Assignment: Epidemiological Analysis: Breast Cancer

Introduction (Identification of the problem) with a clear presentation of the problem as well as the significance and a scholarly overview of the papers content. No heading is used for the Introduction per APA current edition.

Background and Significance of the disease, to include: Definition, description, signs and symptoms. Incidence and prevalence of statistics by state with a comparison to national statistics pertaining to the disease. If after a search of the library and scholarly data bases, you are unable to find statistics for your home state, or other states, consider this a gap in the data and state as much in the body of the paper. For instance, you may state something like, After an exhausting search of the scholarly data bases, this writer is unable to locate incidence and/or prevalence data for the state of. This indicates a gap in surveillance that will be included in the Plan section of this paper.

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Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be specific.
Epidemiological Analysis: Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all of the 5 Ws: What, Who, Where, When, Why. Use details associated with all of the Ws, such as theWho which should include an analysis of the determinants of health. Include costs (both financial and social) associated with the disease or problem.
Screening and Guidelines: Review how the disease is diagnosed and current national standards (guidelines). Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and cost.
Plan: Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation. Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?) Note:â€¯ Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts. All interventions should be based on evidence â€“ connected to a resource such as a scholarly piece of research.
Summary/Conclusion: Conclude in a clear manner with a brief overview of the keys points from each section of the paper utilizing integration of resources.
The paper should be formatted and organized into the following sections which focus on the chosen chronic health condition.
Adhere to all paper preparation guidelines (see below).
Preparing the Paper:
Page length: 7-10 pages, excluding title page and references.
APA format currentâ€¯edition
Include scholarly in-text references throughout and a reference list.
Include at least one table that the student creates to present information. Please refer to the â€œRequirementsâ€ or rubric for further details. APA formatting required.

*When discussing screening and testing please include screening needs for the transgender population also.
* Discuss the sensitivity, specificity, predictive value, and cost of the screening for Breast Cancer

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Epidemiological Analysis: Breast Cancer

Breast cancer refers to epithelial tumors that involve the breast’s ducts or lobules. It is the second most commonly diagnosed cancer in females after skin cancers and the second leading cause of female cancer deaths globally (Siegel et al., 2022). This is a significant health problem owing to its associated morbidity and mortality rates. The purpose of this paper is to discuss breast cancer, including its surveillance and reporting, epidemiology, and screening guidelines, and to create a plan to address the problem by an NP.

Background and Significance of the Health Problem

Breast cancer is categorized into carcinoma in situ and invasive cancer. Carcinoma in situ is characterized by the proliferation of cancer cells within breast ducts and lobules but with no invasion of stromal tissue. There are two types of carcinoma in situ: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). DCIS accounts for approximately 85% of carcinoma in situ and is detected only by mammography. It involves a small or wide breast area (Wen & Brogi, 2018). On the other hand, LCIS is often multifocal and bilateral. It has two types, classic and pleomorphic. Classic LCIS is non-malignant but increases the risk of invasive carcinoma in either breast. It is a non-palpable lesion detected through biopsy and rarely visualized with mammography (Wen & Brogi, 2018). Pleomorphic LCIS acts almost like DCIS and should be removed to negative margins. Invasive carcinoma is mainly adenocarcinoma. Approximately 80% of invasive breast carcinoma is the infiltrating ductal type, while most other cases are infiltrating lobular.

Signs and Symptoms

The early stage of breast cancer is usually asymptomatic with no breast pain or discomfort. Most breast cancers are identified as a mass by the patient or during routine physical examination and mammography. If a mass is identified, the following may suggest possible breast cancer: Skin dimpling or breast skin changes, changes in breast size or shape, nipple inversion or skin change, blood-stained discharge in a single duct, and axillary lump. In situ and invasive carcinoma often manifests with breast skin changes, such as erythema, scaling, crusting, and nipple discharge (Wen & Brogi, 2018). Physical exam findings that warrant further investigations include lump or change in breast contour, skin tethering, inversion of the nipple, dilated breast veins, ulceration, breast edema, or peau d’orange.

Incidence and Prevalence

Data from the North American Association of Central Cancer Registries (NAACCR) (2021) shows that Illinois had a female breast cancer incidence rate of 133.7 per 100,000 from 2014 to 2018. This rate is higher than the national average of 126.9 per 100,000 over the same period (Siegel et al., 2022). Female breast cancer had the highest overall incidence rate, followed by Prostate and Lung cancer. Besides, female breast cancer was the second leading cause of cancer death after Lung cancer, with a mortality rate of 20.9 per 100,000 from 2015 to 2019 (Siegel et al., 2022). The mortality rate in Illinois was slightly higher than the national average, which was 19.9 per 100,000. There are an estimated 11,340 new breast cancer cases in 2022 in Illinois and 1,730 related deaths. The national approximated new cases of female breast cancer in 2022 are 290,560, while the estimated mortalities are 43,780.

Statistic	Illinois	United States
Incidence rate	133.7 per 100,000	126.9 per 100,000
Mortality Rate	20.9 per 100,000	19.9 per 100,000
Approximated new cases	11,340	290,560
Approximated 2022 mortalities	1,730	43,780

Surveillance and Reporting

The Illinois State Cancer Registry (ISCR) is the only source of population-based cancer data in Illinois. Cancer cases are obtained through mandated reporting by ambulatory surgical treatment centers, independent pathology labs, hospitals, non-hospital affiliated radiation therapy treatment centers, dermatologists, and via the voluntary exchange of cancer data with nearby states (Siegel et al., 2022). Healthcare facilities in Illinois are directed to report cancer cases within six months of the diagnosis date or within four months after a patient is discharged from the reporting facility. The NAACCR analyzes all state cancer registries in North America annually for the states’ performance in obtaining comprehensive, accurate, and prompt cancer data.

Descriptive Epidemiological Analysis of the Health Problem

What

Breast cancer is the most commonly diagnosed cancer in women globally, with approximately 2.26 million new cases in 2020. Breast cancer alone accounts for about 29% of all new cancers in women in the US. Although breast cancer is prevalent in females, it also occurs in males. Breast cancer in males accounts for roughly 1% of the total cases (Łukasiewicz et al., 2021. Women in the US have a lifetime risk of about 12% of developing breast cancer. The greatest risk occurs after 60 years, and the risk of dying from breast cancer is approximately 10% within five years after diagnosis.

Who

Older adults are mostly affected by breast cancer. The incidence of breast cancer greatly increases with age, becoming significant before 50 years. In the premenopausal years, the rate of increase in the incidence of breast cancer is common globally, at about 8%-9% annually (Łukasiewicz et al., 2021). The increase in breast cancer persists throughout the lifespan but is reduced significantly after menopause, to about 2%-3% annually. The female reproductive hormones are attributed to this dependent on menopausal status. Approximately 80% of women with breast cancer are above 50, while over 40% are women above 65 years. In men, the average age at diagnosis is 67 years.

White women aged 40 years and older have the highest incidence rate of breast cancer. However, statistics reveal a high prevalence of breast cancer among black women younger than 40 years than white women. After 40 years, white females have higher incidence rates. Nevertheless, Black females have worse 5-year survival rates from breast cancer in all age groups compared to whites (Łukasiewicz et al., 2021). The poor survival rate among Blacks is attributed to social determinants of health (SDOH) like access to health and healthcare. Black females tend to be diagnosed at advanced stages of the disease due to limited access to screening services (Feinglass et al., 2019). Besides, the uninsurance rate is higher in minority populations than in whites limiting their ability to access mammography screening and advanced breast cancer screening services.

Persons with genetic mutations related to breast cancer have an increased risk of breast cancer. For instance, people with BRCA1 and BRCA2 genes, primarily associated with an increased risk of breast carcinogenesis, have a higher incidence of breast cancer (Łukasiewicz et al., 2021). In addition, people with a positive family history of breast cancer have a high risk of breast cancer. About 13–19% of individuals diagnosed with breast cancer have a first-degree relative with the same disorder. The risk of breast cancer considerably rises with an increasing number of first-degree relatives affected, and the risk is higher when the relatives are below 50 years.

Where

The incidence of breast cancer has been escalating in most lower-risk nations and high-risk Western countries since the 1950s. The incidence rates have almost doubled in the past decades in traditionally low-risk Asian nations like Singapore, Japan, and the urban areas of China. The global incidence of female breast cancer varies significantly. The highest incidence is in the US and Northern Europe, followed by South America and Southern and Eastern Europe, and the lowest incidence is in Asia and Africa (Luo et al., 2022). The incidence rates of breast cancer in 2020 were highest in developed nations, but the mortality rates were highest in developing countries in Asia and Africa, accounting for 63% of total deaths. Most women who develop breast cancer in developed countries survive, while many women in most middle-income and low-income countries succumb to breast cancer.

When

Breast cancer incidence and mortality rates have escalated over the past three decades. Statistics show that from 1990 to 2016, the incidence more than doubled in 60/102 nations, while deaths doubled in 43/102 nations (Luo et al., 2022). Breast cancer statistics from 1975 to 2016 reveal a rise in the incidence rates of DCIS from 1983 to 1999 and then a relatively constant rate from 2000 to 2011, followed by a decrease of roughly 2.1% annually from 2012 to 2016. For invasive breast cancer, there was a sharp increase from 1987 to 2000 attributed to increased use of mammography, followed by a rapid decrease from 1994 to 2004 (Luo et al., 2022). The current projections show that by 2030 the global number of new incidences diagnosed will reach 2.7 million yearly, while the number of mortalities will reach 0.87 million.

How

Breast cancer is associated with various non-modifiable and modifiable risk factors. Women with a personal history of breast or ovarian cancer are at a higher risk of developing breast cancer. The density of breast tissue also correlates with the risk of breast cancer. Women with greater breast tissue density have a greater breast cancer risk, and this is observed in premenopausal and postmenopausal women (Łukasiewicz et al., 2021. Modifiable risk factors include Hormonal replacement therapy, consumption of processed foods, physical inactivity, overweight/obesity, excessive alcohol intake, tobacco smoking, inadequate vitamin supplementation, and high exposure to artificial light.

Screening and Guidelines

Breast cancer is screened using mammography, the only available approach for early detection of non-palpable breast cancer. Screen-film mammography (SFM) is considered the gold standard for screening breast cancer. SFM has a high spatial resolution that suits it for detecting microcalcifications (Farber et al., 2021). It is recommended to screen healthy females 50-74 years with no signs of breast cancer. Evidence shows that screening with SFM lowers breast cancer mortality, with a greater absolute decrease for women aged 50 to 74 years than for younger women. Nevertheless, Song et al. (2019) assert that screening women aged 40 to 49 years with an average risk for breast cancer is ineffective. Exposure to feminizing hormones puts individuals at risk of breast cancer. The difference between transgender and non-transgender women is the period of exposure to estrogens and progesterone. Guidelines recommend that breast cancer screening should not start in transgender women until at least five years of using feminizing hormones despite age (Deutsch, 2019). Furthermore, mammography is recommended every two years after a transgender woman reaches 50 years and the 5-10 years of use feminizing hormone criteria are met.

SFM uses X-ray radiation to generate breast images that are read and stored on film, creating room for false positives or inaccurate diagnosis. The breast is a complicated organ to conduct imaging due to tissues with varying densities and glandular tissue interspersed with fat. Consequently, SFM’s sensitivity in detecting carcinoma in dense breasts is reduced. SFM has a 62.9% reduction in sensitivity in dense breast tissue as opposed to 87.0% in breasts with fatty involution (Song et al., 2019). It has an accuracy of 92%. Full-field digital mammography is superior to SFM for characterizing round and irregular masses and low- and high-density masses. Furthermore, it is less cost-effective compared to the new digital mammography.

Plan of Action

The NP will address breast cancer in future practice through primary, secondary, and tertiary prevention methods. Primary prevention will include providing health education on measures to lower the risk of developing breast cancer by eliminating modifiable risk factors. This will include educating patients and the community on healthy lifestyle practices such as a healthy diet, regular physical exercises, cessation of smoking, limiting alcohol consumption, and taking foods rich in vitamins(Sauter, 2018). Secondary prevention will include recommending women 50 to 74 years have biennial screening mammography and following up on mammography results (Sauter, 2018). The NP will initiate prompt medical interventions for patients detected with early-stage breast cancer and refer them to the appropriate specialists. The intervention will be evaluated by measuring the number of patients screened for breast cancer.

In the tertiary stage, the NP will be involved in helping breast cancer patients and their caregivers to deal with the disease, including the side effects of treatment. Besides, the NP will help patients manage their behaviors and lifestyle habits to manage the disease better and promote better treatment outcomes. Depression and anxiety disorders are a major concern in breast cancer patients (Sauter, 2018). Therefore, the NP will screen patients for these disorders and refer them for psychiatric assessment and management. In addition, the NP will be involved in advocacy efforts to increase the accessibility of screening services for all populations. This will increase the number of individuals diagnosed with breast cancer at an early stage and initiated early treatment.

Conclusion

Breast cancer occurs when carcinogenesis occurs in a breast cell or tissue, causing pathological alternations that result in cancer. Illinois has breast cancer incidence and mortality rates higher than the national average. The most affected women are older adults, White women, and those with genetic mutations of BRCA1 and BRCA2. However, minority populations have a lower survival rate due to limited accessibility to screening services. Screen-film mammography is recommended in screening breast cancer in women aged 50-74 years. The NP will educate individuals on lifestyle practices to reduce the risk of breast cancer, recommend mammography, and assist patients in dealing with the disease.

References

Deutsch, M. B. (2019). Screening for breast cancer in transgender women. UCSF Center of Excellence for Transgender Health.

Farber, R., Houssami, N., Wortley, S., Jacklyn, G., Marinovich, M. L., McGeechan, K., Barratt, A., & Bell, K. (2021). Impact of Full-Field Digital Mammography Versus Film-Screen Mammography in Population Screening: A Meta-Analysis. Journal of the National Cancer Institute, 113(1), 16–26. https://doi.org/10.1093/jnci/djaa080

Feinglass, J., Cooper, J. M., Rydland, K., Tom, L. S., & Simon, M. A. (2019). Using Public Claims Data for Neighborhood Level Epidemiologie Surveillance of Breast Cancer Screening: Findings from Evaluating a Patient Navigation Program in Chicago’s Chinatown. Progress in community health partnerships: research, education, and action, 13(5), 95–102. https://doi.org/10.1353/cpr.2019.0042

Łukasiewicz, S., Czeczelewski, M., Forma, A., Baj, J., Sitarz, R., & Stanisławek, A. (2021). Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers, 13(17), 4287. https://doi.org/10.3390/cancers13174287

Luo, C., Li, N., Lu, B., Cai, J., Lu, M., Zhang, Y., … & Dai, M. (2022). Global and regional trends in incidence and mortality of female breast cancer and associated factors at national level in 2000 to 2019. Chinese Medical Journal, 135(01), 42-51. https://doi.org/ 10.1097/CM9.0000000000001814

Sauter, E. R. (2018). Breast Cancer Prevention: Current Approaches and Future Directions. European journal of breast health, 14(2), 64–71. https://doi.org/10.5152/ejbh.2018.3978

Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2022). Cancer statistics, 2022. CA: a cancer journal for clinicians. https://doi.org/10.3322/caac.21708

Song, S. Y., Park, B., Hong, S., Kim, M. J., Lee, E. H., & Jun, J. K. (2019). Comparison of Digital and Screen-Film Mammography for Breast-Cancer Screening: A Systematic Review and Meta-Analysis. Journal of breast cancer, 22(2), 311–325. https://doi.org/10.4048/jbc.2019.22.e24

Wen, H. Y., & Brogi, E. (2018). Lobular Carcinoma In Situ. Surgical pathology clinics, 11(1), 123–145. https://doi.org/10.1016/j.path.2017.09.009