Black women in Boston have higher breast cancer mortality rates than white women, with a rate of 31.1 deaths per 100,000 Black women compared to 24.8 per 100,000 white women from 2001-2012. A key factor contributing to this disparity is that minority and underserved women are often unscreened or screened infrequently for breast cancer due to logistical, personal, and provider-related barriers like lack of transportation, fear of procedures, and not receiving recommendations from providers for mammograms. The Dana-Farber Mammography Van aims to address these inequities by providing mobile mammography services in diverse Boston neighborhoods to improve access to screening, especially for low-income, elderly, immigrant and non
In Latin America, cancer and its control present often stark contrasts—or, in the words of one expert interviewed for this study, “light and shadow”. Rapid change occurs next to stubborn stasis, and substantial progress in some areas is intermingled with still unmet, pressing needs in others.
It is also an issue with growing political salience within the region: past success in the control of communicable diseases has increased the relative profile of non-communicable ones.
This study looks in detail at both the bright spots and the ongoing gaps for Latin American governments as they wrestle with cancer and seek to provide accessible prevention and care to their populations. Its particular focus is on 12 countries in Central and South America chosen for various factors, including their size and level of economic development. These states, referred to as “study countries”, are Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Paraguay, Peru and Uruguay. Together they accounted for 92% of cancer incidence and 91% of mortality in Central and South America in 2012.
The study also introduces a major tool for stakeholders seeking to understand this field: the Latin America Cancer Control Scorecard (LACCS). The LACCS relies on significant desk research to rank the 12 study countries on their performance in different areas of direct relevance to cancer-control access. In addition to the scorecard, the report also draws on its own, separate substantial research as well as 20 interviews with experts on cancer in the region and worldwide. Its key findings include the following.
In Latin America, cancer and its control present often stark contrasts—or, in the words of one expert interviewed for this study, “light and shadow”. Rapid change occurs next to stubborn stasis, and substantial progress in some areas is intermingled with still unmet, pressing needs in others.
It is also an issue with growing political salience within the region: past success in the control of communicable diseases has increased the relative profile of non-communicable ones.
This study looks in detail at both the bright spots and the ongoing gaps for Latin American governments as they wrestle with cancer and seek to provide accessible prevention and care to their populations. Its particular focus is on 12 countries in Central and South America chosen for various factors, including their size and level of economic development. These states, referred to as “study countries”, are Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Paraguay, Peru and Uruguay. Together they accounted for 92% of cancer incidence and 91% of mortality in Central and South America in 2012.
The study also introduces a major tool for stakeholders seeking to understand this field: the Latin America Cancer Control Scorecard (LACCS). The LACCS relies on significant desk research to rank the 12 study countries on their performance in different areas of direct relevance to cancer-control access. In addition to the scorecard, the report also draws on its own, separate substantial research as well as 20 interviews with experts on cancer in the region and worldwide. Its key findings include the following.
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
The presentation begins with a brief history of how cancer epidemiology evolved, and what is the status at present. After describing the burden of the disease of cancer globally and in India, the presentation includes a brief description of Cancer causes and prevention including screening activities. It also talks about the national Cancer Registry Program, NPCDCS and NCCP.
Cost-Effectiveness of Contralateral Prophylactic
Mastectomy Versus Routine Surveillance in Patients
With Unilateral Breast Cancer
Benjamin Zendejas, James P. Moriarty, Jamie O’Byrne, Amy C. Degnim, David R. Farley, and Judy C. Boughey
Cancer de mama
Clinica Ruber
Dr Juan Carlos Meneu
Burden of Cervical Cancer & other HPV Related Diseases : Indian Perspectiv...Lifecare Centre
HPV RELATED DISEASES
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. HPV causes virtually 100% of cervical cancer cases
There is growing evidence of HPV being a relevant factor in other ANOGENITAL CANCERS (anus, vulva, vagina and penis) and head and neck cancers.
HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts
One in 77 women will be diagnosed with ovarian cancer. ISR examines risk factors, prevalence, and the prognosis of ovarian cancer in this infographic.
More at: http://www.isrreports.com/free-resources/ovarian-cancer-profile/
Alex de Carvalho covered why visual storytelling is so effective. He provided a comprehensive review of how two disciplines; visual media and storytelling converge in our brain for maximum impact. His tips offered our audience actionable advice on how to develop a sound visual storytelling strategy. Alex presented at the Visual Storytelling Summit 2016.
Agile Transition in Trouble? Using the Kotter Change Model as a Diagnostic ToolAlistair McKinnell
Agile transitions tend to imply organizational change. According to change expert John Kotter 70% of all major change efforts in organizations fail. Is it any wonder that so many agile transitions deliver only lukewarm results?
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
The presentation begins with a brief history of how cancer epidemiology evolved, and what is the status at present. After describing the burden of the disease of cancer globally and in India, the presentation includes a brief description of Cancer causes and prevention including screening activities. It also talks about the national Cancer Registry Program, NPCDCS and NCCP.
Cost-Effectiveness of Contralateral Prophylactic
Mastectomy Versus Routine Surveillance in Patients
With Unilateral Breast Cancer
Benjamin Zendejas, James P. Moriarty, Jamie O’Byrne, Amy C. Degnim, David R. Farley, and Judy C. Boughey
Cancer de mama
Clinica Ruber
Dr Juan Carlos Meneu
Burden of Cervical Cancer & other HPV Related Diseases : Indian Perspectiv...Lifecare Centre
HPV RELATED DISEASES
Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. HPV causes virtually 100% of cervical cancer cases
There is growing evidence of HPV being a relevant factor in other ANOGENITAL CANCERS (anus, vulva, vagina and penis) and head and neck cancers.
HPV is also responsible for other diseases such as recurrent juvenile respiratory papillomatosis and genital warts
One in 77 women will be diagnosed with ovarian cancer. ISR examines risk factors, prevalence, and the prognosis of ovarian cancer in this infographic.
More at: http://www.isrreports.com/free-resources/ovarian-cancer-profile/
Alex de Carvalho covered why visual storytelling is so effective. He provided a comprehensive review of how two disciplines; visual media and storytelling converge in our brain for maximum impact. His tips offered our audience actionable advice on how to develop a sound visual storytelling strategy. Alex presented at the Visual Storytelling Summit 2016.
Agile Transition in Trouble? Using the Kotter Change Model as a Diagnostic ToolAlistair McKinnell
Agile transitions tend to imply organizational change. According to change expert John Kotter 70% of all major change efforts in organizations fail. Is it any wonder that so many agile transitions deliver only lukewarm results?
The End of the Story - Transmedia Storytelling for Corporate CommunicationMeaning Business
IABC14 Presenation on transmedia story worlds for corporate communication. To listen to the audio of this presentation, check out Soundcloud: https://soundcloud.com/meaningbusiness/meaningbusiness-storyworld-presentation-iabc14/s-wtLwN
The 5.5 questions behind your strategic narrativeWayne Aspland
A strategic narrative is the ‘storification’ of your organisation, brand, project or team’s identity. A simple, inspiring narrative can help everyone around you get, buy, live and share what you’re trying to achieve... together.
Developing your Core Marketing Messaging - A One-Page Framework, by Maggie BarrKat & Mouse Co.
This presentation gives you the steps for developing the key marketing messages you will use for your entire companies marketing materials, or for an entire campaign's marketing materials. Steps include: defining your target customer, understand their options, researching competition, developing your competitive positioning, and writing a messaging framework.
If you would like more information about Kat and Mouse Co. and our internet marketing services, please contact us at www.katandmouse.com, or call us at 408-647-2327.
The Message Map is a visual aid. It allows you to prepare and to organize answers to the questions you are most likely to hear from the news media and from the public during a crisis. It is based on research that looked into how people process information when they are under stress.
SUO_HCM4004_W2_A2_Estevez_Maria.docxby Maria Estevez.docxpicklesvalery
SUO_HCM4004_W2_A2_Esteve
z_Maria.docx
by Maria Estevez
FILE
T IME SUBMIT T ED 24 - JUL- 2017 10:22PM
SUBMISSION ID 83293157 1
WORD COUNT 631
CHARACT ER COUNT 3626
SUO_HCM4 004 _W2_A2_EST EVEZ _MARIA.DOCX (26.86K)
%55
SIMILARIT Y INDEX
%11
INT ERNET SOURCES
%45
PUBLICAT IONS
%48
ST UDENT PAPERS
1 %33
2 %14
3 %3
4 %3
5 %2
EXCLUDE QUOT ES ON
EXCLUDE
BIBLIOGRAPHY
ON
EXCLUDE MAT CHES OFF
SUO_HCM4004_W2_A2_Estevez_Maria.docx
ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to EDMC
St udent Paper
A. Clements. "Diagnosed with breast cancer
while on a f amily history screening programme:
an exploratory qualitative study.", European
Journal of Cancer Care/09615423, 20080501
Publicat ion
Submitted to Walden University
St udent Paper
P Hopwood. "Surviving breast cancer: can
women expect to 'get back to normal'?", Breast
Cancer Research, 2008
Publicat ion
orca.cf .ac.uk
Int ernet Source
SUO_HCM4004_W2_A2_Estevez_Maria.docxby Maria EstevezSUO_HCM4004_W2_A2_Estevez_Maria.docxORIGINALITY REPORTPRIMARY SOURCES
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth inte ...
US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)Innovara, Inc.
A presentation on cancer and ethnicity in the United States, and how the US can learn from other countries in regards to cancer control. - by Barri Blauvelt, CEO, Innovara, Inc.
Bridging Clinical Gaps and Disparities in Care in TNBCbkling
This webinar will focuses on racial, ethnic, and socioeconomic disparities with the clinical gaps in treatment for women with triple-negative breast cancer (TNBC). Our guest speaker Shonta Chambers, MSW, is the EVP of Health Equity and Community Engagement at the Patient Advocate Foundation and Principal Investigator for SelfMade Health Network. Come and learn about this complex subtype, barriers to care, address the myths and fears around clinical trials in specific racial and ethnic communities, and help bridge the clinical gaps to improve survival outcomes for patients with TNBC.
Diagnosed with breast cancer while on a family historyscreen.docxduketjoy27252
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
Diagnosed with breast cancer while on a family historyscreen.docxlynettearnold46882
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
African Americans men are at a greater risk for developing prostate .docxkatherncarlyle
African Americans men are at a greater risk for developing prostate cancer than the white men. In every six individuals from this ethnic group, there is one who is at risk of developing prostate cancer in their lifetime. African Americans are 1.8 times more exposed to the risk of developing the disease and 2.2 times more likely succumb from this disease as compared to white men. The increase in the higher risk of prostate cancer among Africa Americans is linked to socioeconomic status. There is a lower socioeconomic status of African Americans and this exposing to high cases of prostate cancer as a result of poor medical check-up and poor healthcare outcomes (Owens et al., 2014).
There are also racial biases and this is harming African Americans in terms of preventive care since they have lower chances of being provided with the PSA test. Recent studies reveal that men from this ethnic group are unlikely to have early diagnosis for the prostate cancer. They are also not likely to be treated in time for the disease like the white men. There are several treatment options and learning sources about the options for prostate cancer. Therefore, the evidence-based, primary care health promotion recommendation to deal with prostate cancer among African Americans involves the prevention programs that are tailored to African Americans to help in the reduction of health disparities (Jackson, Owens, Friedman, & Dubose-Morris, 2015).
There is a need to incorporate culturally suitable and targeted messages and the images, the performance of faith-based initiatives, and the delivery of the educational programs in non-traditional venues for example the common place where people gather. It is also important to include key partners and the stakeholder in the planning, implementation, and assessment of the health and the cancer educational programs to help in the improvement of the health of the community and supporting community engagement. The development of the IDM education program for African American families through working with the community and the clinical partners is helping in the reduction of prostate cancer diseases (Jackson et al., 2015).
References
Jackson, D. D., Owens, O. L., Friedman, D. B., & Dubose-Morris, R. (2015). Innovative and Community-Guided Evaluation and Dissemination of a Prostate Cancer Education Program for African-American Men and Women.
Journal of Cancer Education, 30
(4), 779-785.
Owens, O. L., Friedman, D. B., Hebert JR, & Jackson, D. D. (2014). An intergenerational approach to prostate cancer education: Findings from a pilot project in the Southeastern USA.
J of Cancer Educ., 29
(4), 649-656.
.
Assignment 2 Final Project Part III Designing a StudyYou are t.docxrock73
Assignment 2: Final Project Part III: Designing a Study
You are the hospital administrator in a medium-sized, urban, for-profit hospital that caters to middle-income groups. You wonder if patients' satisfaction with the hospital stay will increase significantly if they are given better and more flexible meal options. You decide to conduct a research study to find the answer. The first step is to design the study.
Design a descriptive study to investigate if better meal options will increase patient satisfaction. Include the following elements of design:
1. Develop a research question or purpose of the study
2. Selection of subjects for study (what is the sample)
3. Assignment of subjects to experimental or control groups
4. Study time period
5. Type of data to be gathered
6. Measures of meal options and of patient satisfaction
7. Method of data collection
8. Guidelines for data interpretation
After you complete building the study design, list three design elements you considered in your study that were not readily obvious in the one you read last week “Diagnosed with Breast Cancer While on a Family History Screening Programme: An Exploratory Qualitative Study.”
By Tuesday, February 21, 2017, submit your study design and list of three identified design elements in a Word document to the W3: Assignment 2 Dropbox.
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understoo ...
Discussion #1As Rachel’s healthcare provider, I would respect .docxmecklenburgstrelitzh
Discussion #1
As Rachel’s healthcare provider, I would respect her decision and not seek out Kristin. Instead, I would make sure she understands the risks that her sisters have of possessing this gene mutation and subsequent risk of breast and/or ovarian cancer. I would suggest to Rachel that she inform Lisa and urge Lisa to contact Kristin since they are no longer in contact with each other. Patient confidentiality is more than a federal law and a matter of moral respect, it is one of the pillars of medicine and is vital to ensure continued rapport and trust between the provider and patient.
Breast cancer was once the leading cause of cancer related deaths amongst women until it was surpassed by lung cancer (McCance & Huether, 2014). Breast cancer develops due to a mutation on chromosome 17 known as BRCA1. BRCA2 is located on chromosome 13. Both are tumor-suppressor genes, which serve to prevent mutations and negatively regulate cell growth, however, if inactivated or mutated (such as with point mutations), these genes can actually promote cell division and cause cancer (McCance & Huether, 2014). “Women who inherit a mutation in BRCA1 or BRCA2 experience a 50% to 80% lifetime risk of developing breast cancer. BRCA1 mutations also increase the risk of ovarian cancer among women (20% to 50% lifetime risk), and they confer a modestly increased risk of prostate and colon cancers” (McCance & Huether, 2014, p. 174). Rachel posses the autosomal dominant form of the breast cancer gene as evidenced by the presence of a mutated BRCA1 gene. Tumors initiating in epithelial cells that line tissues and organs are often termed adenocarcinomas. Adenocarcinomas of the breast start in the milk ducts or the milk-producing glands known as lobules (American Cancer Society, 2018). “The exact molecular events leading to invasion are complex and not completely understood” (McCance & Huether, 2014, p. 870).
Options for those that have a positive test for BRCA1 or BRCA2 mutation include the following: surveillance for early cancer detection, prophylactic surgery (i.e., bilateral salpingo-oophorectomy), risk factor avoidance and education, and chemoprevention (McCance & Huether, 2014).
BRCA1 and BRCA2 work in the various stages of DNA damage response and DNA repair as tumor suppressor genes, and both serve to protect the genome from DNA damage during DNA replication (McCance & Huether, 2014). If a mutation in BRCA1 or BRCA2 is present, the person is roughly five times more likely to develop breast cancer than a person without the mutation, however, not all those that have the mutation will develop breast or ovarian cancers (McCance & Huether, 2014).
The risk of developing breast cancer rises with age, with 1 person in 202 people affected between birth and 39 years of age, 1 in 26 from age 40-59, and 1 in 28 for those aged 60-69 (Shah, Rosso, & Nathanson, 2014). A familial history of breast cancer is also a risk factor, as well as a personal history. Women that have.
2. Health Inequities in Boston
Black:White disparities in breast cancer mortality have been documented in large cities
nationwide, including Boston, Massachusetts. 1
In the 2001-2012 time period, Black
women in Boston had a breast cancer mortality rate of 31.1 per 100,000 population
compared to 24.8 per 100,000 population among White women. 2
The historical trend
has been that White women are more likely to be diagnosed with breast cancer, but
recent data suggests the incidence rate of breast cancer for Black women is approaching
that of White women.1,3
This will likely result in a worsening disparity if nothing is done
to intervene.
Leading factors of breast cancer racial disparities include1
:
Despite the fact that mammography remains the most effective method for detecting
cancer at the earliest, most treatable stage, many minority and medically underserved
women remain unscreened or are screened infrequently, and thus are at risk for late
stage diagnosis and for increased mortality from breast cancer.4
Given the variation in
screening mammography recommendations, it is important that women have the
opportunity to discuss their options for early detection taking personal risk factors for
breast cancer into account.
Discovery of cancer
at a later stage
Differential
screening access
Differential quality
screening process
Differential
treatment access
Differential
treatment quality
3. Depending on age, women are 4-12
times more likely to have had a
mammogram performed if their
physicians discussed it with them.12
Discuss breast health with
female patients of all ages.
Women who have a gynecologist
are 4 times more likely to have
regular adherence to screening
guidlines than those without.13
Connect patients to an
OB/GYN.
Without a physician
recommendation, Black women
are 28.6% less likely to receive a
mammogram screening than
Caucasian women.14
Recommend that patients
over 40 receive a
mammogram on a routine
basis.
Barriers to Mammogram Screenings
In a meta-analysis of eight studies, the leading barriers to breast cancer screening
among Black, Hispanic, and Asian women were:
Logistical Barriers:
-Language differences4
-Transportation4
-Insurance5
-Cost6
Personal Barriers:
-Fear of pain or embarrassment4,7
-Fear of bad news6
-Having misinformation8
-Not feeling any breast problems10
Provider-related Barriers
-No provider recommendation9
-Unaware of screening necessity10
-Low health literacy4,11
Provider’s Role
Provider-
related
Barriers
Personal
Barriers
Logistical
Barriers
4. Why is the Van right for your patients?
Dana-Farber's Mammography Van launched in
April 2002 as a joint venture between the
Dana-Farber Cancer Institute and the City of
Boston and is the only mobile mammography
van in Massachusetts. The Van seeks to reduce
breast cancer morbidity and mortality,
improve access to culturally competent care,
and address health inequities experienced by
minority populations in Boston.
- Any woman who is medically eligible is screened, though priority populations include
low-income, elderly, immigrant, and non-English speaking women.
- The van travels 3-4 days per week year-round, serving community-based
organizations and health centers across the greater Boston area.
- Board-certified mammography technologists from Dana-Farber and radiologists from
Brigham and Women’s Hospital perform the exams and interpret the films.
- Patients can speak with a breast health educator regarding routine screening, steps
to reduce their risk of developing breast cancer, and to address fear and lack of
knowledge associated with the procedure and results.
- Van staff is diverse and bilingual which helps to ensure a culturally competent
experience for the patient.
- By bringing Dana-Farber's services directly to priority neighborhoods where women
live and work, the Van breaks down cultural, linguistic, financial, and logistical
barriers for those least likely to obtain one.
- The Van serves as a point-of-entry into the health care system. Women who lack
insurance or a primary care provider are connected to our partnering health centers
and are assisted in applying for coverage.
Dana-Farber's Mammography Van provides a convenient and effective way for women to
continually monitor their breast health. By connecting patients to primary care physicians
and health insurance coverage and by ensuring patients receive timely and quality follow-
up services, the van is helping women achieve a higher level of overall health care.
(1) Hunt, B., Whitman, S., Hurlbert, M. (2013). Increasing black: White disparities in breast cancer mortality in the 50 largest cities in the United States. The International Journal of Cancer Epidemiology, Detection, and
Prevention, 38(2):118-23. (2) Boston Resident Deaths, Massachusetts Department of Public Health (3) DeSantis, C., Fedewa, S., Goding Sauer, A., Kramer, J., Smith, R. & Jemal, A. (2016). Breast cancer statistics, 2015:
Convergence of incidence rates between black and white women. CA: A CancerJournal for Clinicians, 66(1):31-42. (4) Engelman, K., Cupertino, P., Daley, C., Long, T., Cully, A.,Mayo, M., Ellerbeck, E., Geana, M., Greiner, A.
(2011). Engaging diverse underserved communities to bridge the mammography divide. Biomedical Central Public Health, 11(2):11-47. (5) Abraído-Lanza, A., Martins, M., Shelton, R. (2015). Breast cancer screening among
Dominican Latinas: A closer look at fatalism and other social and cultural factors. Health Education Behavior,42(5):633-641. (6) Fayanju, O., Kraenzle, S., Drake, B., Oka, M., Goodman, M. (2014). Perceived barriers to
mammography among underserved women in a breast health center outreach program. American Journal of Surgery, 208(3):425-434. (7) Schueler, K., Chu, P., Smith-Bindman, R. (2008). Factors associated with
mammography utilization: A systematic quantitative review of the literature. Journal of Women’s Health, 17(9):1477-1798. (8) Wells., A. Shon, E., McGowan, K., James, A. (2015) Perspectives of Low-Income
African-American Women Non-adherent to Mammography Screening: the Importance of Information, Behavioral Skills, and Motivation. Journals of Cancer Education.(9) Miranda-
Diaz, C., Betancourt, E., Ruiz-Candelaria, Y., Hunter-Mellado, R. Barriers for compliance to breast, colorectal, and cervical screening cancer tests among Hispanic patients. International Journal of Environmental Research
and Public Health, 13(1):1-7. (10) Komenaka, I., Nodora, J., Hsu, C., Martinez, M., Gandhi, S., Bouton, M., Klemens, A., Wikholm, L., Weiss, B. (2015). Association of health literacy with adherence to screening
mammography guidelines. Obstetrics & Gynecology, 125(4):852-859. (11) Rosales, M., Gonzalez, P. (2013). Mammography screening among Mexican, Central-American, and South-American women. Journal of Immigrant
and Minority Health, 15(2):225-233. (12) Fox, S., Murata, P., Stein, J. (1991) The Impact of Physician Compliance on Screening Mammography for Older Women. Arch Internal Medicine,1991: 151(1): 50-56. (13) Zapka, J.,
Stoddard, A., Maul, L., Costanza, M. (1991) Interval Adherence to Mammogram Screening Guidelines. Medical Care, 29(8):697-707. (14) Cronan, T., Villalta, I. (2008). Predictors of mammography screening among ethnically
diverse low-income women. Journal of Women’s Health, 17(4):527-537.
