Health Disparities and Breast Cancer

Breast cancer is the leading cancer in Canadian women and is the second most common cause of cancer death in women. About 26,300 Canadian women were diagnosed with breast cancer in 2017 and 5000 died of it (Government of Canada, 2017). The age standardized incidence rate (ASIR) of breast cancer in Canadian women has remained fairly stable. ASIR of breast cancer was 130.3 per 100,000 women in 2017. The mortality rate, though, has declined from 41.7 per 100,000 women in 1988 to 23.2 per 100,000 women in 2017 (Moher, & Julian Little, 2017). These figures suggest an improvement in breast cancer screenings and treatments. As health care professionals we must inform ourselves, through the best quality evidence, on the factors that impact on breast cancer incidence and mortality.

At present mammography is the most common screening tool used for breast cancer diagnostics. Mammogram screening alone can decrease cancer mortality by 15-18 % in women that are not as significant risk by picking up otherwise undetectable tumors. This enables early detection of breast cancers (stage I or II) where 5-year survival rates are greatly improved; 96% for stage I and 86% for stage II (Canadian Task Force on Preventative Health Care, 2018; Cancer Statistics Advisory Committee, 2007; Moher, & Julian Little, 2017). Yet many women don’t get screened, especially in socially disadvantaged and minority communities, and subsequently have their cancer diagnosed at a later stage which impacts on mortality and survival (Warnecke, Campbell, Vijayasiri, Barrett, & Rauscher, 2019). As well, these women are not aware of primary prevention, like modifications of unhealthy lifestyle behaviours, or of risk factors of breast cancer, such as a genetic predisposition that may necessitate more vigilant screening and follow up. Health inequities for underprivileged women are rooted in the determinants of health and have to be addressed through multilevel interventions (Agurs-Collins, et al., 2019).

Health disparities related to breast cancer screening and prevention have multifactorial causes. To be able to achieve positive outcomes, multilevel interventions must be implemented and assessed for effectiveness. Studies on the effectiveness of these interventions require an appropriate design to produce the best information on outcomes (Agurs-Collins, et al., 2019). Using a multilevel interventions model like PRECEDE/PROCEDE can facilitate the planning, implementing and evaluating of interventions for primary and secondary prevention of breast cancer in the full context of the women’s lives and communities and not just on an individual level (Rural Health Information Hub, 2019).

Elizabeth

References

Agurs-Collins, T., Persky, S., Paskett, E. D., Barkin, S. L., Meissner, H. I., Nansel, T. R., Arteaga, S. S., Zhang, X., Das, R., & Farhatet, T. (2019). Designing and assessing multilevel interventions to improve minority health and reduce health disparities. American Journal of Public Health 109(S1), S86-S93. DOI: 10.2105/AJPH.2018.304730 Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2018.304730

Canadian Task Force on Preventative Health Care. (2018). Patient Tool - All Ages. Breast Cancer Screening for Women Not at Increased Risk. Retrieved from https://canadiantaskforce.ca/wp-content/uploads/2019/01/CTFPHC_Breast_Cancer_1000_Person-Final_v10.pdf

Cancer Statistics Advisory Committee. (2007). Canadian Cancer Statistics 2007. Toronto, ON: Canadian Cancer Society; 2007. Available at: cancer.ca/Canadian-Cancer-Statistics-2018-EN (accessed [date]). Retrieved from http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2007-EN.pdf?la=en

Moher, D., & Julian Little, J. (2017). Breast cancer screening: Part A. An evidence report to inform an update of the Canadian Task Force on Preventive Health Care 2011. Guideline. Public Health Agency of Canada. Retrieved from https://canadiantaskforce.ca/wp-content/uploads/2019/02/Systematic-Review-Evidence-Report_v2_FINAL.pdf

Rural Health Information Hub. (2019). PRECEDE/PROCEDE. Retrieved from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/program-models/precede-proceed

Warnecke, R. B., Campbell, R. T., Vijayasiri, G., Barrett, R. E., & Rauscher, G. H. (2019). Multilevel examination of health disparity: The role of policy implementation in neighborhood context, in patient resources, and in healthcare facilities on later stage of breast cancer diagnosis. Cancer Epidemiol Biomarkers Preventions, 28(1) 59-66; DOI: 10.1158/1055-9965.EPI-17-0945 retrieved from http://cebp.aacrjournals.org/content/28/1/59