Breast Cancer Screening - Research Paper Example

Breast Cancer Screening Introduction Approximately 12 percent of American women in their lifetime is affected by breast cancer - the second most common type of cancer (Humphrey, Helfand, Chan & Woolf, 2002). The risk of developing this disease increases with age. Thus, it is common in older women above 50 years of age. Many deaths associated with cancers are due to late detection that results in poor treatment outcomes. In order to prevent or improve the treatment of breast cancer, the U.S. Preventive Services Task Force recommended for every person between 50 and 74 years old to have a screening mammogram every two years. In addition, those of 40 to 49 years should contact their doctors and plan for testing. However, anyone with cancer symptoms should not hesitate in getting screening (Grol, Bosch, Hulscher, Eccles&Wensing, 2007). Like any other project, evaluation of this program for its performance is necessary as it would help in identifying areas of improvements and make it successful. Thus, the National Committee for Quality Assurance (NCQA) endorsed the measure, Breast Cancer Screening (BCS) and assessed it for its effectiveness. Using the process of clinical quality measures as the primary measure domain, NCQA determined the percentage of women who had undergone this process of mammogram screening. Both research and non-research based evidence were used to support the process. They included clinical practice guidelines, peer-reviewed clinical research, expert consensus, and one or more studies in the indexed and peer-reviewed journal of National Library of Medicine (NLM). As for any research, the inclusion and exclusion criteria of the participants were also critical to this performance measurement. It involved women aged 52 to 74 years who had undergone screening for breast cancer screening with mammography prior to or during the measurement year. Inclusions included one or two mammograms any time on or between October 1 two years before the measurement and December 31 of the measurement year. The medical factors played a significant role on the exclusions or exceptions. Those who had had a bilateral mastectomy during December 31 of the measurement year were not eligible for the study. In addition, other methods of screening such as biopsies, magnetic resonance imaging (MRI) and breast ultrasounds were not counted as they are not primary breast cancer screening. The Measure: Breast Cancer Screening (BCS) Breast cancer accounts for a quarter of new cancer cases among the U.S. women (Siegel, Naishadham&Jemal (2013). In 2012 alone, it claimed about 40,000 deaths and is the second leading of cancer deaths among women. The family history and age are the most significant risk factors for breast cancer in United States.However, about 85 percent women with no family history of breast cancer develop it (Siegel, Naishadham&Jemal, 2013). In addition, the breast cancer costs U.S. $7 billion dollars with late-stage treatment taking $2billion. As the condition progresses from one stage to another, it becomes even more difficult and expensive to treat. However, early diagnosis can result in better survival with five-year survival rate being 98.6 percent compared to those diagnosed late with survival rate of 24.3 percent. The patients’ access to mammography at least twice a year is necessary to reduce the morbidity and mortality due to breast cancer. Apart from eliminatingthe financial burden of treating breast cancer, it would also enable an appropriate screening of the average-risk women for breast cancer. Currently, there are three methods of breast cancer screening. They include mammograms, clinical breast exam (CBE) and the breast self-exam (BSE). In mammography, X-rays are used to examine the breast for cancer cells. CBE involves the doctor examining a woman’s breast for any lump, change in size or shape or any other abnormal change. On the other hand, an individual checks her breast for any symptoms of breast cancer in BSE. Of the three methods, mammography is the best method since it can detect breast cancer early when it is still too small. Thus, improving treatment outcomes and reduces deaths due to breast cancer. Mammography can be done at a hospital, clinic or doctor’s office. Despite its effectiveness in early identification of breast cancers, it is an expensive procedure and poses serious health risks to the patients due to over-diagnosis associated with it. The difficulty of differentiating between slow-growing and life-threatening cancers results in indiscriminate treatment with surgery, radiotherapy, and chemotherapy. One out of the five diagnosed cancers usually would not cause harm if untreated. In addition, four of the five women recalled for further tests turn out negative thus causing unnecessary anxiety (Esserman, Thompson, Reid, Nelson, Ransohoff, Welch &Srivastava, 2014). In cases where the mammograms cannot conclusively be used to detect breast cancer, other invasive methods such as biopsy can be performed to rule out cancers. The technique also uses X-rays that have been associated with radiation-related cancers that contribute to a small number of cancers every year. Strategies for Improving BCS and Quality of Care Outcome In order to reduce harms related to breast cancer screening using mammograms and improve patient outcomes, it is imperative to identify who to screen, what to use in testing and what to do when found with cancer. In identifying individuals to screen for breast cancer, a person’s family history and the lifestyle are paramount. Since there is evidence that breast cancer can be related to familial genes, frequent monitoring is required for women with faulty versions of individual genes such as BRCA1and BRCA2. According to Smith, Manassaram-Baptiste, Brooks, Cokkinides, Doroshenk, Saslow& Brawley (2014), identifying these high-risk individuals for regular mammograms compared to those with low risk has several benefits. It would lead to fewer false positives, fewer mammograms and lower levels of over-diagnosis. With the help of relevant agencies for quality improvement, better heath care can be offered by preventing and treating the leading causes of mortality. This goal can be achieved by prioritizing the health and well-being of communities. Systemic approaches can be used to improve the quality of care delivery and ensure reliable screening for patients. Increased insurance coverage, subsidized mammography services for low-income women and educational outreach to providers and the public have increased mammography rates (Grol, Bosch, Hulscher, MEccles&Wensing, 2007). The program, the National Breast and Cervical Cancer Early Detection (NBCCEDP), sponsored by CDC showed that community outreach, partnerships, and financial subsidy of the cost of testing improved mammogram screening rates. Evidence-based models such as Care and Critical Pathway have also been used to improve breast cancer screening. Care model approach involves implementing changes to improve care delivery. It focuses on the different aspects of care including the health care, clinical information systems, delivery system design, community, decision support, and self-management support. On the other hand, the Critical Pathway model focuses on the change areas for improvements. The integration of the health care into an organizational infrastructure aims to provide quality patient care. The patient information and breast screening results can be stored in databases known as the Clinical Information Systems (CISs). This data can be accessed by the providers and allow information sharing for a better care delivery. Through the delivery system design, tasks such as preparing paperwork for screening referral, putting reference in a chart and making appointments for patients can be accomplished. Communities also play a significant role in breast cancer screenings. An organization can partner with the community such as the local specialists to provide free screenings as well as providing patient education. Due to cultural differences where breast screening is not a common practice among many communities, it might fail to achieve its desired result. For this reason, providers and other staff require education on ethnic/cultural diversity and this can be reached through decision support. On the other hand, patient education can be provided through the self-management support where they would be informed of the purpose and procedure for screening. The three areas of Critical pathway include the patient, care team and the health system changes. Patient changes involve supporting self-management, promoting patient engagement and navigating the care system. On the other hand, the changes to the care team include redesigning the responsibilities, workflows to help in managing patients in a care and provide breast cancer screening based on evidence. Finally, the health systems should be changed to promote care delivery independent of the provider. It would ensure that the testing and the treatment services are offered regardless of the personnel present. The critical pathway model also identifies appropriate screening for risks for breast cancer in female patients early in their twenties as another way of improving breast cancer screening. It would ensure that patients at high risk of developing the condition are identified early for appropriate treatment. It acknowledges that patient education on the importance of regularly updating their care providers about their risks and active participation in decision-making. According to Grol, Bosch, Hulscher, Eccles&Wensing (2007), the critical pathway advocates for breast cancer screening in female patients of 20 or more years of age and providing them with educational resources. In addition, the identification of the barriers to breast cancer screening and addressing them with the patients would be of much significance. The care providers and the health system should promote breast cancer screenings for patients 40 years and above any time of the visit and ensure implementation of the testing protocols. More importantly, they should inform all the females the importance of periodic testing. The patients should also be encouraged to assist in self-management and developing strategies for overcoming barriers to breast cancer screening and risk assessment. The health professionals should also provide a responsible and culturally-competent patient education to support breast cancer screening. They can use the evidence-based guidelines for screening developed by the health system Shared decision-making based on risk is also important in ensuring quality care. Patient education on the importance would enable them to make informed decisions regarding the intervention. The team would also be able to share screening procedure, clinical guidelines, and the current care plans. Sharing this information with the patients would not only allow them access to services but also improves their treatment outcomes (Grol, Bosch, Hulscher, Eccles&Wensing (2007). The health systems should also provide a list of free or low-cost mammography services and developing routine mammogram referrals for patients. Technological advances have also been used to improve the quality outcomes. Digital mammogram that is better than the conventional 2D mammography has been developed. It uses computers to capture, manipulate and store the image rather than a film. It also offers better quality with lower X-ray doses, has a small storage space and can be re-analyzed by a range of sophisticated computer techniques. Barriers to improvements Some of the challenges experienced in improving breast screening in women of over 50 years arise from the program effectiveness, cost, feasibility, and acceptability. An effective breast screening program should be able to detect cancers more effectively with minimal harms. In addition, it must be affordable to be useful to the health systems and shows a broad range of applicability. Since its use is going to involve various people including the public, the health professionals, and the policymakers, it should be acceptable to them. Lack of insurance and costs present a significant challenge to patient testing. Addressing this problem requires organization to put more resources at the community level to offer mammography screening at a reduced cost, thus creating a partnership in patient care. Performance Measurement of Breast Cancer Screening Performance evaluation is critical to the success of this program as it helps to identify room for improvement. Based on the evaluation, an organization would improve its systems so that all women of the appropriate age and average risk have access to regular breast cancer screening, thus increasing screening to all women. According to Grol, Bosch, Hulscher, Eccles&Wensing (2007), an effective performance measure should be relevant, measurable, accurate, and feasible. this program should measure the occurrence of breast cancers and have an impact on the patients. The approach of measuring the program should be realistic and efficiently quantified with the available resources. In order to ensure accuracy and validity, it should be based on accepted guidelines or formal consensus. Finally, it would only be feasible if it can be improved with the limited clinical services and patient population. Meeting these characteristics are often based current evidence-based guidelines and proven measures. Conclusions The early detection of breast cancer results in a varied range of treatment options, thus reducing treatment cost and the risk of succumbing to the disease. Regular mammograms also eliminate the need for mastectomy or chemotherapy. Screening of women at higher risk such as those with a prior history of breast cancer, certain familial syndromes, and specific genetic markers should be done at an earlier age. In addition, health insurance is essential to reducing the cost associated with screening and treating breast cancer. References Esserman, L. J., Thompson, I. M., Reid, B., Nelson, P., Ransohoff, D. F., Welch, H. G., ...&Srivastava, S. (2014). Addressing overdiagnosis and overtreatment in cancer: a prescription for change.The lancet oncology, 15(6), e234-e242 Grol, R. P., Bosch, M. C., Hulscher, M. E., Eccles, M. P., &Wensing, M. (2007).Planning and studying improvement in patient care: the use of theoretical perspectives.Milbank Quarterly, 85(1), 93-138 Humphrey, L. L., Helfand, M., Chan, B. K., & Woolf, S. H. (2002). Breast cancer screening: a summary of the evidence for the US Preventive Services Task Force. Annals of internal medicine, 137(5_Part_1), 347-360 Siegel, R., Naishadham, D., &Jemal, A. (2013).Cancer statistics, 2013.CA: a cancer journal for clinicians, 63(1), 11-30 Smith, R. A., Manassaram-Baptiste, D., Brooks, D., Cokkinides, V., Doroshenk, M., Saslow, D., ...& Brawley, O. W. (2014). Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening.CA: a cancer journal for clinicians, 64(1), 30-51 Read More