Breast Cancer Treatment Breast Cancer Is Not

Breast Cancer Treatment

Breast cancer is not an illness which can be cured with medication, it is a fatal disease. If not detected at an early stage it is incurable. A famous Chinese proverb states "We cannot control the wind, but we have the power to adjust its sails"; in the same manner, we cannot prevent breast cancer, but it is in our power to take appropriate measures to reduce its fatality. Annual mammography screening is one of the ways to detect this disease at an early stage. Doctors recommend women to get it done at least once in a year. Despite all this, African-American women do not give much attention to this. Cancer screening, spreading awareness about its side effects and health related issues are concepts alien to these women. Such an attitude constitutes a major obstacle in the way of dealing with this disease. This article attempts to identify the liaison between social, psychological and cultural factors affecting women's ability to accept the bitter truth of life. This study takes into account even the tiniest details of this syndrome, starting with its side effects to making it curable in some way. This topic has proved to be quite famous amongst researchers who explored almost all possible areas, including the individual's reaction to dealing with the different challenges of life, most appropriate procedures for cancer screening and constituents of Health Belief Model (HBM) (Ries et al., 2002).

Background

The fatal disease of breast cancer prevails throughout the world. Approach of women regarding the existence of this disease varies in each region and this affects the mortality rates of the particular region. For example, research work highlighted an incompatible relationship between the fatality and prevalence rates of African-American women when compared to Caucasian-American women. Although frequency of this disease amongst Caucasian-American women is higher, the death rates of African-American women surpass the other (Ries et al., 2002) This inconsistency was first identified in 1976, and since then it has been reported frequently in various population-based surveys conducted by Surveillance, Epidemiology and End Results (SEER) program (Ries et al., 2003). This research also revealed that African-American women are more prone to the inception of this disease.

Studies show that low prevalence rates are inconsistent with the high fatality rates of African-American women. There is no reasonable explanation for this discrepancy. An attempt has been made to arrive to a rational conclusion by mentioning the advanced stage distribution amongst African-American women, but the actual question remains unanswered (Ries et al., 2002-03).

Contraceptives and Steroid Hormone (CASH) study focuses on the prevalence of breast cancer disease among African-American women. Although the factors behind high prevalence rates have been discussed, the study failed to establish the exact reasons for their existence (Mayberry, 1992; 1994).

Mayberry and Stoddard-Wright (1992) further investigated the CASH study to ascertain that the familial and gynecological factors affected the prevalence rates in a different way. The analysis was based on various breast cancer cases (a total of 3,934 Caucasian-American women, and around 490 African-American women) and its preventive measures (a total of 3,901 Caucasian-American women, and a total of 485 African-American women). The different factors taken into consideration include surgical menopause, family history and age at menarche. Family history had a greater effect on African-American women as compared to Caucasian-American women. This is evident from facts which state that the existence of breast cancer amongst first and second degree family history for African-American (odds ratios, 1.61 and 1.71, respectively) is greater than that of Caucasian-American women (odds ratio, 2.16 for first-degree relatives, and 1.44 for second-degree relatives). Along with this, African-American women have been noted to have an early age for start of menstrual cycle. Study reveals that this also increases breast cancer risk but fails to deduce a logical reason for this statement (Bernstein et al., 2003).

Another study relates the frequency of this disease with its age of inception and the resulting conclusions are worth having a look at (Ries et al., 2002; 2003). Theory indicates that the possibility of getting diagnosed with this fatal disease increases with age. Research contradicts with this point as the prevalence rate is higher for those African-American women who are younger than 45. Rates for Caucasian-American women in this age group are low on the other hand. Fifth decade is the meeting point for both ethnicities as prevalence rates are almost equal, but it does not last long. For women over the age of 50, the relationship graph takes a U-turn. Now, prevalence rates for Caucasian-American women are higher than those of African-American women. This relationship is also evident in numerical terms. According to statistics, only 20% of Caucasian-American women get diagnosed with this disease under the age of 50, whereas the percentage for African-American women is around 30-40% (National Cancer Data Base, 2004).

Regardless of the details and statistical facts, this is an observable fact that cannot be relied upon. This is because the notion was first introduced in 1960s (Krieger, 1990) and SEER program was initiated in 1970s. SEER program is the most deep-rooted and authentic program for the maintenance of cancer-based data in U.S.

The research conducted by Pathak and colleagues (2000) is amongst the researchers who took an initiative to explore the details behind the occurrence of breast cancer at an early age. This study builds a relationship between the postpartum period and premenopausal breast cancer risk. The study was based on an analysis that indicated that African-American women experienced child bearing at an early stage which results in breast cancer risk. Palmer and colleagues (2003) further contribute to these details by stating an interesting fact in The Black Women's Health Study. They identified a twofold connection between pregnancy and breast cancer risk. Early pregnancy increases breast cancer risk before the age of 45, but reduces the same risk when a woman crosses the age limit of 45 years.

Another factor for breast cancer is postmenopausal obesity (Colditz, 2000). In the non-existence of ovarian function, estrogen levels increase as a result of fatty tissue metabolism of adrenal gland steroids. This factor has been exploited by Flegal and colleagues (2003) who scrutinized the Third National Health and Nutrition Examination Survey (NHANES III) and identified that the ratio of obese women (body mass > 30) amongst African-American women under the age of 40 was more than 50%, and the ratio of overweight women within the same age group was more than 80%. The reasons behind this relationship are still undiscovered however. Although researchers have identified physical inactivity, and inappropriate intake of micro nutrients amongst the factors that lead to high risk of breast cancer, logical justification is still missing (Forshee, 2003). On the contrary, the prevalence rates in the postmenstrual age group are significantly lower for these women.

In spite of the innumerous efforts to avert this disease, the occurrence rates have taken an increasing trend since 1980s (American Cancer Society [ACS], 2005). Along with this, the inconsistencies between incidental and mortality rates for African-American and white women continue to rise. Based on the extensive research work, ACS anticipated that around 211,240 women in U.S. will be diagnosed with this disease and from this around 40,410 will lose their lives.

As mentioned earlier, the occurrence rate for African-American women is lower than that for Caucasian-American women (119.9 per 100,000 compared with 141.7 per 100,000), however, fatality rate for the same is higher. (35.4 per 100,000 compared with 26.4 per 100,000) (ACS) Although the actual reasons behind this inconsistency have not been documented, researchers have proposed a few in an attempt to resolve the query. These reasons include lack of awareness about cancer and the fact that it is curable, ineffective communication, lack of financial support and limited access to health care (Paskett et al., 2004; Schwartz, Crossley-May, Vigneau, Brown, & Banerjee, 2003; Smedley, Stith, & Nelson, 2003).

Problem Statement

Breast cancer is the top ranked disease amongst women (American Cancer Society, 2006a). Besides being the most popular form of cancer, it is also the major contributor to high ratio of cancer related deaths in U.S.. Following the increasing prevalence rates, it is projected that 212,910 women will be diagnosed with breast cancer in 2006, with 6,290 women in North Carolina (American Cancer Society, 2006a). The prediction for breast cancers started from 2005, and in the first year of prediction, 250 women were expected to be diagnosed with this syndrome (Central Cancer Registry & American Cancer Society, 2005).

Once a woman is diagnosed with cancer, the first question to consider is whether it is fatal or not. The answer lies in the stage at which cancer is detected. The disease is curable if detected at an early stage. This is evident from the fact that the ratio for endurance is 98% for those women whose cancer was diagnosed at an early stage as compared to 26% for those women whose cancer reached the advanced stage (American Cancer Society, 2005a). Research has revealed that African-American women mostly become victims of advanced stage cancer increasing the death rates for this demographic (Ghafoor et al., 2003; Li, Malone, & Daling, 2003). Once remedy for prevention of cancer was mentioned earlier, i.e. annual mammography screening. But when should a woman start the cycle of annual mammography screening. According to the extensive research work, annual screening should start at the age of 40 to reduce fatality rates (American Cancer Society, 2006b).

Work of HBM was concerned with different aspects of mammography screening. The first step was to identify the reasons behind women's attitude towards cancer screening. Therefore, a sample of women was selected to fill a questionnaire. The sample represented groups of women in favor of screening and women who oppose this. Results were concluded using relationships between different variables of HBM. Along with this, multivariable regression models were used to identify factors affecting social support and other constituents of the HBM model.

Purpose

This article intends to make a connection between social, psychological and cultural factors that have an impact on African-American women and their attitude to cancer treatment and annual screening. After establishing the factors, the next step is to explore the concept of annual mammography screening from every possible aspect. In order to achieve the main purpose, research work has been based on a variety of factors which can be changed according to different situations in order to arrive at a logical and reasonable conclusion. The factors include cancer fatalism, dispositional optimism, social support, perception of general health, components of HBM and mammography in the past year (Trochim, 2006).

This study was initiated with a survey conducted amongst older African-American women to discover the driving force behind their attitude to cancer screening and treatment. The area of focus was South Carolina and women under the age of 50 were encouraged to participate in this activity.

Assistance was provided by local hospitals and housing authorities who generated a list of low income houses and an estimate of the number of old women residing in that area. Housing unit managers invited women to participate after explaining the reason behind the study and coordinated with participants to arrange focus group sessions in these houses.

The session started with an opening speech about the objectives of the research work, and a formal and written approval was obtained from all participants. A questionnaire was distributed amongst the group containing two open ended questions. The questions were planned to incarcerate the extent to which women have accepted this bitter truth of life and their motivation levels to deal with the biggest challenge of life. It was also concerned about the way in which women prefer to receive such information. After the questionnaires were filled, participants were given details about cancer, cancer screening and locations at which they can get access to free mammograms.

Significance of the Study

Researchers have put in a lot of effort and hard work in order to reveal answers to the unanswered questions, and these efforts have been acknowledged widely. Works of various researchers have been compiled in this article to provide a complete picture of breast cancer, its hazards, treatment and its preventive measures. As the article focuses on African-American women, it helps to enhance knowledge about cancer treatment in that region. Also, it serves as the starting point for healthcare practitioners who can improvise community health programs targeted for African-American women to make them more effective. Nonetheless, the article is a valuable addition to the existing data on cancer treatment and annual screening among African-American women (Trochim, 2006).

Nature of the Study

Logically, reason for a particular theory can be looked at in two ways, using the deductive approach or using the inductive approach (Trochim, 2006). The deductive approach first considers the general and broad view which is then broken down to more specific sections. The strategy is similar to the top down method. For example, a canvasser will first work towards the basics i.e. having a clear idea about the general and basic concept of a particular topic. The second step is to explore different areas of this topic, to break down the topic into sub-topics, including the factors affecting it. Later, researcher uses various assumptions for further analysis. The results of these experiments are compiled to reach to a conclusion and this conclusion is linked to the main topic. The end result either confirms the theory or rejects it completely (Trochim, 2006).

The second method, inductive approach, is the complete opposite of the above stated theory. It can be termed as the bottom up approach which starts with specific sections and notion and works on those facts to present conclusions on a bigger picture. Here, the conclusion is taken as the starting point and work is planned to reach to a theory that confirms our findings. (Trochim, 2006)

Both approaches contradict each other. The deductive approach is mainly concerned with various assumptions and the experiments and factors are taken into consideration to justify that assumption. On the contrary, inductive approach is more concerned with findings and conclusion. Practically, both the theories are used concurrently. Instead of two separate graphs, researchers combine both theories to form a circular graph, and the concept is represented as an ongoing cycle, first breaking down the general concept into specific facts and then linking those facts to the main theory. Researchers have the ability to overcome limitations imposed by project and environment in order to come up with innovative ideas and theories (Trochim, 2006). This article mainly uses the deductive reasoning approach.

Designing research is time consuming work and requires a lot of effort and concentration. The first step is to define the scope of research, whether to base its research for a fixed time period termed as cross sectional research, or to focus on a study for a particular period of time, such as for 1-2 years. Such a research is termed as longitudinal research work. Longitudinal research is further broken down into two measurements, repeated measures and time series. Theory does not differentiate between the two methods. Based on practical examples it can be deduced that if less than two waves are used for measurement, it is classified under repeated measures. To be classified under the time series, many waves should be used for measurement (Trochim, 2006).

Minimum number of waves has not been mentioned in any research work. However, generally 20 are considered to be the borderline to be categorized under time series. The minimum number has been decided on the basis of practical examples. For time series, authors are required to use more than 20 observations in order to reach a reasonable conclusion. On the contrary, for repeated measurements such as ANOVA, the number of observations is usually less than 20. For the purpose of this article, cross sectional research is more appropriate (Trochim, 2006).

Surveys are the back bone of any research, and can be categorized in two ways, interviews or questionnaire. The only difference between the two types of surveys is the way in which it is conducted. Where one entails the use of written evidence, the other is a verbal one-on-one communication approach. However, for interviews to be effective the researcher has to bear additional expense of hiring an interviewer who has the required communication skills (Trochim, 2006).

There is a general perception that interviews contain open ended questions, giving the participant more room to present his view, whereas questionnaires are brief and relevant to the point only. In reality, it depends on the interviewer and the researcher setting questions for questionnaires. Even interviews can contain close ended questions and questionnaires can be designed in a way to allow the participant to present his views (Trochim, 2006).

The kingdom of survey research has turned over a new leaf in the last 10 years. Automated mechanism has been introduced to select numbers randomly for mobile phone interviews. For focus groups, group interviews have been innovated and new ideas are promoted. This has resulted in the rise of the concept of service delivery. Questionnaires are encouraged for this new concept as it is consistent with the mode of surveys (Trochim, 2006).

Conceptual or Theoretical Framework

This framework deals with the walls surrounded around the concept of screening that prevent women from entering inside. These obstacles include conveyance issues resulting from cost and transportation issues, not having access to health care facilities and insufficient information about cancer screening and its treatment. The most powerful obstacle in the way to improvement is perception of women who believe that the disease is incurable and a thing to be ashamed of, because people start looking at you with sympathy and regret (Jernigan, Trauth, Neal-Ferguson, & Cartier-Ulrich, 2001; Powe, 2001; Shankar, Selvin, & Alberg, 2002).

In today's world, people are so busy with their own lives that the disease of cancer and its risk of occurrence are normally overlooked by women. As a result, cancer screening is undertaken only when it is predicted. Therefore, it takes a crisis orientation approach rather than a prevention orientation approach (Shankar et al., 2002) Now, mammography screening is a requirement recommended by doctors when cancer is predicted and not part of normal health care routine as it should be (Powe, 2001). For it to be part of normal health care routine, it should be encouraged by health care providers, explaining to people that it does not mean something bad, but this is just a safety measure. Unfortunately, health care providers also ignore the need for annual screening which leaves the impression that it is just a waste of time and money. (Davis, Emerson, & Husaini, 2005; Lukwago et al., 2003; Powe, 2001)

Fatalism can be defined as a resignation to fate. Cancer fatalism is the principle that cancer is incurable and death is waiting for you ahead. With this belief in mind, women do not adopt a positive attitude towards mammography screening. Cancer fatalism is not a bud; it is a well grown tree having strong roots beneath. The idea of cancer fatalism emerges from the side effects of cancer and past experiences of cancer patients losing their lives in the process. Cancer patients go through a mixed feeling of helplessness and pain and feel that there is nothing good left for them in life (Powe, 1995b). With the passage of time, the roots are getting stronger and the idea of cancer fatalism is getting more and more popular amongst African-American women (Powe, 1995a; Powe & Finnic, 2003; Skinner, Champion, Menon, & Seshadri, 2002). Women over the age of 50 who come from a low income background are more affected by this principle as they do not have sufficient resources to gain access to knowledge about this disease and its treatment (Powe, 2001; Powe & Finnic; Powe & Weinrich, 1999).

On the contrary, even older women can promote cancer screening if they have adequate knowledge about the disease and if they know someone who has been diagnosed with this illness, regardless of the fact that he survived or not (Jernigan et al., 2001). Along with this, nature of a woman in general also influences the outcome. A pessimistic woman who only thinks about the worst outcomes will never be motivated about the mammography screening, as compared to an optimistic woman who always picks out the good things from every decision (Clarke, Lovegrove, Williams, & Machperson, 2000).

This article uses the HBM model to identify the reasons behind different attitudes of people. For example, some women perceive mammography screening as a health care procedure while others perceive it to be a punishment from God (Clarke et al., 2000). HBM model is based on an assumption that decision regarding health promotion is entirely dependent on the individual's perception of that particular disease.

This specific perception is based on an individual's knowledge about the disease and its effects on personal lives and health of that person. In order to promote precautionary measures, it is necessary that the positivity should take over the negative factors associated with these measures. HBM revolves around health behavior and the paradigm of HBM incorporates all kind of factors starting with social and economic factors to warning signs of illness and recommendation by health care professionals. In the last 10-15 years, the entire focus has been on African-American women and a variety of experiments have been conducted to analyze an individual's behavior and attitude towards cancer screening (Clarke et al., 2000; Gasalberti, 2002; Thomas-Vadaparampil, Champion, Miller, Menon, & Skinner, 2003).

Definitions of important terms

Breast Cancer - Breast Cancer is a famous non-skin cancer that is usually produced in the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk) of breast. Men and women both can be victims of this disease; however, the frequency of breast cancer amongst males is significantly low (Ries et al., 2003).