New Public Health Approaches to Tackling Breast Cancer - Case Study Example

Public Health, Health Promotion and New Public Health Approaches to Tackling Breast Cancer IntroductionBreast cancer has been identified as the number one threat to the health and welfare of women in the UK. How a country reacts to an illness such as this can have a significant impact not only on how the citizens of that country react to the disease, but also in terms of how much research can be conducted, what types of treatment can be provided and how many people suffer long-term or fatal effects from it. By looking at the type and incidence of the disease, one can gain an understanding of just how prevalent breast cancer is within the UK, the number of individuals and families that are affected by it, as well as the difficulty being faced in working to defeat it. Current initiatives involving research techniques, treatment programs and public outreach efforts can provide a picture of how involved the government and other organizations might be in trying to reduce the number of losses to the disease while a look at the effectiveness of these programs to date can indicate whether they are having a positive effect as yet. Once these things are identified, any gaps in the current programs can be determined and addressed with new approaches that either modify an old system or introduce completely new initiatives designed to address previously unknown aspects. Therefore, to determine whether the UK is doing an adequate job of reducing the incidence and losses to breast cancer within its borders, it is necessary to take a look into the public health, health promotion and new approaches being taken within the United Kingdom to conduct research, provide innovative treatments and work to identify new approaches to treating and preventing this disease. What is breast cancer? Contrary to popular belief, breast cancer can occur in both men and women, but because of the overwhelming number of women who are diagnosed with it as compared to the number of men, it is often thought of as a women’s disease. This form of cancer typically begins in the breast area and is detected as a small lump. This lump grows at a variable rate, sometimes slow and sometimes quickly, and can spread the disease to other parts of the body. Although causes for the disease are not known specifically, several key factors have emerged. According to AstraZeneca (2003), one out of every 10 women will be diagnosed with breast cancer at some point in their lives. For most women, this happens in their later years, typically following menopause. In addition, women with long menstrual lives have proven more susceptible to the disease than those who have relatively short menstrual lives. There are a wide range of treatments that may or may not be utilized on a case by case basis. These treatments include surgery to remove the lump in most instances, chemotherapy, hormonal therapy and/or radiation. In addition, some patients who are treated successfully may still have recurrences of the illness. “Doctors know that breast cancer develops in phases from early to advanced stages (when it has spread to other organs). The earliest stage may have taken only a few weeks to develop before it is detected” (AstraZeneca 2003). Patients with the best chances of surviving breast cancer are those patients who have discovered the disease in its early stages, before it’s had a chance to spread to other parts of the body. Other parts of the body that are usually affected include the back, ribs, bones, lungs, liver and sometimes the brain. It is for this reason that doctors advocate early detection through community screening programmes and mammograms as well as promotion of self-examinations by women. Incidence That breast cancer is on the rise is evident in that “the number of registered cases of an early form of breast cancer called Ductal carcinoma in situ (DCIS) has increased, according to new figures released […] by Cancer Research UK. These show that in 2002 nearly 3800 women in the United Kingdom were diagnosed with DCIS compared with 2910 five years earlier” (“Early Form” 2006). Although DCIS has been debated as being either a very early form of cancer in which the cells have just started to turn into cancer cells or a pre-cancerous condition due to its tendency to develop into an invasive cancer if it is not treated, women who have had this disease are identified as being more likely to develop cancer in one or both breasts and are more likely to develop more advanced forms of breast cancer. Statistics from 2002, the most recent year for which statistics were available, indicate a crude rate of breast cancer incidence among all UK residents as being 7.1, making it the number 1 ranking cancer in the UK. Specifically, the number of new cases in England were 35,047 of a population of 49,342,229; 2,359 in Wales with a total population of 2,911,958; 3,665 in Scotland’s population of 5,056,627 and 952 new cases reported in Northern Ireland’s 1,695,574 population for a total of 42,023 new cases in 2002 reported for the entire UK, population 59,006,388 (“Cancer Incidence” 2006). Initiatives RNA Interference One such initiative aimed at finding a way of curing cancers of many types including breast cancer is targeting research on the RNA Interference. This is a huge collaborative project being conducted in conjunction with the Netherlands Cancer Institute to systematically deactivate each of the 10,000 genes, one at a time, to discover exactly what each one of them does. The goal in mind is to find out how each of these genes might contribute to the development of cancer cells in the body. “Their ultimate aim will be to identify the cluster of genes which constitute the essence of cancer – likely to be ideal targets for new anti-cancer drugs” (“Charity” 2003). This ‘shutting off’ of individual genes is possible through the discovery of the RNA Interference, a process found in the nematode worm in which tiny pieces of double-stranded RNA are used to switch off specific genes which would otherwise cause the worm harm. Scientists discovered man-made RNA strands can also be used in humans to perform the same function. “Scientists from Cancer Research UK and the Netherlands Cancer Institute plan to use RNA interference to create cells in which all genes are fully functional bar one … The library of cells will be available for use throughout both organisations, allowing researchers to study the behaviour of cells in detail, and particularly how they respond to losing individual genes” (“Charity” 2003). It is hoped researchers will be able to discover through this research not only the genetic makeup of a malignant cell, but also to discover the “crucial group of cancer genes in the human genome” that revert to normal again because these “are likely to be extremely good targets for future anti-cancer drugs” (“Charity” 2003). Treatment initiatives The treatment process is similar in both the United States and Britain in that both countries approach the disease with a combination of surgery, chemotherapy and radiation treatment, but success rates in the United States are reported at the 85 percent level while success rates in the UK are only hitting an approximately 67 percent level. “That discrepancy, that missing 18 percent, translates into millions of lives” (Reiss 2001). The reasons given for this include a more aggressive approach in the United States that places extreme emphasis on early detection that allows clinicians to perform more biopsies on suspicious lumps and encourages them to try out new treatments as well as access to a greater variety of drugs, including those used to treat advanced breast cancer. “Memorial Sloan Kettering in New York, considered to be the leading cancer hospital in America, recommends a mammogram every one to two years for women over 40 – plus an annual clinical examination and monthly self examination. In this country, mammograms are not offered by the NHS until women are 50, and then are only given once every three years.” (Reiss 2001). It is suggested these greater awareness levels, both among clinicians and among women in the general population, are to be commended for having a significant impact on reducing the numbers of breast cancer related deaths. The UK also has another similarity to the United States in the access women have to medical care in treating breast cancer. Although “every woman in this country is promised comprehensive treatment regardless of her ability to pay” (Reiss 2001), the NHS remains woefully underfunded to provide the newest treatments available and women’s access to more effective medicines remains limited within the system. “Five-year data in the Lancet show anastrozole is better at preventing the spread and return of cancer than tamoxifen in postmenopausal women. Such women should be put on the drug immediately and any on tamoxifen switched, the authors recommend. But at about £1,000 a year compared to £20-30 for tamoxifen, it may be some time before it is free on the NHS” (“Advance” 2006). Yet the results seem overwhelming in favor of anastrozole. “Compared with tamoxifen, anastrozole increased disease-free survival by over 10 percent and increased the time to cancer recurring by around 20 percent” (Reiss 2001). According to Anna Wood with Breast Cancer Care (2006) agreed saying “inequalities in accessing new treatments also remain, particularly with respect to Herceptin for treating advanced breast cancer, which has proven benefits. Delays in accessing treatments influences survival, and could explain the regional variations. It is imperative that all patients in the UK receive equal access to treatment and care, on a par with the rest of Europe. There must be continued efforts in this area to make this happen.” Finally, research indicates that poorer women have lower survival rates from breast cancer from those women who are members of the more affluent sections of society (Wood 2006). Awareness/prevention Even with all the research and available healthcare, there remains the problem of making the public more aware of the importance of seeking early detection and treatment for breast cancer if the numbers of fatalities are to decrease. “Public awareness messages about cancer and its risk factors are not reaching all communities, directly impacting on patient outcomes. Breast Cancer Care is working hard to reach diverse communities through awareness-raising campaigns; however, greater resources and partnership working is needed for public health initiatives to be truly effective” (Wood 2006). A study conducted in 2001 agreed, saying “thousands of women are failing to seek early medical treatment for breast cancer because they are failing to recognise the first signs of the disease” (“Women Fail” 2001). More than simply not recognizing their symptoms for what they were, several women reported waiting to visit their general practitioner for at least three months after they first noticed something unusual because they simply didn’t want to bother him/her. Because this is a study conducted in London, it can be presumed the women involved in the study were comparably educated on the symptoms and importance of early detection of breast cancer as any of the other women in the country, yet they still failed to understand the dangers implicit in waiting for treatment. Caroline Burgess, lead researcher and research psychologist at St. Thomas’s [where the study was conducted], said the findings highlighted the need for more information to be made available. ‘This study suggests that the most important stage in the help-seeking process for women with breast cancer is the initial one, where the patient identifies and labels the symptoms. This suggests that the public perception of the presenting symptoms of breast cancer may need to be broadened.’” (“Women Fail” 2001). However, it is also important not to go over the top when broadcasting the dangers and urgency regarding breast cancer to avoid causing widespread hysteria. “A New York Times poll reveals breast cancer is the most feared disease among American women, even though strokes and heart disease kill far more. Some doctors fear this public awareness may lead to over-treatment, with women insisting on very aggressive therapies even when their cancers are small and slow growing” (Reiss 2001). Indeed, new DNA testing for the BRCA1 and BRCA2 genes, genes recently identified as having a possible link to breast cancer but that do not necessarily indicate the presence or definite onset of the disease, has become indiscriminate in the United States, which “has been blamed for spurring people into making unnecessary choices” (Reiss 2001). Effectiveness Despite the problems faced by current responses to breast cancer, its treatment, research and awareness, there have been significant improvements in the rates of breast cancer fatalities in recent years. Cancer Research UK (“Dramatic Improvement” 2005) is quoted as saying “Almost two thirds of all women newly diagnosed with breast cancer are now likely to survive for at least 20 years.” Seventy-two percent of those women most commonly diagnosed with breast cancer, those at the menopausal ages between 50 and 69, are now estimated to reach the 20 year survival mark while almost 80 percent are expected to at least hit the ten year mark. “Overall, women diagnosed in the early 1990s had around a 54 percent chance of surviving for more than 10 years and a 44 percent chance of surviving more than 20 years … the rates for today’s breast cancer patients are predicted to improve by between 17 and 20 percent. Newly diagnosed women are predicted to have a 72 percent chance of 10 year survival and a 64 percent chance of 20 year survival” (“Dramatic Improvement” 2005). Much of this improvement is attributed to the advanced screenings and increased awareness as well as a brighter outlook, helping those individuals who do find a lump feel less fearful about going to see their general practitioner. Professor Coleman with Cancer Research UK (“Dramatic Improvement” 2005), claims “Overall long-term survival for women with breast cancer has improved dramatically over the last 10 years and we are seeing even better survival statistics for women in their fifties and sixties” while Professor Tony Howell, Cancer Research UK consultant medical oncologist at the Christie Hospital, Manchester (“Dramatic Improvement” 2005), made the connection regarding taking some of the fear out of seeking treatment saying “These results are highly encouraging for women who are worried about their cancer coming back. They will also encourage women to go for mammography since women with screen detected cancers fare particularly well.” Indicating the success of research and prevention programs in bringing the numbers down, Dr Richard Sullivan, director of clinical programmes at Cancer Research UK (“Dramatic Improvement” 2005), said “women diagnosed today have a much brighter future than those who faced breast cancer a generation ago. Detection rates have certainly increased as a result of the breast screening programme … And breast cancer treatments have improved enormously thanks to the success of cancer research.” Indeed, programs are already underway to fix some of the inadequacies that have been identified in reaching breast cancer and possible breast cancer patients and their families. Although the UK screening system has been criticized as being inadequate thanks to the age at which mammograms are scheduled, Reiss (2001) reports this is a situation that has been under review and may change. “The whole issue of advocacy and campaigning is far better established in the American psyche than it has been in Britain. I feel this is changing now. This is partly because NHS policies state we have to speak to patients and involve them at the planning level. People are also more willing now to question their doctors and participate in decisions about their care.” Conclusion Breast cancer is a deadly and prevalent disease that affects primarily women in great numbers throughout the UK, with approximately one in every nine women experiencing some form of the disease within their lifetime. Although the causes and cures for breast cancer remain unknown, the UK has proved willing and able to participate and conduct studies that help identify and isolate specific genes and gene clusters that contribute to the development of the disease. Although they have occasionally been quicker to approve a new drug such as tamoxifen for the treatment of the disease, they have also proven slow in approving the use of other new drugs such as anastrozole and Herceptin that have proven to have strong effects in early and late treatment respectively. At the same time, access to these more effective drugs are not always equally available as the statistics continue to show a higher fatality rate with the disease among poorer class individuals than among women of a more affluent household. Also contributing to a higher rate of death among UK women as compared with women in the United States is a lack of awareness among women in the UK regarding the possible symptoms and importance of early detection, allowing many women to delay their initial appointment for fear of diagnosis and reducing their own chances for survival. However, research and new treatment programs have been proven effective in reducing the losses to breast cancer that were seen only ten years ago and increased screening and public awareness have led more women to seek treatment at earlier stages. This positive effect on the survival rate has further worked to help alleviate fears among women regarding diagnosis and demonstrated the benefits of early detection. Areas of weakness in terms of public awareness and prevention techniques are currently being reviewed and addressed in various ways, including changes in policies extending the ages for mammography, encouragement in approving new medications to treat the disease, continued support for research and increased public participation. References “Advance in Breast Cancer Treatment.” (8 December 2004). BBC News. Retrieved 1 March 2006 from < http://news.bbc.co.uk/1/hi/health/4075205.stm> AstraZeneca. (2003). “What is Breast Cancer?” Patient Health International. Retrieved 1 March 2006 from “Cancer Incidence Statistics by UK Country: Table 8.3: Persons.” (January 2006). Cancer Research UK. Retrieved 1 March 2006 from “Charity Launches Groundbreaking Initiative on RNA Interference.” (4 February 2003). Cancer Research UK. Retrieved 1 March 2006 from “Dramatic Improvement in Breast Cancer Survival.” (10 October 2005). Cancer Research UK. Retrieved 1 March 2006 from < http://info.cancerresearchuk.org/pressoffice/pressreleases/2005/october/81797> “Early Form of Breast Cancer on the Rise.” (25 January 2006). Cancer Research UK. Retrieved 1 March 2006 from Reiss, Madeleine. (22 November 2001). “A Question of Geography.” iVillage: iHealth. Retrieved 1 March 2006 from < http://www.ivillage.co.uk/health/whealth/cancer/articles/0,,181030_182752,00.html> Wood, Anna. (26 January 2006). “Comment in Response to the Public Accounts Committee Report.” Breast Cancer Care. Retrieved 1 March 2006 from < http://www.breastcancercare.org.uk/content.php?page_id=3024> Read More