Breast Cancer Awareness - Research Paper Example

PROPOSAL FOR A HEALTH EDUCATION PROGRAMME IN BREAST SCREENING AWARENESS AMONG BLACK AFRICAN WOMEN IN UK Abstract The emerging challenges faced by National Health Service in its transformation of the health sector are noticeable. An example challenge is making sure that every group of population gets an equal right to the health services (Hall 2013). This is a study proposal of the health education programme in breast screening awareness among black African women of the age of 50 in UK. Even though the programme of cancer screening have attained respectable attention, there are suggestions that certain groups of population, for instance those with learning difficulties, people living in deprived areas, minority ethnic groups and are not permitted to access these services due to different reasons. A different challenge affecting programme of cancer screening is the addition of the present breast screening programme to those from ages of 65 to 70 years of age as the older age group and the likelihood of innovative programme of screening. This implies that the women 50 years group is not listed in this programme yet they are most likely to lack an insurance cover (Street 2012). The fact that the women group of 50 years is black means they are not in a position to afford the health facility or will be discriminated from assess. Civilization is major emphasis of the health inequalities issue in combination with a set age group cut out by government health policies (Hall 2013). The correlation between health status and ethnicity was recognized by health researchers and epidemiologists. Even though the ethnicity design as a societal classification is challenging and the ethnicity use as a self-regulating adaptable in research of health is emphatically disputed by precarious examiners, it has been proposed that ethnicity can proclaim a self-regulating outcome on inequalities of health coupled. Henceforth, it must never be distorted into categories of socioeconomic and age groups. Objectives (i) To discover problem that is faced in endorsing breast screening among black women in prime care. (ii) To build a programme of health promotion in addressing problems recognized facing the black 50 year old women. (iii) To device the programme of health promotion programme and to assess the absolute limitations and success of this program in supporting all age groups and ethnic backgrounds. Even though there is a connection between access to the health system and people health results, this correlation is well unstated. The access notion is multilayered and complex as well as can be associated to the service quality and equity of the service (Woolf 2011). On the other hand, it is regularly intellectualized, one or the other from the perspective of service or user, even though seldom an active practice concerning the correlation between systems of health and individuals in a varying public setting. Proposal justification Increasing the life expectancy has been of the focus of various governments and healthcare participants across the globe. This is reflected in various policies, including the sustainable development policies. Nonetheless, there are various challenges that the United Kingdom government has to overcome. Cancer prevalence is widely cited as one of these challenges, most notably, breast cancer. Indeed, the trend of breast cancer prevalence and criticality is well documented by UK Cancer. Research (2012) Statistics, which acknowledges that breast cancer is rated the most common type of cancer in United Kingdom, as from 1997. Cases of breast cancer among women have been on the increase since 1970s and it is particularly alarming that the increase touched 72 percent by 2010. These figures might not fail to accommodate certain minority age groups, since they were probably not exemplified. Even alarming is the fact that the rate of increase has been going up by 2 percent per year since 1970s. In the 1980s, following the introduction of the cancer screening programs, the number of victims as a result of prevalent pool of undiagnosed patients (like 50 year old black women). The trend returned to the post-screening phase, increasing steadily until the close of the decade. Breast cancer also accounted for as significant as 31 percent of the new cancer cases among women. In 2010 alone, as many as 49, 961 new cases of breast cancer were recorded, all of which women were underrepresented (Woolf 2011). Besides, it is needless to say that consequences of breast-cancer are as far-reaching as timely death. In response, women have been urged to seek breast screening as early as possible and the notion that prevention is better than cure has dominated. The crucial question is whether, as far as breast cancer is concerned, the point that prevention is always appropriate. This could imply for certain ages and for certain race considered less important to survive. Indeed, the question of whether breast screening is accompanied by more benefits is a heated debate. The debate revolves around the ethical implications of breast cancer screening, which further attracts questions of extents to which breast screening has significantly reduced the mortality rates and costs of cancer suffering, as well as over diagnosis. The rest of the paper is organized as follows.  First, the ethical implications of breast cancer screening are explored. The common approach to ethical dilemma is to assess whether the costs of the breast screening programs outweigh the benefits. In regard to this, other elements of breast cancer screening are explored, including the cost-effectiveness, social and economic implications and over diagnosis. Eventually, a reflection of cost-benefit assessment, in regard to ethical considerations, is carried out to arrive at a conclusion. ETHICAL IMPLICATIONS One of the ethical implications of breast cancer screening pertains to autonomy entitled to individuals. Respect for the decision of individuals, as well as informed consent is particularly crucial as it reflects commitment in fostering the autonomy of the patients. In most cases, the respect of the autonomy of individuals is a legal provision (Anderson 2012). Nevertheless, it is worth noting that respecting the autonomy of the patents is not all about entitling patients the choices. It is also necessary that patients should be told the risks, as well as the benefits of over screening. As if not enough, it is also worth acknowledging that patients have different values about what constitutes costs and benefits. In this regard, it is always necessary that the breast cancer screening tests are accompanied by some explanations that may touch on the prevalence of the diseases, the associated morbidities, cases of over-diagnosis, and the implications of treatment and even further screening tests. As it is for many cases of cancer, some patients feel having it diagnosed early may compromise the quality of life. Cases of some patients dying prematurely of heart diseases following cancer diagnosis are never uncommon, even far before the symptoms of cancers are detected (Fallow field and Hall 2011).  There has been concern that breast cancer screening tests are infringing into the autonomy requirements. The groups that manufacture and benefit from the cancer screening and testing rarely communicate the risks to patients. Breast cancer screening is also accompanied by the concerns that the limits of confidentiality are always surpassed in the practice. As far as the fields of clinical genetics are concerned, the information about the relatives of the patient is often sought.  The initial source of information is the patient himself, who then gives information about the family history in relation to cancer (Bond 2013). There have been no citations that such processes are a violation of third party privacy. However, on the legal grounds, it is an obvious violation of the rights. Closely related to ethical issues in breast cancer screening is the issue pertaining to beneficence. One of the concerns, as far as ethics is concerned, is that clinicians and other professionals have been insistent that treatment and screening protocols that are often observed as effectively secure as safe. However, there abound questions on whether their claims should be treated with substantial trust. It has been widely suggested that the presence of an external, independent party would be imperative in ascertaining the efficacies and the reliability of such claims. In some cases, these have called upon granting sponsorship to the various clinical trials (Bond 2013). This should ensure that the costs of the breast cancer screening programs do not outweigh the benefits. However, there is always the allowance for the epidemiologist to make estimates of the costs and benefits of the breast cancer screening programs, even without basing on the clinical trial results. This is particularly the case when the prevalence of the disease, as well as the sensitivity of the available breast cancer screening modalities. The general approval procedure is that in the cases where the diseases are not prevalent, it would not be uncommon to expect the false positives. Other ethically sensitive areas i. Breast cancer Screening and mortality reduction ethical Question Even pivotal to ethics is whether breast cancer screening is effective at reducing mortality rates or it is mere scam. The main aim of breast cancer screening is diagnose breast cancer so that treatment can be done in the most appropriate time. Breast cancer screening is aimed at detecting breast cancer on timely basis to increase chances of high life expectancy through treatment. This is regardless of whether breast screening is accompanied by any benefits. In this regard, the most appropriate measure of breast cancer is that oriented towards the reduction of the mortality rates. Most studies that have focused on the area have inclined towards randomized control trials, which are considered to give reliable and comprehensive information on the potential benefits of screening. A study by NHS (2011), which carried randomized controlled trails on breast screening, established that as breast cancer screening reduces mortality rates by as significant as 20 percent for women who sought screening. However, the finding is marred by some inherent uncertainties. The first uncertainty pertains to the statistic, where the 95 percent confidence interval of 0.80 was found to be 0.73-0.89. The second uncertainty pertains to bias, considering that there have been various discussions on their internal validity, several decades after the trials were reported. The third uncertainty pertains to the relevance of the old trials to the current screening programs, considering that various developments have taken place. As far as absolute benefits are concerned, there are varied benefits between single breast cancers deaths prevented through screening among 100 women and a single similar case prevented through the screening of a 2000 women. The main determinant of this is the age at which the women are subjected to breast screening, the length at which they are screened and the duration at which a follow up is made. The age of women subjected to screening is crucial considering that cancer mortality increases with age. Instead of basing on data on the absolute data reduction, the study applied a negative 20 percent adjustment to achieve cumulative absolute risks of breast cancer associated mortalities between age 55 and 79. The study made an assumption that women who are first subjected breast screening at 50 and continued for the subsequent 2 decades would not befit in the first five years. However, the reduction of the mortality rates would still be significant even 10 years after screening. The eventuality was that, for every 235 women subjected to breast cancer screening, a single death of breast cancer would be prevented by (NHS 2011). This is a representation of 43 out of 10, 000, the number of women subjected to breast screening (Street 2012). This implies that the absolute benefits of women who seek screening would are often relatively high. In order to prevent a single death of cancer, about 200 women would be required to seek screening. ii. Breast cancer Screening and cost-effectiveness Ethical question it is not uncommon for programs to insist on promoting certain practices even when such are not beneficial. Sometimes, such practices are merely carried by some people who are interested in satisfying their self-vested interests. In this regard, the subject of the costs incurred in the prevention of breast cancer through screening becomes a pertinent ethical issue. The crucial question is whether breast cancer screening costs raise ethical questions. Cancer is considered a costly illness, especially in the cases where the detections and treatment have been delayed. For the victims who are not covered by appropriate health insurance schemes, the financial consequences are particularly profound (NHS 2011). However, it is factual that even having access to insurance cover does not necessarily imply one could be cautioned from the mounting cancer expenses. As a matter of fact, most cases of bankruptcy that is associated with medical cover are filed by people with health complications (Cuzick 2011). It is also worth noting that very few insurance companies are often ready often willing to offer cover to all medical expenses incurred in the treatment of cancer. This is because even with the best possible plans that one can have, there would be always the unexpected charges and which would require the patients to meet the payments because they are not covered in the health insurance schemes (Department of Health 2013). Whereas there have been various developments focused on the reforming the insurance systems, there are still chances that the out-of-pocket costs would continue burdening the affected cancer patients. The treatment of cancer during the advanced stages is so costly that it is not uncommon for a significant number of patients to be disillusioned of pursuing treatment. However, when it gets to such extent, such patients can only expect to find things getting more expensive, considering that skipping cancer treatment worsens health outcomes. There are two types of cancer care costs; secondary and primary care costs. Proposal challenges encountered From the perspective of psychosocial, uptake of problems are in most cases observed as originating from the target population (Cuzick 2011). Hardly were effects of system for example of alignment of the administrative procedures, services of screening, how schemes request and evoke screening partakers and proficient capability in skills, promotion knowledge, health education not just in strategies of screening in working, educating and communicating with organizations based on community which is a factor in need of investigation. 12 of the 19 studies on the population reviewed alluding to the effects on system. On the other hand, this mostly centers on accessing well-defined barely by whether or not womenfolk got ‘ordinary healthcare source’. This is clearly a significant distress in the UK, where lacking insurance cover can refute women a typical care source and thus right to use to preventive facilities. In the United Kingdom, assessing the black women unable to get services from breast cancer facility it is clear women of 50 are cut out of assess to this facility. This shows that it will not be applicable to a big population proportion since the National Health Service offers it freely to all citizens. On the other hand, this problem is probable to be pertinent for the increasing refugees who are homeless, asylum seekers in United Kingdom (Hall 2013). As a result of their circumstances and social positions, these individuals are expected to set up a high movable inhabitation in various innermost towns; as a result, the ‘typical care source’ could be inhibiting the breast screening for this age group of black women. Generally, these studies of survey approve that, in the United Kingdom, services of screening are not well utilized by the 50 year black women due to being in minority group and age being count out. The determinants of psychology concerning little uptakes discovered by these studies were status of social and economy, beliefs, literacy, age, attitude, knowledge of screening (Cuzick 2011). On the other hand, outcomes were time and again inconsistent. Moreover, these studies outcome had inadequate overall lack of ability, as a result of their methodological and theoretical fault. Determinants of health beliefs The health beliefs studies as uptakes determining breast screening behaviors studied are of unpredictable value. There is existence of discrepancy in the implementation of the specified hypothetical contexts, which are HBM abbreviation for Health Belief Model and the TPB abbreviation for Theory of Planned Behaviour. There is shortage of procedural accuracy. As a result, leads to spawn as a consequence of this research which needs to be understood with attention (Forbes 2011). Despite the fact that the research could give some awareness into the likelihoods of diverse reactions from diverse groups to breast cancer screening, generalizing to a great extent of these outcomes could, at greatest, preserve mistaken belief of cancer in particular breast cancer that is in existence through the different ethnicities and, at most awful, strengthen ethnic typecast like the 50 year black women. Sustainability Encounter with ethnic elucidations of actions based on health might be realized just in an exclusive view of a rationalist. The challenge with these model is the fact they disregard the social components and affective that might affect behavior of health. Additionally, every minority ethnic culture is not a colossal, unchangeable complete society existing in a societal space. Most cultures of minority are expected to be subjective by their positions structurally vis-à-vis the prevailing society and ideology (Forbes 2011). These are expected to affect their everyday living, therefore probably strengthening or altering their views especially in age matters. It is relatively difficult to assess the cost-effectiveness of the cancer screening approach because every diagnosis is followed by treatment. Furthermore, for every cancer diagnosis, the major treatment is the secondary care, which account for substantial treatment costs. It may be of importance to look at the consequences that follow late diagnosis or events where breast cancer is never diagnosed. The most unfortunate is the eventual death. Whereas it is difficult to quantize the cost of life, it is possible to estimate the economic costs that follow death. Patients suffering from terminal breast cancer will succumb only within the first care setting and this could be either while in a hospice, hospital or home setting. The percentages of succumbing while in these setting are equally the same (Hall 2013). Whereas the costs of dying at home are assumed to be zero, those of dying in hospice and hospital setting are considered to be significant. Additionally, while these could include the nursing support costs, the study was unable of finding the comprehensive data on the area. This implies that there is the tendency that such costs are always underestimated. Besides, the hospice-associated costs are often calculated by multiplying the average stay duration and the daily average hospice care costs. This only gives conservative estimates of some hospice care costs, considering that some patients could have the tendency of seeking more than one hospice care. It is argued that screening programs could have a significant impact on the cancer prevalence. According to UK Cancer Research (2011), it is worth estimating that reduction of cancer incidents could help the country save as significant as 80 million pounds that is incurred in the treatment of these cases. This is takes into the account the assumption that prevented costs may incur the same costs the cases that are diagnosed, only that costs of death are saved. Breast screening helps the discovery of over 681 cancer cases for women who seek screening for over 20 years and as many as 43 percent of these deaths would be prevented (Wolstenholme and Smith, 1998). It can be derived from the above figures that saving lives saves the economy as significant as 1 million pounds. iii. The over-diagnosis ethical Questions In this case, over-diagnosis refers to the tendency of breast screening to detect cancer that may not have been detected in the lifetime of a patient or even caused any harm if it would otherwise not have been detected through screening. Several studies have sought to ascertain the effect of breast screening on population and assessed the over-diagnosis degrees. There is always the fluctuation in the cancer rates among populations and the variations in the over-diagnosis degrees are a reflection of these differences, as well as ways of accounting of the lead times. Some studies have focused on the comparison of the projections previous incidents with the post-screening incidences of breast cancer. These have given varying results of the over-diagnosis degrees, both positive and negative. There are also studies that have compared the incidences of breast cancer trends in countries that screen and those that do not screen breast cancer. The variations are also not uncommon; some associate screening with benefits while other dissociate. The study by Gotzsche and Nielsen (2011) established that it could not be disputed over diagnosis occurs. The implication of over-diagnosis is that the victims are subjected to surgery, medication or even radiotherapy. However, the participants do not know whether the detected cases would have been accompanied by health complications during lifetime or even lead to death. The study established that the probability of having a victim over-diagnosed is about 19 percent. Applying the 19 percent risk treatment to women of age between 50 and 70 who seek treatment for 20 years implies that, out of 10, 000 women, 129 would be over screened (Gotzsche and Nielsen, 2011). Thus, for every screening case, the probability of screening is considered to be at 1 percent. There certain forms of cancer that are not necessarily life threatening and which may be over-diagnosed, for instance, the ductal carcinoma in situ. Ductal carcinoma is tumor that develops in the epithelium of the breast and is composed of the neoplastic cells. Even so, these cells do not develop beyond these regions; thus, are restrained in the ducts that they are formed. There are three classes of ductal carcinoma; low, high and intermediate. Despite the fact that the cells have the appearances of malignancy, they are not characterized by any forms of invasiveness; hence, the phenomenon is not considered life-threatening. Conclusion There are many harms associated with the breast cancer screening, albeit less serious in terms of magnitude to the 50 year old black woman. First as seen the government seems to cut them out on this programme of health. Secondly they might be subjected to a lot of psychological, physical and social pain. Mammography is accompanied by substantial pain that deter some women from seeking further operations. Furthermore, about 4 percent of women are subjected to a repeat of mammography operations. Of these, only 20 percent would be found with cancer. This means there is need to create much awareness to this age group ethnicity of minority black. This considering that of the remaining percentage, 70 percent would only need to be subjected to imaging while 30 percent would require biopsy. These procedures are accompanied by psychological stress. Profound psychological implications also follow the diagnosis disclosure. Counseling and supporting these women financially and emotionally will help in addressing the challenge facing these women. References Association of Breast Surgery, 2012, An audit of screen detected breast cancers for 2011/2012. Retrieved on January 11, 2013, from http://www.cancerscreening.nhs.uk/breastscreen/publications/ Anderson, I et al. (2002). Long-term effects of screening: updated overviews of randomized trials. Lancet 359: 909-19. Bond, M., 2013, Psychological consequences of over-diagnosis in the UK. Evid Based Med. 3(4); 234 256. Cuzick J. et al, 2011, Tamoxifen and radiotherapy effects in women with excised ductal carcinoma Lancet Oncol 12: 21-29. Department of Health, 2013. The Health of the Nation - One year on. London, Department of Health. Duffy, S. Ming, A.  and Chen T, 2012. Long-term benefits of breast screening. 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Economic Burdens of Breast Cancer in Trent Region Int J Health Tecsh Ass 14: 277-289 Read More