevalence rate of mortality due to breast cancer was same for Whites and African Americans in contrast to the recent reports (2005- 2009) which display that African American women display 41 percent more mortality rate than White women, even though the incidence rate is higher in White women. Menashe et al., (2009) addressed numerous contributing factors responsible for higher mortality rate in African American women. Disparity in African American women and White women to access and make use of means helpful in early detection and treatment of breast cancer is reported in the article. Moreover, disparity is also reported in nature of tumor in these two groups. Press et al., (2008), addressed how late stage diagnosis in African American women is featured to diminished frequency and lengthy intervals between mammograms (additionally poor follow-up is displayed by African American women in case of suspicious results). Smith et al, (2009) and Lund et al., (2008) revealed one of the important findings related with the inequality in receiving on time and high-quality treatment between African American women and White women. Bauer et al., (2007), addressed that elements related to the socioeconomic condition plays a vital role in biological performance of breast cancer. However Gordon (2003) addressed how the factors like poverty, enduring environmental conditions, physical activities, reproductive performances may influence the pathology as well as the genetic markers of the disease condition. Framework The theoretical framework of this study is guided by numerous factors considering the complexity of breast cancer pathogenesis and epidemiology. Moreover the prevalence is subjective to the multitude of environmental and lifestyle factors that influence the lifetime hormone exposures. Major factors contributing to the prevalence encompass genetic, cultural involving ethnic background and socioeconomic status. These features congregate to provide a contradictory pattern in African American women displaying lower incidence of breast cancer, higher mortality rate as well as younger age distribution (Newman, 2005). Other governing factors involve later stage at diagnosis, postponement in diagnosis and treatment, disparity in treatment, prevailing biological factors, emotional and psychotherapeutic interventions, support groups, patient navigation system (Barg & Gullatte, 2001). However, prolonged breast cancer screening programs and consideration to reassuring fairness in delivery of care should answer to a greater extent of enhanced effect. Essentially the African-Americans must be ensured about the improved accretion of chemoprevention as well as treatment trials (Newman, 2005). Research Questions Early detection of breast cancer saves lives and detection is facilitated through screening and tests. Whether this is true for African-American women between the ages of 18-49 in Franklin County Ohio is yet to be identified. The questions to be addressed in this study are: RQ 1) What is the role of mammogram in early detection of breast cancer among African-American women between the ages of 18-49 in Franklin County, Ohio? RQ 2) Does the non utilization of mammogram contribute to delayed diagnosis of breast cancer among African-American women between the ages of 18-49 in Franklin County, Ohio? Hypothesis 1: For the African-American women, aged 18 to 49 years in Franklin County Ohio, non utilization of mammogram contributes to delayed diagnosis of breast cancer.  Hypothesis 2: For the African-American women, aged 18 to 49 years in Franklin County Ohio, there is association between non utilization of mammogram and delayed diagnosis of breast cancer. Nature of the Study The nature of this study will be a single instrumental case study with a qualitative focus. According to Creswell (2007), “case study research involves the study of an issue explored through one or more cases within a bounded system”(p. 73). The present study is being carried out in order to understand the aspects playing vital role in delayed diagnosis of breast cancer in African-American women in the age group of 18-49 years in Franklin County, Ohio. Possible Types and Sources of Information or Data 1. The problem statement and significance of this study are both written from the background on delayed diagnosis of breast cancer in African-American women belonging to the age group of 18-49 years. 2. Sampling for this research will be purposeful. Individuals selected for interview will be both married and unmarried women, having issues or issueless belonging to the age group of 18-49 years. The present study will explore the theories of the origins of breast cancer disparities among African- American women especially "The psychological Impacts of Cancer" in understanding this phenomenon. Based on the interview results will be analyzed. References American Cancer Society, Surveillance Research. (2011). Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf. Brag, F. K., & Gullatte, M. M. (2001). Cancer support groups: Meeting the needs of African Americans with cancer. Seminars in Oncology Nursing, 17(3), 171- 178. Bauer, K. R., Brown, M., Cress, R. D, Parise, C. A., Caggiano, V. (2007). Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)- negative, and HER2- negative invasive breast cancer, the so-called tri­ple-negative phenotype: a population- based study from the California cancer Registry. Cancer, 109(9), 1721-1728. 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