NURS 6700 Wk 8 Epidemiology of Breast Cancer
The chosen article discusses the benefits of screening for breast cancer using mammography and breast self-exam (BSE) and includes recommendations, rationales, and evidence that supports the proposal. NURS 6700 Wk 8 Epidemiology of Breast Cancer There has been a significant decrease in breast cancer rates in women in the United States due to early screening and advanced treatment. The U.S. Preventative task force (USPSTF) finds evidence that screening with film mammography reduces breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for women aged 40 to 49 years, with the strongest evidence for the greatest benefit is among women aged 60 to 69 years (2009). The reason for this is that false positive reports are more common for women aged 40 to 49 and a concern for over diagnosis in the older age group. There is also strong evidence associated with harms with teaching BSE and inadequate evidence with harms of clinical breast exam (CBE). The harms associated with breast screening include psychological, unnecessary imaging tests and biopsies, inconvenience due to false positive screenings, over diagnosis, unnecessary early treatment, and radiation exposure. NURS 6700 Wk 8 Epidemiology of Breast Cancer
The USPSTF currently recommends against routine screening of women aged 40 to 49 years, recommends biennial screening mammography for all women aged 50 to 74 years, and provides an I statement regarding screening of women older than 75 years (2009). It also recommends against teaching BSE. It does not make any recommendation regarding digital mammography and magnetic resonance imaging (MRI) as there is insufficient evidence about harms or benefits of methods.
According to the World Health Organization (WHO) risk reduction might be achieved with prevention, however, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries where breast cancer is diagnosed in very late stages (2018). Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control (WHO, 2018). Considering this and my own personal experiences of family members who passed away with breast cancer prior to the age of 40, I am not in agreement with the USPSTF recommendations. Family history and inherited genetic factors place women under the age of 40 at increased risk for breast cancer. These risk factor can easily be overlooked if women under the age of 40 do not get early screening. I am in accordance with the American College of Physicians recommended in 2007 that screening mammography decisions in women aged 40 to 49 years should be based on individualized assessment of risk for breast cancer; that clinicians should inform women aged 40 to 49 years about the potential benefits and harms of screening mammography; and that clinicians should base screening mammography decisions on benefits and harms of screening, as well as on a woman’s preferences and breast cancer risk profile (USPSTF, 2009).
A recent study that supports my position investigated the epidemiological and histopathological characteristics of breast cancer in Bangui. This was a retrospective study that collected records from pathological anatomy records from 2003 to 2015 of women with a mean age of 45.83, with a study population of 29.3% that was between the age of 45-54, most of the participants living in cities, and 64.9% having invasive ductal carcinoma. The study found that left breast cancer was mainly common and the time between first symptoms and consultation was 48 months (Balekouzou et al., 2016). Additionally, most of the women studied developed the disease in an advanced stage. This study supports my position as it finds that breast cancer is common among women between the age of 40-49 and by the time they receive a consultation the disease has advanced. The results of this study promote early detection to reduce the incidence of breast cancer. The data from this study is essential in moving policy forward in screening women beginning at age 40.
The USPSTF screening program is population-based as the screening test is recommended to all individuals above the age of 50. Some women may be within the high-risk category due to having a family history, specifically a first-degree relative. The USPSTF population-based screening test interferes with early assessment of the high-risk population.NURS 6700 Wk 8 Epidemiology of Breast Cancer
References
Balekouzou, A., Yin, P., Pamatika, C. M., Bishwajit, G., Nambei, S. W., Djeintote, M., … Koffi, B. (2016).
Epidemiology of breast cancer: retrospective study in the Central African Republic. BMC Public
Health, 16(1). doi:10.1186/s12889-016-3863-6
U.S. Preventative Services Task Force. (2009). Screening for breast cancer. Retrieved from
World Health Organization. (2018). Breast cancer: prevention and control. Retrieved from
http://www.who.int/cancer/detection/breastcancer/en/
NURS 6700 Wk 8 Epidemiology of Breast Cancer