Maryland Nurse - August 2018

Page 18 • The Maryland Nurse News and Journal August, September, October 2018
The Center for Disease Control and Prevention
(CDC, 2017) and the American Cancer Society (ASC,
2017) define cancer as cells that grow out of control.
When this process starts in tissue of the breast, it is
diagnosed as breast cancer. Excluding cancers of the
skin, breast cancer is the most universally diagnosed
cancer in women. It is the second leading cause of
cancer death in women (ASC, 2017). Within the
United States (US) breast cancer deaths generally have
declined, however a redistribution of diagnosed cases
identifies risk for breast cancer increasing for African
American, Hispanic, Asian, and Pacific Islander
women (CDC, 2017).
Breast Cancer is a diagnosis that has relevance
for all races; however it is a particularly significant
Exploring Breast Cancer Risks and Deterrents
to Interventions Among Women of Color
Charlotte M. Wood, Ph.D., MSN, MBA, RN Associate Professor
Joan S. Tilghman, Ph.D., RN, CRNP, WHNP-BC, CNE Professor
Nayna Philipsen, JD, PhD, RN, CFE, FACCE, MNA DNA2 President
Charlotte M. Wood,
PhD, MSN, MBA, RN
issue for African American and Hispanic women. Breast cancer is the leading
cause of cancer deaths in Hispanic women and the second leading cause of
cancer deaths in African American women (CDC, 2017). African American
and women of Hispanic or Latino (Spanish-speaking) origin make up greater
than 40 million of our country’s entire population, and have been identified as
a target population with pronounced breast cancer disparities (United States
Census Bureau, 2010; Phillips & Cohen, 2011).
In 2013, the American Cancer Society estimated that there would be
232,340 new cases of invasive breast cancer diagnosed among women, as well
as an estimated 64,640 additional cases of in situ breast cancer. More than
1,500 Americans are expected to die of cancer each day. Cancer is the second
most common cause of death in the US, exceeded only by heart disease,
which accounts for nearly 1 out of every 4 deaths (ACS, 2017). There were
approximately 226,870 new cases of invasive breast cancer diagnosed among
women in the US during 2012. About 2,190 new cases were expected in men.
School Nursing Opportunities
Prince George’s County Public Schools
As one of the nations largest school
systems, Prince George’s County Public
Schools in Maryland has immediate openings
for the following:
School Registered Nurse
If you are RN with a bachelor’s degree, have pediatric, community
health experience or emergency room we are looking for you. We
offer a competitive salary, excellent benefits, and the opportunity
to work in an environment where you can contribute to the health
and well-being of our students.
To view the complete job description and to apply online,
please visit our website at: www.pgcps.org, or contact
the Office of School Health at (301) 749-4722
for additional information.
Bilingual candidates encouraged to apply.
We are an equal opportunity employer.
African American women have a higher incidence
rate before age 40 and are more likely to die
from breast cancer at every age (ASC, 2017). The
mortality rate for African American women is 32
out of 100,000, the highest rate among all ethnic
groups reported in the US (ASC, 2017; CDC, 2017).
Although the overall survival can be as high as 97%
(Kelley, 2011), breast cancer survival rates are only
about 77% for African American women.
Interventions and Deterrents
There are a host of reasons why both African
American and Hispanic women are at greater risk
for this disease than the general population. Some of
the behavioral risk factors are primary and include
a sedentary life style, diets high in fat, and a lack
Nayna Philipsen,
JD, Ph.D., RN, CFE,
FACCE
of dietary fiber (Kelley, 2011). General risk factors include increasing age,
personal history, and family history (ASC, 2017). Given the current outcomes,
it is vitally important that community engagement be addressed to mitigate the
deterrents to breast cancer screening, and to promote early detection initiatives
needed for the prevention of advanced breast cancer.
One of the primary deterrents to breast cancer screening for African
American women reportedly is the fear of cancer (Kelley, 2011). Another
barrier is cost. According to the US Census Bureau (2010), almost 51 million
Americans were uninsured in 2009; almost one-third of Hispanics (32%) had
no health insurance coverage.
The lack of health insurance and other financial barriers prevent many
African American and Hispanic women from receiving optimal health care.
Uninsured patients and those from ethnic minorities are substantially more
likely to be diagnosed with advanced breast cancer. The National Institutes of
Health (NIH) estimates that the over-all costs of cancer in 2007 were $226.8
billion: $103.8 billion for direct medical costs (total of all health expenditures)
and $123.0 billion for indirect mortality costs.
Other barriers are elements of human communities that most effectively can
be impacted at the community level. These include the cultural beliefs, lack of
knowledge and limited access to information, socioeconomic factors, access
to screening and treatment, and a lack of early detection practices (McCaskill,
2006). Prevention of advanced breast cancer and the reduction of breast cancer
mortality begin with early detection.
Early Detection Techniques
Routine screenings are fundamental to early detection and prevention of
breast cancer. Included in routine screenings is diagnostic testing such as
mammography, ultrasound, and breast magnetic resonance imaging (MRI),
(Ravert & Huffaker, 2010). Early detection and prevention involve genetic
counseling, clinical breast examinations (CBE), and self-breast examinations
(SBE). When individuals actively participate in early detection techniques and
routine screenings, evidence based practices (EBP) have shown that breast
cancer mortality and morbidity rates decrease (McCaskill, 2006).
Community Strategies to Address Breast Cancer Disparities
Strategies to address breast cancer disparities among African American
and Hispanic women involve identifying and engaging trusted community
leaders, and creating community-based breast health education programs and
services. Peer-centered breast health education programs can be established
through churches and community associations. The programs must be
culturally and linguistically sensitive to maximize their effectiveness. They
should include encouraging CBE, SBE training, educational hand-outs, peer
testimony, promotion of regular exercise and the eating of healthy nutritious
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