Educating Women about Mammography Screening for Diagnosis and Cancer Treatments - Literature review Example

BREAST Introduction This research reviews a condition pathway through breast care services (all relevant departments), engaging in critical analysis and evaluation of the services, treatment and interactions, and using clients’ experience in the published literature. This research also deals with the condition of breast cancer and the role of screening for breast cancer, including mammography screening for diagnosis. There is a large and diverse body of extant literature on the subject of breast cancer, and this literature approaches the cancer from many different perspectives. The interest of this paper lies in examining screening and detection, treatment options, and factors related to pathology of the cancer. The report advocates the position that mammography screenings for diagnosis are a way of combating the disease in a specific as well as a general population, and there are critical and scholarly articles in existing literature that also approach the subject from this perspective. “High incidence of breast cancer, coupled with the availability of improved methods for early detection, has spurred the development of several interventions aimed at increasing women’s use of mammography screening” (Finney and Iannoti, 2005, 133). With increases in medical technology, patients can see the benefits of better results. Breast screening Breast screening can be accomplished in a number of different ways and in different locations, including static units like hospitals and mobile units. Generally, effectiveness and time for each client differs according to the standard of care, and client communication and empathy skills remain very important to establish the link and helping relationship. In terms of screening and detection, it is important that breast cancer is detected early if the most effective treatments are to be given to the condition. Studies show that women tend to develop the cancer in the middle and late-middle ages, showing that detection and prevention efforts in terms of screening should start before this life stage. Moore pointed out further that the incidence of breast cancer doubles between the ages of 40 to 44 and 45 to 49, “at the same time mammography finds earlier and slower growing cancers with generally better prognoses. Optimal frequency of mammographic screening for women in their forties has not been determined, Moore noted, adding ‘I offer mammograms on an every other year basis to all women in their forties’” (Finney and Iannoti, 2005, 138). In another part of the article, the authors come across another source, Kern, and also presents this other doctor’s point of view. Physicians are tempted into the misdiagnosis of breast cancer by the young age of patients and false negative readings of mammography, “not by vague findings or difficult diagnostic situations. Kern advised liberal use of fine needle aspiration, and core and open surgical biopsy when a palpable mass exists to help avoid diagnostic delays and lawsuits” (Finney and Iannoti, 2005, 144). What Finney and Iannotti are basically doing is to get together a lot of theory and then test it in reality, regarding the vital importance of breast cancer screening measures. In terms of the importance of screening, it is important to make a firm connection between the world of theory and the real world of healthcare delivery. In critique, this method of research presents a balanced perspective and lets many voices be heard, but often provides a difficult forum to see what side of the issue the authors himself or herself advocate. Nonetheless, this method of research can give indications to the issue at hand because it approaches these issues through the reportage of different involved entities. “Comprehensive community health promotion models typically combine community organization and citizen participation principles with behavioral theories to address ways to generate change at the individual and policy levels” (Finney and Iannoti, 2005, 144) . Different communication paradigms exist between the policy level and the individual level in making an effective community awareness program about breast cancer screening and how important early detection is in finding effective treatments for the condition. Breast assessment clinics Breast assessment clinics offer many services, such as FNA, wire localization, cyst aspiration, and other services. There are also different sorts of clinic, including Rapid Assessment Clinics. There are various services available therein such as Sterotactic core assessment, and care is easily personalized using multidisciplinary meetings. Breast assessment clinics tend to give basic services and also provide education. Breast cancer is a basically medical problem that is crying out for a cure or a way of easing symptoms, but the condition also needs someone to cry out about it on behalf of others in a way that is positive for survivors and high risk groups. Therefore it is very important to address this problem at the level of assessment clinics and make sure that everyone knows what risk factors are and how to get a mammogram. In one study under review, the authors “interviewed women who were 35 to 64 years old. A total of 4575 women with breast cancer and 4682 controls were interviewed. Conditional logistic regression was used to calculate odds ratios as estimates of the relative risk (incidence- density ratios) of breast cancer” (Young and Kitou, 2005). The authors found that, “Among women from 35 to 64 years of age, current or former oral-contraceptive use was not associated with a significantly increased risk of breast cancer” (Young and Kitou, 2005). I also personally believe that complimentary and non-Western medicine is an area that should be looked into in terms of easing symptoms, and that we should not take a narrowed cultural view on how to treat this problem also in terms of community education. This is not something that was inherent to Young and Kitou’s analysis, however, which instead focused on other factors that were relevant to mammography screening for diagnosis. However, this would make a more interesting topic for future research. Techniques like fine needle aspiration are given at assessment clinics, which “is where cells are drawn off using a fine needle and syringe. The sample is sent to the laboratory where it is looked at under a microscope. Sometimes the result is available the same day, the doctor or nurse in clinic will be able to tell you when your result will be ready” (Breast, 2009). It is important to view the role of the clinic as proactive in terms of services. There is a lot of talk about breast cancer advocacy and the social sides of cancer suffering and how it impacts life and its representation in society through the clinic setting. It is also important to understand that breast cancer is also and perhaps at its fundamental roots a medical rather than a social problem. This is not to say that activism is not encouraged or that the history of breast cancer treatment and awareness may not show a point of interest and concern, but to ignore the medical side of the problem and focus exclusively on the social aspect is to only see half, if that, of the picture. Clinic settings therefore need to focus as mentioned above on prevention as well as treatment, and on ways that detection can reduce the high rates of breast cancer in women, in terms of presenting solutions to the problem rather than commentary or reasons, working from portrayals of the problem in existing literature and working towards an understanding of the problem and its solutions through these perspectives and theories. “Although the rising incidence of breast cancer has prompted a surge of intervention strategies aimed at increasing women’s use of mammography screening, the majority of patient directed interventions have not been driven by theoretical work” (Wells and Roetzheim, 2007). Screening remains an important part of detection and awareness, but there also needs to be a real world frame in which breast assessment clinics provide a vital link on the chain of knowledge. Pathology In terms of pathology, it is vital that breast cancer professionals, including nurses, work in league with their breast pathologists to instigate and format a report that will result in a situation where there is consistent and relevant information and communication with the patient. Especially since cancer is such a devastating diagnosis in the first place, many patients go seeking a second opinion, so it is important to review cancer tissue pathology reports in a macroscopic manner. “It should be noted that only the original pathologist has the opportunity to view and describe the original piece of tumor. After this description is completed, the tumor is sliced into smaller pieces to make slices for further microscopic examination of the tumor” (Lee and Strickland, 2003, 153). These slides can then be reviewed by any competent and qualified healthcare professional to check the cancer. Pathology is doubly important when one considers the essentiality of the description of the cancer, and what this means to the professionals involved in the process. That is, without communication at every step in the process, things can be dropped like descriptions and slides, so that doctors will not be able to talk about the best future with their patients. In general, a typical breast cancer pathology report contains a preoperative diagnosis, a microscopic description, a description of the cancer cells themselves, a diagnosis, a localization on the patient’s anatomy, the stage and grade of the cancer, calcium deposit presence, axillary lymph node tissue, and possible spread of the cancer to the lymph nodes (a bad sign). “The vast majority of breast cancer originates from the lining cells (epithelium) of the breast duct or the secretory cells at the terminal end of the breast duct. These malignancies are termed carcinomas” (Lee and Strickland, 2003, 154). Reasonable conclusions from a pathology report could include the conclusion that a patient is a good candidate for a certain type of therapy such as breast conservation therapy, to reduce the risk of systemic spread. This is why pathology is so important. Regarding triple diagnosis, non operative tissue diagnosis, and issues of why cytology specimens (FNA) itself is insufficient and Histology specimen are good, there are still factors of false negative and human error, so all tests must be done to avoid a compromise of care. Factors relating to the pathology of breast cancer are not fully understood, and there is a wide range of theories ranging from genetics and heredity to the susceptibility of certain groups through socio-economic or physical living conditions. This is the focus for a lot of investigations on breast cancer and mammography, including Fowler and Wells and Roetzheim’s emphasis on accessibility and susceptibility. In terms of different groups being susceptible, “Minority women such as West African women have a lower incidence of breast cancer; however, they have a higher mortality rate when compared to Caucasian women. Recent data have indicated that the five-year survival rate for breast cancer among West African women is 73% compared to 88% among Caucasian women” (Wells and Roetzheim, 2007). This shows a difference in incidence. Treatment Regarding treatment, as with many cancers, the choice is generally between the operating theatre, chemotherapy, and radiotherapy. There are other choices as well. The operating theatre option involves Lumpectomy or mastectomy. Radiotherapy involves planning and delivery of targeted therapy, staff attitudes, patients’ experience, and the clarity of presented alternatives to Radiotherapy. As with most cancers, there are various treatment options for breast cancer. In terms of holistic treatment on a community level, breast cancer should be treated in a way that shows the need for staged interventions to raise awareness about the condition and treatment options. This is coming from a perspective on healthcare and health promotion that emphasizes the need in communities for the type of coordinated intervention that can target different levels and therefore maintain high relevancy in different populations and their demographics, including socio economic issues. In other words, as Poplack et al. note, “The viability of screening mammography may depend on the economics of breast imaging service provision. Increasing demand for mammography may outpace current levels of technical and professional staffing and result in access problems” (2005, 23). This is a serious problem because from a social-ecological perspective of community health care and promotion, there is the need to reach all clients, not just some, or not just those who can afford services. At the same time, it must be remembered that in this kind of model, the client is at the center of care, so there has to be planning about the client in their environment, which is the community or locality where the breast cancer screening measures are being given. In terms of mammography screening for diagnosis from this perspective, as this source and others point out, it is often a social and community issue for problem-solving, as well as a healthcare one, for meeting the needs of the client, which are supposed to be priority number one. In terms of perspectives during the process of diagnosis, treatment, and prognosis of breast cancer, it is important to emphasize results. In Johnson’s study, the women were all post treatment one year of breast cancer and volunteered from a cancer support group in the southeast Texas area. This qualitative and descriptive study looks into the positive effects of humor on breast cancer survivors’ coping and spirituality. There is a fair case made for doing the study, and the author has cited both medical and nursing research on the topic. “Nursing and medical programs are incorporating humor into patient care and encouraging clinicians to laugh with their patients to help them relieve stress and spiritually uplift them” (Johnson, 2002, 691). Other authors state that, “Comprehensive community health promotion models typically combine community organization and citizen participation principles with behavioral theories to address ways to generate change at the individual and policy levels” (Altpeter et. al, 1998, p. 104). These authors show how in terms of holistic treatment on a community level, breast cancer should be treated in a way that shows the need for staged interventions to raise awareness about the condition and treatment options. “The social-ecological perspective of community health promotion emphasizes the need for coordinated interventions targeted at several levels of the community, ranging from individuals and their social networks to institutions and policymakers” (Altpeter et. al, 1998, p. 106). One of the last options for many with breast cancer is the chemotherapy option. “Chemotherapy is usually given after surgery, and before radiotherapy. It usually starts between three and four weeks after surgery, giving your body some time to recover from the effects of the operation” (Chemotherapy, 2008). Chemotherapy is often very difficult and rough on an individual’s system. Role of nursing professional The role of the breast care nurse is that of a caring professional, and is different from that of a normal nurse in that the breast care nurse provides vital empathy and caring for the patient directly. “Breast cancer patients repeatedly emphasised the importance of the role of their breast care nurses throughout their experience of breast cancer. The support that breast care nurses provided incorporated the following components: communication, rapport and an awareness of the women's needs, availability, reassurance and practical information” (Wilkinson, 2000). Throughout the patients journey, the breast care nurse needs to realize how it is important to bring the problem back down to the immediate level of caregiver-client interaction through treatment, which is where real change can happen in terms of the caregiver being able to recommend mammography screening for diagnosis for the population of clients and the clients being able to take this and reach a healthier outcome. However, there are, as authors above have mentioned, often logistical problems that are more complicated than this outwards social theory perspective would hold. “Mammographic screening for breast cancer can be a complicated process. While the majority of women undergo a single examination that involves bilateral mammographic views, an important subgroup undergo supplemental imaging, clinical evaluation or biopsy” (Poplack et al. 2005, 23). Note, however, that for the majority, the examination is rather simple. What may be even more simple, as some other research notes, is the propagation of BSE (Breast Self Exam) knowledge. Conclusion The objectives of the current report in terms of the healthcare setting has been to measure ways in which the helping relationship between practitioner and client can be facilitated by educating women about mammography screening for diagnosis and cancer treatments. This is done in this case by increasing worker and environmental cognizance of unique issues facing women dealing with breast cancer. This process takes place on many systemic levels, including the ability of the nurse or other healthcare professional to show core values of empathy and understanding for client populations. This process of communication will optimally result in a situation in which, for the client, there will be positive communication in terms of disclosure and also a higher than normal rate of trust and empathy between the client and the caregiver. Trust must be established with this sort of client before overtures toward empowerment are made effectively. From this point, treatment can proceed. This is why communication is so important among healthcare professionals. This is a fairly polemical and activism-oriented portrayal of breast cancer as a primarily social problem, but it is also important to remember the medical nature of the problem itself. This is more clearly put forth in the work of other authors who draw links not between social activism and breast cancer, but between social context, BSE education, and breast cancer survival rates, and the context and relevance of survival variables. REFERENCE Dixon J.M.(2000). ABC of Breast Diseases. BMJ Books. Finney, L and R Iannotti (2005). Message framing and mammography. Behavioural Medicine 12(2) 133-154. Fowler, B (2000). Variability in mammography screening legislation. Journal of Woman’s Health 38(4) 1628-1637. 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