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Trends In Socioeconomic and Race -Ethnic Disparities In Breast Cancer Incidence, Diagnosis, Mortality, Treatment And Survival

Patricia Amaefuna N704: Social Justice and Health Disparities Professors Jean Sweeney and May Dobal December 2010

Trends in Socioeconomic and Race Disparities in Breast Cancer Incidence, Diagnosis, Mortality, Treatment and Survival among Black Women ABSTRACT The incidence of breast cancer in which has been on the rise for decades has dramatically declined in the United States. The decline varies systematically be race ethnicity and socioeconomic status. The incidence of breast cancer has not declined among black women and the incidence f ductal Carcinoma in situ has not witnessed a comparable decline. Previous studies focused on disparities between particular group only. To improve our understanding of driving factors for breast cancer trends, this paper will discuss evidence and present state of science in breast cancer incidence disparities analyze cultural, economic, political health policy and social justice associated with race ethnic disparities in breast cancer incidence, screening and survival. And discuss implication to nursing education practice and research.

1. Evidence and present state of science associated with race-ethnic disparities in breast cancer incidence. The state of science conference held in 2009 explored and assessed current scientific knowledge regarding diagnosis and management of ductal carcinoma in situ. Basically, this occurs when abnormal cells replace normal cells at breast ducts without invasion and it is detected via mammographic screening for invasive breast cancer. According to state of science statement (2009) The incidence and prevalence of ductal carcinoma in situ (DCIS) has increased tremendously in United States and has remain with

no decline, It is also more prevalent in woman aged 50 years and above. Several studies have shown higher breast cancer mortality and recurrence rate among black women who have DCIS complained with white women. Although there are no differences in screening disparity ???????????. even when controlling for differences in age treatment and survival. (state of science 2009). Magnetic resonance imaging (MRI) and lymph node biopsy one major diagnostic techniques used to inform the patients with DCIS. Numerous studies demonstrate poor outcome among women young already presented with systems compared with women whose DCIS was detected by mammography alone. Randomized clinical trials shows that patients benefits from radiotherapy however there may be subgroup of women. The following major areas has been mapped as critical in the advancement of our understanding of DCIS. Development of standard reporting system across all disparities Data collection on clinical, radiologic pathologic and molecular characteristics of DCIS Further development in decision acids along with intergrated with clinical practice impact on quality of care for cancer patients with DCIS need investigation. Research needed on patient-provider communication, informed constant, patient preference discussion making for treatment and diagnosis. Aids for decision should be developed evaluated and intergrated into clinical practice. Research on treatment methods for DCIS. Conclusion:Analyze the culture economic political health polify and social justices issues disparities in breast cancer incidence screening mortality treatment survival

Culture: Some studies showed that black women are deep rooted in their culture which influences their decision making regarding breast cancer screening , diagnosis and treatment. Culture specific fears and beliefs about breast cancer have been associated with differential screening practices black women may not go for mammography which may be the cause for late stage breast cancer detection among black women (Gerend and Pac, 2008). Fear of insufficient and in effective treatment for breast cancer may lead to display of less confidence in western medicine and instructed which is partially rooted in history of experiment and abuse of African-Americans, several researchers suggested that may effect black women decision about seeking care and interaction with medical providers (Gerald Pai, 2005) Adequate understanding of the impact of cultured barriers on breast cancer behaviors with enable provides to assist and provides to assist and provide better care for their patients. Economic: Poverty is associated with poor breast cancer outcomes and larger population of black women them white lives in poverty, black women are move likely to face poverty related barriers associated with racial disparities across the entire breast cancer Continues includes lack of health insurance poor transportation lack of primary care physician lack of information and knowledge risk promoting lifestyles (Swanson etal 2000 Frend and Pai 2008) In assessing temporal trends in race ethnic and socioeconomic disparities across breast cancer related outcomes Haper et al (2005) adapted a statical perpesctive congrulent with the healthy people 2010 framework, which tries to eliminate disparities across entire range of subgroup. The researchers collect nationality and 5-year cause specific death rate from SEER and data from national health interview survey 4anea- socioeconomic groups were used based on percentage poverty in participating restudy area and 5 race ethnic groups ????

^ socioeconomic duty between race ethnic groups may play a role in breast cancer mortality and survival disparities. A recent meta-analysis of breast cancer survival studies that included measures of socioeconomic position found that 27% increased mortality risk among black women after adjustment for socioeconomic position (Harper et al, 2005) Trends in health insurance does not have much effort race-ethnic survival disparities are evident among insured populations with access to medical care and there evidence of widening disparities among soon where access to care is free Political: Developing creative approaches to the conduct of studies of African-American women that includes their broad culture ethnic background and life experiences and perceptions of discriminations is a step in the right direction (Bernstein et al, 1994) establishing a multistate, long term, longitude color study with representation of AfricaAmerican women of varied levitate will be merus of establishing risk factors for breast cancer great effort should be grieved towards obtaining full participation of AfricanAmerican women which is the way to success of the study. One way to improve ??????????? rates for breast cancer researchers studies is to use the advocacy community as partner (Bernstein et al 1994) Partnership with community based organization and community leaders, including survivals of breast cancer and advocates should be key elements in planning process to improve success of researchers studies. Health Policy: An important step towards elimination of health care and disparities is systematic collection and analysis of healthcare data to help policy matters and reaches top areas of greatest needs monitor trends overtime and identify programs to help harness the needs (National health

disparity report) There should be special screening guidelines for women width severe comorbidity would be investigators must consider competing cause of death clinical trials should be conducted w/ quality of life and points The report suggested that elimination disparities in health is goal healthy people 2010, suggested that racial, ethnic and socioeconomic disparities are national problems.

Social Justice: There is no direct evidence linking disparities in breast cancer to social injustice. However there are clear reasons for suspecting that racial prejudice and discrimination contribute to disparities in breast cancer among black- white women, some studies suggest rate-in breast cancer incidence differential referrals for mammography screening and inequality in treatment. Taylor et al ( ) found a popular relationship between perceived racial

discrimination and incidence of breast cancer which was pronounced among black women younger than 50 years. Venon et al (1993) found that African Americans were more likely than whites to cite lack of physician recommendation as reason for not undergoing breast cancer screening on the same note a report from 2000 national health interview study indicated that a greater proportion of African American women reported that their doctor never suggested mammography physician perception of patients are affected by patients race and economic status (gerendtrai)

Synthesis finding of literature and identify gaps and for need associated with the disaparity. Jatori et al (2008) reported blacks with health insurance or have adequate coverage which limit their access to screening and decision regarding use of adjuvant therapy earlier, Jatori et al had reported. The breast cancer mortality decline in estrogen receptor positive tumor more common among whites than black women and suggested the difference in decline may be due to increase use of ????? which is highly effective in ERT cancers. Thus ER cancer higher among black women may contribute to low mortality declines. Mortality trends to by raceethnicity and tumor characterisitics may need detailed examination. Findings by chu et al (2003) indicated that black females have less early stage disease in each age group for tumor characteristics in the 1980spreviously black women under there is need for more early detections and timely cancer diagnosis. Provision of access to medical services for earlier detection and testing is therefore necessary. Recently national survey indicated that black women use of mammography is similar to white female for younger and older. Any recent delay in diagnosis is re;ated to lack of follow-up on abnormal mammorgram may lead to later stage diagnosis. Amount of late-stage disease in balck females reflect difficulties in getting underserved minority populations to participate in screening ACCOUNTING FOR LATER STAGE OF DIAGNOSIS AMONG THE POPULATION. Several studies maintained that regular mammography is an essential factor in increasing survival rate. Differences in stage distribution in dictates need for black women of all age to attend routine mammography when due and follow up on abnormal screening result. Swanson et al (2002) identified two problems with current breast cancer screening methods, pointing out that current methods carnival identify breast cacners at the earliest moleculier stage

and there is no efficious screening method for women lass than 40 years therefore there is need to develop mew method of screening especially one that most effective in younger women. Haper et al observed slower mortality decline among black women with 10% decline compared to white with 22% several other studies have also noted widening disparities between balck and whites for breast cancer mortality and survival a large body of evidence suggest that multiple factors are related to poor survival among black women including poor access to health insurance decreased treatment, more comorbid condition, later style diagnosis high rates of obesity. GEarnd and Pai (2008) identified low social economic status as a variable that characters Africa-American women plays as part in mainting black-white disparities in breast caner mortality and survival. Harper et al (2005). Findings by tammemagi et al suggest that control of comorbosity may be an important way of improving, survival of black breast canc er patients and further investigation is needed to establish generalization of study finding other population. Discuss implications to nursing education, pratical and reaserch. Nursing education There is great need to teach and create awareness of culture diverse nurse to awakeness of cultural beliefs and practical that affect black women is decision about breast cancer will help about and guide and issues resolved timely nurses should be able to provide education that dresses cancer misconceptions common among black women community that is courage them from seeking medical help on time, family should be involved during patient educaiotn as they play important role in patient decision. Messages about breast cancer preventions screening,

diagnosis and treatment could be culturally tailored and be disseminated via influencial mebers of the commmuntiy Practice: small scale changes need to be implemented Practice: in order to reduce racial disparities, there is need to implement small scale changes into the practice of emphasis or cancer prevention practices early detection screening and treatment need to draft strategy for primary care prevention directed to known and modified risk factors obesity physical altwings and healthy feeding screening should be directed towards black women younger than regular than 50 years which emphasize on maintain regular routine ammography and followup maintain an existing navigation program should set aside money to fund the navigation program to recuce some barriers. Facilitate should set aside money to fund the navigation program Research: Start commercial research is needed an causes, prevention treatment of breast cancer. Future research is needed to map specific strategy to monitor how health outcomes effort should be geared towards reducing social, economic and cultural barriers to narrow gap in breast cancer mortality ( Gerad and Pai 2008) future research should assess the extent to which social, economic and cultural barriers impact other ethnic groups commitment is required by health researchers to work towards understanding possible impact of discrimination on health outcomes among US black. Future studies are needed to understand cultural homes that my contribute to the development of women, move research is necessary to nail move research is necessary to nail sources of disparity treatment outcome and also to identify know differention treatment outcome are a function of provider, patient and system

Conclusion: although kept up with prevation, diagnosis and treatment of breast cancer requires continued research, a lot of progress can be achieved by applying existing knowledge to all breast cancer coninum, and breast cancer disparities also need continued effort to ensure that all women have detection and treatment. The determinants of suboptimal treatment may included inadequate physican patient communication, poor treatment, social support network, comorbodity and oter factors, a better understanding of these association may laed to intervention that can improve breast cancer outcome and reduce racial disparites in breast cancer survival

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