Assignment: Epidemiological Analysis: Breast Cancer

Assignment: Epidemiological Analysis: Breast Cancer

Assignment: Epidemiological Analysis: Breast Cancer

Introduction (Identification of the problem) with a clear presentation of the problem as well as the significance and a scholarly overview of the paper’s content. No heading is used for the Introduction per APA current edition.

Background and Significance of the disease, to include: Definition, description, signs and symptoms. Incidence and prevalence of statistics by state with a comparison to national statistics pertaining to the disease. If after a search of the library and scholarly data bases, you are unable to find statistics for your home state, or other states, consider this a gap in the data and state as much in the body of the paper. For instance, you may state something like, “After an exhausting search of the scholarly data bases, this writer is unable to locate incidence and/or prevalence data for the state of …. This indicates a gap in surveillance that will be included in the “Plan” section of this paper.

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Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be specific.
Epidemiological Analysis: Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all of the 5 W’s: What, Who, Where, When, Why. Use details associated with all of the W’s, such as the “Who” which should include an analysis of the determinants of health. Include costs (both financial and social) associated with the disease or problem.
Screening and Guidelines: Review how the disease is diagnosed and current national standards (guidelines). Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and cost.
Plan: Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation. Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?) Note:  Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts. All interventions should be based on evidence – connected to a resource such as a scholarly piece of research.
Summary/Conclusion: Conclude in a clear manner with a brief overview of the keys points from each section of the paper utilizing integration of resources.
The paper should be formatted and organized into the following sections which focus on the chosen chronic health condition.
Adhere to all paper preparation guidelines (see below).
Preparing the Paper:
Page length: 7-10 pages, excluding title page and references.
APA format current edition
Include scholarly in-text references throughout and a reference list.
Include at least one table that the student creates to present information. Please refer to the “Requirements” or rubric for further details. APA formatting required.

*When discussing screening and testing please include screening needs for the transgender population also.
* Discuss the sensitivity, specificity, predictive value, and cost of the screening for Breast Cancer

ASSIGNMENT CONTENT
Category	Pts	%	Description
Identification of the Health Problem	15	7.5%	Comprehensively and succinctly states the problem/concern. Clear presentation of the problem as well as the significance with a scholarly overview of the paper’s content.
Background and Significance of the Health Problem	30		Background and significance is complete, presents risks, disease impact and includes a review of incidence and prevalence of the disease within the student’s state compared to national data. Evidence supports background. If the student discovers a gap in data (no state level data), this is stated within the section. A student created table is included using APA format.  In the case of a gap in data the student will select two other sets of data to use in the student created table.
Current Surveillance and Reporting Methods	30	15%	Current state and national disease surveillance methods are reviewed along with currently gathered types of statistics and information on whether the disease is mandated for reporting.  Supported by evidence.
Descriptive Epidemiological Analysis of Health Problem	35	17%	Comprehensive review and analysis of descriptive epidemiological points for the chronic health problem.  The 5 W’s of epidemiological analysis should be fully identified. Supported by scholarly evidence.
Screening, Diagnosis, Guidelines	30	15%	Review of current guidelines for screening and diagnosis. Screening tool statistics related to validity, predictive value, and reliability of screening tests are presented.
Plan of Action	30	15%	Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation.  Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?)  Note:  Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts.  All interventions should be based on evidence – connected to a resource such as a scholarly piece of research.
Conclusion	15	7.5%	The conclusion thoroughly, clearly, succinctly, and logically presents major points of the paper with clear direction for action.  Includes scholarly references
	185	92%	Total CONTENT Points=185 pts
ASSIGNMENT FORMAT
Category	Points	%	Description
APA current ed.	10	5%	APA is consistently utilized according to the current edition throughout the paper.
Grammar, Syntax, Spelling	5	3%	The paper is free from grammar, unscholarly context or “voice” and spelling is accurate throughout.
	15	8%	Total FORMAT Points=15 pts
	200	100%	ASSIGNMENT TOTAL=200 points

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Epidemiological Analysis: Breast Cancer

Breast cancer refers to epithelial tumors that involve the breast’s ducts or lobules. It is the second leading cancer in women after skin cancers and the second common cause of female cancer deaths globally (Siegel et al., 2022). This is a significant health problem owing to its associated morbidity and mortality rates. The purpose of this paper is to explore breast cancer, including its surveillance and reporting, epidemiology, and screening guidelines, and to create a plan to address the problem by an NP.

Background and Significance of the Health Problem

Breast cancer is categorized into carcinoma in situ and invasive cancer. Carcinoma in situ is characterized by growth of cancer cells in the ducts of the breast and lobules but the cancer cells do not invade the stromal tissue. It is grouped into ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). The DCIS accounts for approximately 85% of the total cases of carcinoma in situ and is diagnosed through mammography. It involves a small or wide breast area, and the latter is involved (Wen & Brogi, 2018). On the other hand, LCIS is usually multifocal and affects both sides. It is categorized into, classic and pleomorphic LCIS. Classic LCIS is usually non-cancerous but heightens the risk of developing invasive malignancy in any of the breasts. It is a non-palpable lesion that is diagnosed through biopsy and hardly ever detected using mammography (Wen & Brogi, 2018). Pleomorphic LCIS acts similar to DCIS and ought to be excised to zero margins. Invasive cancer is mainly adenocarcinoma. Approximately 80% of invasive breast carcinoma is the penetrative ductal type, while the other cases are penetrative lobular.

Signs and Symptoms

The early stage of breast cancer is usually asymptomatic with no breast pain or discomfort. In most cases, breast cancers are identified because of a mass by an individual or during physical exam and mammography. If a mass is identified, the following may suggest possible breast cancer: Skin dimpling or breast skin changes, changes in breast size or shape, nipple inversion or skin change, blood-stained discharge in a single duct, and axillary lump. In situ and invasive carcinoma often manifests with breast skin changes, such as erythema, scaling, crusting, and nipple discharge (Wen & Brogi, 2018). Physical exam findings that should warrant further investigations include lump or change in breast contour, skin tethering, inversion of the nipple, dilated breast veins, ulceration, breast edema, or peau d’orange.

Incidence and Prevalence

The 2021 North American Association of Central Cancer Registries (NAACCR) statistics show that Illinois had a female breast cancer incidence rate of 133.7 per 100,000 from 2014 to 2018. This rate is higher than the national average of 126.9 per 100,000 over the same period (Siegel et al., 2022). Female breast cancer had the greatest overall incidence rate, seconded by Prostate and Lung cancer. Besides, female breast cancer was the second common cause of cancer-related mortality after Lung cancer, with a mortality rate of 20.9 per 100,000 from 2015 to 2019 (Siegel et al., 2022). The mortality rate in Illinois was slightly higher than the national average, which were 19.9 per 100,000. There are an estimated 11,340 new cases of breast cancer in 2022 in Illinois and 1,730 related deaths. The national approximated new cases of female breast cancer in 2022 are 290,560, while the estimated mortalities are 43,780.

Statistic	Illinois	United States
Incidence rate	133.7 per 100,000	126.9 per 100,000
Mortality Rate	20.9 per 100,000	19.9 per 100,000
Approximated new cases	11,340	290,560
Approximated 2022 mortalities	1,730	43,780

 

Surveillance and Reporting

The Illinois State Cancer Registry (ISCR) is the sole resource of cancer data based on populations in Illinois. Diagnosed cases of cancer are obtained by reporting, which is mandated on ambulatory surgical treatment facilities, independent pathology labs, hospitals, radiation therapy treatment facilities, dermatologists, and via the exchange of cancer statistics with neighboring states (Siegel et al., 2022). Healthcare facilities in Illinois are directed to convey diagnosed cases of cancer within six months of the date of diagnosis or within four months after the cancer patient is discharged from the facility. The NAACCR analyzes all state cancer registries in North America annually for the states’ performance in obtaining comprehensive, accurate, and prompt cancer data.

Descriptive Epidemiological Analysis of the Health Problem  

What

Breast cancer is the leading cancer in females worldwide, with about 2.26 million new incidences in 2020. In the US, it takes up about 29% of all new cancers in females. Although breast cancer is prevalent in females, it also occurs in males. Breast cancer in males accounts for roughly 1% of the total cases (Łukasiewicz et al., 2021. Women in the US have a cumulative lifetime risk of about 12% of developing breast cancer. Much of the risk occurs after the age of 60 years, and the risk of mortality from breast cancer is approximately ten percent within five years after being diagnosed.

Who

Older adults are mostly affected by breast cancer. The prevalence of breast cancer greatly increases with age, becoming significant before 50 years. In the premenopausal years, the rate of increase in the cases of breast cancer is about 8%-9% annually (Łukasiewicz et al., 2021). The increase in these cancers persists throughout the lifespan but is reduced significantly after menopause, to about 2%-3% annually. The female reproductive hormones are attributed to this dependent on menopausal status. Currently, approximately 80% of women with breast cancer are above 50, while over 40% are women above 65 years. In men, the average age at diagnosis is 67 years.

White women aged 40 years and older have the highest incidence rate of breast cancer. However, statistics reveal a high prevalence of the disorder among black females below 40 years than white women. However, white females above 40 years a have higher prevalence rate. Nevertheless, Black females have worse survival rates with five-years of diagnosis in all age groups compared to whites (Łukasiewicz et al., 2021). The poor survival rate among Blacks is attributed to social determinants of health (SDOH) like access to health and healthcare. Black females are mostly diagnosed with the disorder when it has advanced due to limited access to screening services (Feinglass et al., 2019). Besides, the uninsurance rate is higher in minority populations than in whites limiting their ability to access mammography screening and advanced breast cancer screening services.

Persons with genetic mutations of breast cancer have a high risk of developing the disease. For instance, people with BRCA1 and BRCA2 genes, which are primarily linked with a high risk of breast carcinogenesis, have a higher incidence (Łukasiewicz et al., 2021). In addition, persons with a family history of the disorders have a high risk of developing breast cancer. About 13–19% of individuals positive for breast cancer have a close family member with the condition. The risk of breast cancer considerably rises when a person has more close relatives with the condition, and the risk is much higher when these family members are below 50.

Where

The incidence of breast cancer has been escalating in most of the lower-risk nations and in high-risk Western countries since the 1950s. The incidence rates have almost doubled in the past decades in traditionally low-risk Asian nations like Japan, and the urban China. The global prevalence of this condition varies significantly. It is mostly prevalent is in the US and Northern Europe. South America, Southern Europe, and Eastern Europe have the second highest prevalence, and Asia and Africa have the least (Luo et al., 2022). The prevalence of breast cancer in 2020 was highest in developed nations, but the mortality rates were highest in developing regions in Asia and Africa, taking about 63% of total mortalities. Many patients who develop breast cancer in developed countries survive, while many from middle-income and low-income countries succumb.

When

The incidence and mortality rates of breast cancer have escalated in the past three decades. Statistics show that from 1990 to 2016, the incidence doubled in 60/102 nations, while mortalities doubled in 43/102 nations (Luo et al., 2022). Breast cancer statistics from 1975 to 2016 reveal a rise in the incidence rates of DCIS from 1983 to 1999 and then a relatively constant rate from 2000 to 2011, followed by a decrease of roughly 2.1% annually from 2012 to 2016. For invasive breast cancer, there was a sharp increase from 1987 to 2000 attributed to increased use of mammography, followed by a rapid decrease from 1994 to 2004 (Luo et al., 2022). The current estimates show that the global new incidences will reach 2.7 million yearly, while the mortalities will reach 870,000 by 2030.

How

Breast cancer is associated with various non-modifiable and modifiable risk factors. Women having a history of breast or ovarian cancer face a high risk of having breast cancer. The density of breast tissue also correlates with the risk of breast cancer. Premenopausal and postmenopausal women with denser breast tissue face a high risk of breast cancer (Łukasiewicz et al., 2021. Modifiable risk factors include Hormonal replacement therapy, consumption of processed foods, physical inactivity, overweight/obesity, excessive alcohol intake, tobacco smoking, inadequate vitamin supplementation, and high exposure to artificial light.

Screening and Guidelines

Breast cancer is screened using mammography, the only available approach for early detection of non-palpable cancerous breast mass. Screen-film mammography (SFM) is considered the gold standard for screening this condition. SFM has a high spatial resolution that suits it for detecting microcalcifications (Farber et al., 2021). It is recommended to screen healthy females 50-74 years with no signs of breast cancer. Evidence shows that screening with SFM lowers deaths related to breast cancer, with a greater absolute decrease in females 50 to 74 years than those who are younger. Nevertheless, Song et al. (2019) assert that screening women 40 to 49 years with a standard risk is ineffective. Exposure to feminizing hormones puts individuals at risk of breast cancer. The difference between transgender and non-transgender women is the period of exposure to estrogens and progesterone. Guidelines recommend that breast cancer screening should not start in transgender women until after at least five years of use of feminizing hormones despite age (Deutsch, 2019). Furthermore, mammography is recommended every two years after a transgender woman reaches 50 years and the 5-10 years of use feminizing hormone criteria are met.

SFM uses X-ray radiation to generate breast images, which are read and stored on film, that create room for false positives or inaccurate diagnosis. The breast is a complicated organ to conduct imaging due to tissues with varying densities and glandular tissue interspersed with fat. Consequently, SFM’s sensitivity in detecting carcinoma in dense breasts is reduced. SFM has a 62.9% decrease in sensitivity in dense breast tissue as opposed to 87.0% in breasts with fatty involution (Song et al., 2019). It has an accuracy of 92%. However, Full-field digital mammography is more superior in defining round and irregular breast masses and masses of all densities. Furthermore, it is less cost-effective compared to the new digital mammography.

Plan of Action 

The NP will address breast cancer in future practice through primary, secondary, and tertiary prevention methods. Primary prevention will include providing health education on measures to lower the risk of developing breast cancer by eliminating modifiable risk factors. This will include educating patients and the community on healthy lifestyle practices such as a healthy diet, regular physical exercises, cessation of smoking, limiting alcohol consumption, and taking foods rich in vitamins (Sauter, 2018). Secondary prevention will include recommending women 50 to 74 years have biennial screening mammography and following up on mammography results (Sauter, 2018). The NP will initiate prompt medical interventions for clients detected with breast cancer in the early-stage and refer them to the appropriate specialists. The intervention will be evaluated by measuring the number of patients who get screened for breast cancer.

In the tertiary stage, the NP will be involved in helping breast cancer patients and their caregivers to deal with the disease, including the side effects of treatment. Besides, the NP will help patients in managing their behaviors and lifestyle habits to better manage the disease and promote better treatment outcomes. Depression and anxiety disorders are a major concern in breast cancer patients (Sauter, 2018). Therefore, the NP will screen patients for these disorders and refer them for psychiatric assessment and management. In addition, the NP will be involved in advocacy efforts to increase the accessibility of screening services for all populations. This will increase the number of individuals diagnosed early with breast cancer and who are promptly treated.

Conclusion

Breast cancer occurs when carcinogenesis occurs in a breast cell or tissue, causing pathological alternations that result in cancer. Illinois has breast cancer incidence and mortality rates higher than the national average. The most affected women are older adults, White women, and those with genetic mutations of BRCA1 and BRCA2. However, minority populations have a lower survival rate due to limited accessibility to screening services. Screen-film mammography is recommended in screening cancer of the breast in women 50-74 years. The NP will educate individuals on lifestyle practices to alleviate breast cancer risk, recommend mammography as well as, assist patients in dealing with the disease.

References

Deutsch, M. B. (2019). Screening for breast cancer in transgender women. UCSF Center of Excellence for Transgender Health.

Farber, R., Houssami, N., Wortley, S., Jacklyn, G., Marinovich, M. L., McGeechan, K., Barratt, A., & Bell, K. (2021). Impact of Full-Field Digital Mammography Versus Film-Screen Mammography in Population Screening: A Meta-Analysis. Journal of the National Cancer Institute, 113(1), 16–26. https://doi.org/10.1093/jnci/djaa080

Feinglass, J., Cooper, J. M., Rydland, K., Tom, L. S., & Simon, M. A. (2019). Using Public Claims Data for Neighborhood Level Epidemiologie Surveillance of Breast Cancer Screening: Findings from Evaluating a Patient Navigation Program in Chicago’s Chinatown. Progress in community health partnerships: research, education, and action, 13(5), 95–102. https://doi.org/10.1353/cpr.2019.0042

Łukasiewicz, S., Czeczelewski, M., Forma, A., Baj, J., Sitarz, R., & Stanisławek, A. (2021). Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers, 13(17), 4287. https://doi.org/10.3390/cancers13174287

Luo, C., Li, N., Lu, B., Cai, J., Lu, M., Zhang, Y., … & Dai, M. (2022). Global and regional trends in incidence and mortality of female breast cancer and associated factors at national level in 2000 to 2019. Chinese Medical Journal, 135(01), 42-51. https://doi.org/ 10.1097/CM9.0000000000001814

Sauter, E. R. (2018). Breast Cancer Prevention: Current Approaches and Future Directions. European journal of breast health, 14(2), 64–71. https://doi.org/10.5152/ejbh.2018.3978

Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2022). Cancer statistics, 2022. CA: a cancer journal for clinicians. https://doi.org/10.3322/caac.21708

Song, S. Y., Park, B., Hong, S., Kim, M. J., Lee, E. H., & Jun, J. K. (2019). Comparison of Digital and Screen-Film Mammography for Breast-Cancer Screening: A Systematic Review and Meta-Analysis. Journal of breast cancer, 22(2), 311–325. https://doi.org/10.4048/jbc.2019.22.e24

Wen, H. Y., & Brogi, E. (2018). Lobular Carcinoma In Situ. Surgical pathology clinics, 11(1), 123–145. https://doi.org/10.1016/j.path.2017.09.009