Introduction
Epidemiology is a study about the occurrence of a particular disease in focused/targeted/selected population. The frequency of occurrence, of a particular disease in a population, aids in understanding the causes of it. Therefore, epidemiology can be understood as the field that studies how often a particular disease occurs in different groups of people and what the causes of it are (Gordis, 2013). Generally, an epidemiological study generates a piece of information (epidemiological information), which facilitates in formulating strategies and policies that aim to prevent or reduce illness in population groups. These policies also improve patients’ management, in whom the disease has been diagnosed. As epidemiology is the study of the prevalence of a particular disease in a certain population; therefore, the major emphasis of the study is on the collection and statistical analysis of valid and relevant data. Data is collected in a particular manner, and it is then statistically analyzed to understand not only the frequency of occurrence but also the nature and causes of occurrence. Generally, the diseases that are fatal and occur more frequently in certain ethnic, racial and social groups are the subject of epidemiological studies. One of these diseases or illness is Breast Cancer.
The types of cancer, which are diagnosed most commonly in women, are breast and ovarian cancers. It is believed that breast cancer is an epidemiological problem of developed countries; however, statistics show that in less developed countries to cancer is being diagnosed at an alarming rate. For instance, in the year 2008, 50% of instances of breast cancer occurred in less developed regions (Asia-Africa-Middle East). Also, 58% of breast cancer-related deaths also occurred in the third world or less developed countries/regions (WHO.Int, 2018).
The statistics, related to Breast Cancer, reveal that the rate of occurrence varies across the continents and racial/ethnic groups. For instance, in every 100, 000 women, of Eastern Africa, only 19.3 women are diagnosed with breast cancer, whereas in Western Europe 89.7 out of 100, 000 women are diagnosed with this type of cancer. We also learn from the methodical study of literature on breast cancer that in several developing regions/countries, the incidence rate is not more than 40 per 100, 000 women (in every 100, 000 women, around 40 women have either breast or ovarian cancer).
Studies have also concluded that in particular racial groups, the occurrence rate of cancer (breast) is higher. For instance, Ashkenazi Jews are more exposed to the threat of breast cancer than other racial groups. It suggests that breast cancer could be a genetic disease. Epidemiological studies are striving to study the disease in different groups of populations so that its prevalence and causes can be determined.
This study will review how epidemiological studies on breast cancer are reducing its prevalence/occurrence in different populations. The country, which we have selected for this academic exercise, is the United States.
Literature Review
Breast cancer is a type of cancer that occurs in the breast tissues of both men and women. Generally, this type of cancer appears in the form of a lump, which alters the shape of a breast. The simplest definition of breast cancer is the “out-of-control growth of breast cells that eventually form a tumor in the breast.” The particular type of symptoms is associated with this type of cancer, and when these symptoms begin to appear (gradually), individuals take notice of it. The most common symptoms, which are associated with breast cancer, are swelling of the breasts, pain in nipples, nipple retraction, the surface of different parts of breast turning red and nipple discharge (Tao, et al., 2015).
Statistics about the prevalence of breast cancer allow us to understand the illness in great detail. For instance, we know that the incidence rate of breast cancer varies from continent to continent and from racial groups to racial groups (DeSantis, Ma, Sauer, Newman, & Jemal, 2017). It suggests that there different factors, such as genetics and environmental conditions, that influence the incidence rate of breast cancer globally. Epidemiological studies, on this subject, identify different factors that might be responsible for triggering breast cancer. It is imperative to acknowledge that the factors, which trigger breast cancer in both men and women, have not been identified precisely. However, different risk factors have been identified, which may cause breast cancer. For this particular reason, the emphasis on epidemiological studies about breast cancer is on the risk factors. From the methodical study of literature and statistics, we learned that some risk factors are more strongly correlated with breast cancer than the other risk factors are. For instance, any genetic mutation in tumor suppressor genes, BRCA-1 and BRCA-2, augments the probability of occurrence of breast cancer in women many folds. Some studies have concluded that age is also correlated with breast cancer (women, who have crossed their mid-40s, have a greater chance of being diagnosed with breast cancer (Beesley, et al., 2010).
Some studies have suggested that a particular lifestyle may also increase the chances of occurrence of breast cancer in women. Previous studies hinted towards the difference between Western and the rest of the socioeconomic systems as a factor. However, contemporary studies are suggesting that genetic and hormonal factors might be at play and probably a legitimate cause of breast cancer in women. It is also quite evident that not only does the incidence rate of breast cancer vary from region to region and race to race, but also it varies from gender to gender. It is a fact that breast cancer develops in both male and females; however, in females, the probability of the development of breast cancer, is way higher. For instance, only one in one thousand men are diagnosed with breast cancer, making it a rarity for men. From this information, we can deduce that breast cancer is prevalent only in the female gender. It is one of the reasons why scientists have begun to study it the hormonal and genetics contexts.
In the United States epidemiologists are studying breast cancer from various perspectives. For instance, epidemiologists are studying the rate of occurrence/diagnosis across counties and racial groups. The map below provides information regarding the breast cancer incidence rates by county. When this information is studied in the context of demography, we learn how prevalent breast cancer is different among racial groups.
(National Community Mapping Institute, 2016)
Current Surveillance Methods
The surveillance methods, for breast cancer are designed for two purposes; 1) to project the probability of breast cancer and 2) to identify tumor breast in its early stage. It is essential to recognize that breast cancer is easier to control and eliminate when it is in its early stages. Therefore, surveillance methods are a major component of the strategy that aims to decrease the occurrence rate of breast cancer in the United States, especially among the women, who are more exposed to this risk/threat in comparison to men. As surveillance is a major component of the strategy; therefore, it has a method to it, and the American Society of Clinical Oncologists has formulated guidelines for it. For instance, members of the population at risk must have themselves physically examined every three to six months for three years, and after three years they should go to a clinic (for physical examination) every six or twelve months. Surveillance guidelines must prohibit individuals from regular blood tests such as CBF and LFT. During this period, reports regarding genetic and clinical history must also be prepared and managed. This surveillance strategy is designed for individuals who are conscious of the risk.
The surveillance strategy of clinics and health units is quite different. For instance, when individuals, who are a member of populations at risk, visit health units and clinics, they are suggested to go through a series of tests, such as mammography to detect a mutation in tumor suppressor genes to project (possibility of) or identify the breast cancer in both men and women. However, it is the discretion of an individual to consider and act upon the suggestion or not (Antoniou, et al., 2001). This surveillance method is effective; however, it relies heavily on information about the various populations at risk.
During the surveillance, various types of data are gathered, which is then arranged in a manner that is comprehensible (table/charts) and employable in the different statistical analysis. Health units/clinics provide this data to researchers and organizations to study.
Descriptive Epidemiology
We have already discussed that the data collected by health units and clinics are used in various studies, which examine the pattern and causes of occurrence of breast cancer. One of such studies asserts that in the United States, the country we have selected for this academic exercise, around 1 in 8 women develops a type of breast cancer that spreads (invasive). These statistics are staggering and points towards the alarming increase in the occurrence and diagnosis of breast cancer in American women. Studies have projected the incidence rate of breast cancer for American men/women for the year 2018. As per projections, around 2,2250 men and around 266, 120 women might get diagnosed with breast cancer in the current year (2018).
(Greif, Pezzi, Klimberg, Bailey, & Zuraek, 2012)
The above table provides information regarding the occurrence of breast cancer, in men and women, across different racial and ethnic groups in the United States. It is evident from the table that in White Americans, the probability of the occurrence/development of breast cancer is higher than other racial groups. For instance, the racial group (male), in which breast cancer was prevalent, was of White American. Among Native American men, the disease or illness is almost non-existent.
Statistics also reveal that among White American women, the development of cancer in the breast is quite common. However, Native American women, breast cancer’s rate of occurrence is quite low. The study endorses this viewpoint that genetic factors are strongly associated with breast cancer. From the scrutiny of different conclusions (drawn from studies) and statistical evidence, we have learned that mutation in tumor suppressor genes, such as BRCA-1 and BRCA-2, surges the susceptibility to breast cancer. It is because these tumor suppressor genes produce special proteins that repair DNA molecules with great precession. In some racial groups, this mutation occurs at a greater rate, which increases the size of risk for the members of these racial groups (Sugano, et al., 2008).
It is quite obvious that genetic factors are strongly correlated with breast cancer; therefore, special emphasis must be on mutation tumor repressor genes such as BRCA-1 and BRCA-2. Other risk factors and probable causes, such as hormones and environmental factors must also be studied to discern precisely the causes of breast cancer. Thus, the prevention plan includes special emphasis on populations at risk and improved surveillance methods.
Diagnostic Methods
Various tests and procedures employed for the diagnosis of breast cancer. Some of these tests and procedures are more common than the others.
Mammogram: Two types of mammograms are used to detect/diagnose/discern breast cancer. A simple mammogram is a type of X-ray, which is designed to detect any abnormality in a breast. If any abnormality is detected, a diagnostic mammogram is suggested or recommended.
Breast Exam: It is one of the simplest tests or procedures, during which a doctor examines the lymph nodes that are present in the armpits and breasts. It is done to find a lump or other such abnormalities.
Other techniques include Breast Ultrasound, Breast MRI, and Biopsy. In the United States, Mammograms and MRI scans are commonly used for the detection or the diagnosis of breast cancer. Other methods, such as Breast exam that is simple and less effective, are used in preliminary testing and screening. Generally, individuals follow the suggestions of their physicians regarding the type of test they must have for the diagnosis of breast cancer. The cost of a diagnostic test is inversely correlated with the number of physical examinations for breast cancer.
How I Will Address the Issue
To address the disease efficiently, I must have adequate information about the populations (racial groups and genders) at risk for which I will scrutinize/study contemporary literature. I will gather information, evidence or data of members of the risked populations and study it, to learn about the pattern and causes of its occurrence. At the clinical level, I would suggest members of the populations at risk different tests and screenings that will detect any development of tumor in the breast. Most of the studies suggest that information and awareness regarding the risk factors associated with breast cancer have played a major role in the decline of breast cancer. As more information is available regarding the populations at risk, clinics can efficiently address epidemiological disease.
A major component of my strategy is to detect a mutation in tumor suppressor genes in all populations to learn how a mutation in tumor suppressor genes, such as BRCA-1 and BRCA-2, raises the probability of the occurrence of breast cancer across various racial/ethnic groups
Steps That I Will Take to Measure Outcomes of My Action
- The size of evidence I produce from various actions, such as mammography tests.
- The relevance of the information/evidence/data produced by my actions. The relevance will be checked by comparing my evidence/data with other such data.
- Conclusions drawn from the statistical analysis will be compared with the conclusions that are drawn from similar studies.
Conclusion
In the end, it can be concluded that breast Cancer is an epidemiological problem that needs to be addressed effectively. Because of greater awareness (regarding the subject) and cost-effective projection and detection techniques, breast cancer cases have declined in the United States. However, the rates of occurrence among different racial groups have remained the same. In my understanding, a comprehensive cross-racial study of breast cancer will allow us to identify relevant causes of breast cancer. Also, as the cost of diagnosis will reduce, the size of deaths related to breast cancer will reduce drastically.
References
Antoniou, A. C., Pharoah, P. D., McMullan, G., Day, N. E., Ponder, B. A., & Easton, D. (2001). Evidence for further breast cancer susceptibility genes in addition to BRCA1 and BRCA2 in a population‐based study. Genetic Epidemiology, 21(1), 1-18.
Beesley, J., Antoniou, A. C., McGuffog, L., Sinilnikova, O. M., Healey, S., Neuhausen, S. L., & Rebbeck, T. R. (2010). Common breast cancer susceptibility alleles and the risk of breast cancer for BRCA1 and BRCA2 mutation carriers: implications for risk prediction. American Association for Cancer research, 70(23), 9742-9754.
DeSantis, C. E., Ma, J., Sauer, A. G., Newman, L. A., & Jemal, A. (2017). Breast Cancer Statistics, 2017, Racial Disparity in Mortality by State. CA: a cancer journal for clinicians, 67(6), 439-448.
Gordis, L. (2013). Epidemiology (5 ed.). Elsevier Health Sciences.
Greif, J. M., Pezzi, C. M., Klimberg, S. v., Bailey, L., & Zuraek, M. (2012). Gender Differences in Breast Cancer: Analysis of 13,000 Breast Cancers in Men from the National Cancer Data Base. Annasl of Surgical Oncology, 19(10), 3199-3204.
National Community Mapping Institute. (2016, November 18). Breast Cancer Incidence Rates by County (2006 – 2010). Retrieved from http://communitymappingforhealthequity.org/map-of-the-day/breast-cancer-incidence-rates-by-county-2006-2010/
Sugano, K., Nakamura, S., Ando, J., Takayama, S., Kamata, H., Sekiguchi, I., & Ubukata, M. (2008). Cross‐sectional analysis of germline BRCA1 and BRCA2 mutations in Japanese patients suspected to have hereditary breast/ovarian cancer. Cancer Science, 99(10), 1967-1976.
Tao, Z., Shi, A., Lu, C., Song, T., Zhang, Z., & Zhao, J. (2015). Breast Cancer: Epidemiology and Etiology. Cell biochemistry and biophysics, 72(2), 333-338.
WHO.Int. (2018, January 1). Breast cancer: prevention and control. Retrieved from World Health Organization: http://www.who.int/cancer/detection/breastcancer/en/index1.html
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