Cancer incidence in women and men: breast and prostate cancer estimates

Breast cancer forms the second largest cause of deaths from cancer in American women. In the year 2015, roughly 232,000 women, mostly between 55 and 64 years of age, showed positive cancer diagnoses, with 40,000 succumbing to the disease. The median breast cancer-linked mortality age is 68 years. The US PSTF (Preventive Services Task Force) advises all females aged between 50 and 74 years to undergo screening mammography once every two years. Women may individually even decide to commence screening mammography before turning fifty. Those who set greater store by the potential advantages as compared to disadvantages of screening can even opt for screening once in two years once they turn forty. For those displaying average breast cancer risk, much of the benefits linked to mammography will result from two-yearly screening between 50 and 74 years of age. Of all age groups, the 60-69-year-old group displays the greatest likelihood of avoiding death due to breast cancer if they undertake mammography screening (U.S. Preventive Services Task Force, 2016).

Explain how the factors you selected might impact decisions related to preventive services

Genetic factors

High-risk women include those with cancer in the family (enough to elevate calculated lifetime cancer development probability above the 20 to 25 percent benchmark) or those with a known influencing genetic mutation. Preliminary population screening researches and researches on individuals suffering from breast cancer indicates that 10 to 15 percent of females with a significant family history are probably BRCA1/2 mutation carriers, with roughly 50% not aware of their carrier status. Screening is recommended for such individuals, along with genetic testing and counseling, risk-reduction surgery, chemoprevention counseling, and increased surveillance options in case the individual meets genetic or familial risk conditions (Padamsee, Wills, Yee & Paskett, 2017).

Ethnic factors

Evidence from research on health-related ethnic disparities maintains that inadequate knowledge on cancer, its symptoms, related services, and ethnic minority and African-American populations’ lower healthcare service access are factors contributing to their relatively lower cancer service utilization. Certain studies reveal that Black immigrants continue to be marginalized when it comes to health promotion, on account of the ‘migration effect’ (new immigrants might lack adequate knowledge of health programs, contributing to their lower service utilization and access). Experiences of stereotyping, racism, cultural and linguistic obstacles (which include screening guidelines failing to be culturally relevant) apparently lead to late diagnoses among ethnic minority and Black populations. Moreover, studies reveal that cultural and religious factors intervene and impact health behaviors of patients, including the perceived advantage of undertaking disease prevention efforts, the delay in seeking medical assistance, and treatment alternatives chosen (Bamidele, Ali, Papadopoulos & Gurch, 2017).

Describe drug treatment options for patients diagnosed with the type of cancer you selected.

Chemotherapy involves using drugs for the purpose of destroying cancer cells, typically through ending cancer cells’ growth and division capability. Chemotherapy might be performed in the preoperative stage as well (neoadjuvant chemotherapy), for shrinking large tumors and making operations easier. On the other hand, adjuvant chemotherapy (post-operative) aims at reducing recurrence risks. Breast cancer is treated via several kinds of chemotherapy (Cancer.Net, 2017). The most widely used drugs are:

· Cisplatin (Platinol)
· Carboplatin (Paraplatin)
· Capecitabine (Xeloda) (Cancer.Net, 2017)

Targeted therapy targets specific cancer genes, tissue or proteins aiding cancer survival and development. Such therapy is highly-focused and functions differently from chemotherapy, blocking cancer cell development and proliferation and simultaneously ensuring that very few healthy cells are damaged. Hormonal therapies were the foremost targeted treatments approved in case of breast cancer. Endocrine or hormonal therapy works successfully on a majority of tumors testing progesterone or estrogen receptor-positive. Such a tumor’s growth is fueled by hormones. Hormone blockage may deter breast cancer recurrence as well as death if used alone or following neoadjuvant or adjuvant chemotherapy. The drug, tamoxifen, prevents estrogen linkage to cancer cells, effectively reducing recurrence and distant recurrence risks (Cancer.Net, 2017).
After hormonal therapy gained approval, HER2-targeted treatments were approved, for treating HER2-+ breast cancer. The ‘trastuzumab’ drug has been approved in case of non-metastatic HER2-+ breast cancer. At present, stage I-III patients of breast cancer ought to be prescribed a trastuzumab regimen, usually combined with chemotherapy, after completing an adjuvant trastuzumab regimen for one year. Trastuzumab-prescribed patients display a 2-5% heart problem risk, which increases in case of the presence of other heart disease risk factors or with chemotherapy which simultaneously increases heart problem risks. These heart-related issues might disappear later and are curable with medicines (Cancer.Net, 2017).

Explain the short-term and long-term implications of these treatments.

Chemotherapy’s side-effects are governed by individual patient physiology, medication administered, and its dosage and schedule. Common side-effects are fatigue, infection risks, hair loss, appetite loss, diarrhea, and vomiting and nausea, which are normally successfully manageable or preventable during therapy using supportive medication. Also, they generally go away following treatment completion. Lasting side-effects like secondary cancer, heart damage or nerve damage seldom occur (Cancer.Net, 2017).

Hormone therapy’s side-effects are mainly dependent on treatment type and drug used. A widely-adopted switching approach for adjuvant treatment, where patients are prescribed tamoxifen for a 2-3 year period, and subsequently aromatase inhibitor (also for 2-3 years), can effectively balance these hormonal treatments’ harms and advantages. Commonly experienced hormonal therapy side-effects include vaginal dryness, hot flashes, and night sweats. Further, hormonal therapy disrupts premenopausal women’s menstrual cycle (National Cancer Institute, 2017).

While targeted therapy is usually linked to mild side-effects, some might be serious. Pertuzumab, ado-trastuzumab emtansine, or trastuzumab medication may cause heart damage and subsequent congestive heart failure in some patients. However, in most cases, the effect is of a short-term nature and the patient recovers after therapy completion. Heart problem risks are higher if the aforementioned medication is prescribed along with heart damage-causing chemo drugs like epirubicin (Ellence) and doxorubicin (Adriamycin) (American Cancer Society, 2018).

References

American Cancer Society. (2018). Targeted Therapy for Breast Cancer. Retrieved May 3, 2018, from https://www.cancer.org/cancer/breast-cancer/treatment/targeted-therapy-for-breast-cancer.html

Bamidele, O., Ali, N., Papadopoulos, C., & Gurch, R. (2017). Exploring Factors Contributing to Low Uptake of the NHS Breast Cancer Screening Programme among Black African Women in the UK. Diversity & Equality in Health and Care, 14(4).

Cancer.Net. (2017). Breast Cancer - Treatment Options. Retrieved May 3, 2018, from https://www.cancer.net/cancer-types/breast-cancer/treatment-options

National Cancer Institute. (2017). Hormone Therapy for Breast Cancer. Retrieved May 3, 2018, from https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet

Padamsee, T. J., Wills, C. E., Yee, L. D., & Paskett, E. D. (2017). Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Research?: BCR, 19, 34. http://doi.org/10.1186/s13058-017-0826-5

U.S. Preventive Services Task Force. (2016). Final Recommendation Statement: Breast Cancer: Screening - US Preventive Services Task Force. Retrieved May 3, 2018, from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1