1. Health Promotion Activities surveillance
for
African American women
with Breast Cancer
Liberty University
Advanced Physiology and Pathophysiology
Final Project Presentation
Funmilayo Whitaker
NUR - 506

2. Breast Cancer is…
 A disease in which abnormal breast cells grow at an
alarming rate. The type of breast cancer you have
depends on which breast cells turn cancerous. Breast
cancer, like other cancers, can spread and eventfully
kill – if not detected early enough.
 Breast cancer is the first most common cancer in
women of all races, however African American women
bear a larger burden from the disease than any other race.
http://www.cdc.org

3. Pathophysiology…
 Various types of breast cancer have been identified based on
their histologic characteristics and growth patterns. The main
component of the breast are lobules (milk-producing glands) and
ducts(milk passages that connect the lobules and the nipple). In
general breast cancer arise from the epithelial lining of the
ducts(duct carcinoma). Breast cancer may be invasive or in situ.
Most breast cancer arise from the ducts are invasive.
 The natural history of breast cancer varies considerably from
patient to patient. Cancer growth rate can range from slow to
rapid. Factors that affect cancer prognosis are size, axillary node
involvement, tumor differentiation, DNA content and estrogen
and progesterone receptor status. ( Lewis et. al. 2004)

4. Population Characteristics
African Americans are
about 34% more likely to
die of cancer than are
whites.
African American women
are more likely to die of
breast and colon cancers than
are women of any other race.
http://www.healthypeople.gov//document/thml/volume/03cancer.htm

5. BRCA Statistics…
 Cancer exacts a higher toll in African Americans than in whites. The
mortality is higher across virtually all tumor types and stages. In breast
cancer, more African American women present with advanced
disease. Even in patients with similar stages of disease at presentation,
survival is worse for African Americans. Only 76 percent of African
American women diagnosed with breast cancer survive compared to 90
percent of white women.
 More cancers are diagnosed in African American adults -722 new cases
per 100,000-compared to 665 new cases in whites. Male African
Americans share the heaviest burden in this disparity in
incidence. Cancer mortality also is higher in African Americans, where
237 per 100,000 will die compared to 190 Caucasians. Although cancer
mortality has generally decreased, the age-adjusted morality rate is 36%
higher in African American males than in white males.
http://www.hopkinskimmelcancercenter.org/index.cfm/cID/471?CFID=7255723&CFTOKEN=54473558

6. Breast Cancer Incidence
The incidence rates for White American women is higher than
African American women. The incidence of breast cancer has
risen steadily since 1950 and is leveling off at about 110 cases per
100,000 women.
135
African
130 American
women,
125 118.3 per
100,000
120 White
American
115 women,
132.5 per
100,000
110
Incidence
American Cancer Society (2007-2008). Cancer Fact & Figures for American (pp

7. Breast Cancer Mortality
The death rate for African American
women is much higher than that of White
American. 35
30 African
American
25
women,
20 33.8 per
100,000
15 White
American
10
women,
5 25.0 per
100,000
0
Mortality
http://www.omhrc.gov/templates/content.aspx?ID=2826

8. Breast Cancer Prevalence
The 5 year survival rate for 1996 – 2002 was 77
% for African American women and 90% for
White American women.
American Cancer Society (2007-2008). Cancer Fact & Figures for American American

9. Breast Cancer Morbidity
 Depression
 Pain
 Nausea/vomiting
 Hair loss
 Fatigue
 Oral complications
www.cancer.gov

10. Breast Cancer Risk Factors
 Age
 Personal history with breast cancer
 Family History
 Genetic Predisposition
 Socioeconomic status
 Geographical variation
www.cdc.gov/cancer

11. Healthy People 2010 findings on
Breast Cancer in African
American Women
 African Americans have a higher death rate from breast cancer
despite having a mammography screening rate that is nearly the
same as white women.
Http://www.healthypeople.gov/document/html/uih_2.htm

12. African American Women often forego
vital treatment…
A new study finds that nearly one in four African American women
with late stage breast cancer refuse chemotherapy and radiation
therapies. Published in the July 2009 issue of CANCER, a peer-
reviewed journal of the American Cancer Society , the study
indicates that more efforts are needed to ensure that all women with
breast cancer receive appropriate care.
Http://www.sciencecentric.com/news/article.php?q=09052248-african-american-
women-...

13. Goals
Two goals set forward:
 The first is to help persons of all ages increase life expectancy and
improve their quality of life.
 The second goal is to eliminate health disparities among segments of
the population, including differences that occur by gender, race or
ethnicity, education or income, disability, geographic location, or
sexual orientation.
http://www.askew.fsu.edu/current/masters/actionreport/sp2004/Josette%20
Sykes%20%20Eliminating%20Health%20Disparities%20among%20African.pdf

14. Breast Cancer Geographical Differences
 According to the US Census Bureau, Top 10 states with the
largest African American population.
 New York, California, Texas, Georgia, Florida, North Carolina,
Illinois, Michigan, Maryland and Virginia.
www.cdc.gov/cancer

15. Examples of Evidenced base
efforts
 Primary - Education/teaching/communication
To increase knowledge/awareness of breast cancer
To educate medical community.
 Secondary – Screenings/ Mammography
Early detection of breast cancer
Prompt diagnosis of breast cancer
 Tertiary – Treatment/Clinical research
Treatment options
Clinical Research
Rehabilitation/Survivorship programs.

16. Primary Level
resources/efforts
CDC/Cancer.org/Alabama REACH/Susan G.
Komen/Sisters Network, Inc.
Breast Cancer Continuing Medical Education
 This new program educates clinicians to be culturally sensitive and
to provide appropriate and timely information to African American
women regarding breast cancer.
 The need for training healthcare professional in communication
strategies which is designed to engage patient in medical decisions
and reduce disparities is evident in all stages of the cancer
continuum.
http://www.cdc.gov/cancer/nbccedp/cme.htm

17. Primary Level resources/efforts
through Cancer.org
 CancerPlan.org enables State and Community Cancer Control
Planners to share resources and tools to effectively develop,
implement, and evaluate Comprehensive Cancer Control (CCC)
Plans.
http://www.cancerplan.org/portal/server.pt/space=communityPage8

18. Primary Level resources/efforts
Alabama (REACH) Susan G.
Komen/Sisters Inc. Program
Community Education & Awareness Programs
 The university of Alabama at Birmingham Breast and Cervical Cancer
Coalition involved a variety of community-based, religious, grassroots, and
health care organizations that serve the underserved populations.
 Designed to reduce disparities in breast cancer education/awareness and
outcome between African American and white women through the use of
community advisors.
 Susan G. Komen/Sisters Study Inc. reaching out to provide breast cancer
awareness and education to African-American community.
http://www.healthierus.gov/steps/summit/prevportfolio/programs/cancer.htm

19. Secondary Level
resources/efforts
CDC(NBCCEDP)/USDHHS(WISEWOMAN)
 CDC provides low-income, uninsured, and underserved women access to
timely, high-quality screening and diagnostic services, to detect breast
and cervical cancer at the earliest stages, through the National Breast and
Cervical Cancer Early Detection Program (NBCCEDP).
 In 1993 Congress established WISEWOMAN program. Well integrated
screening and evaluation program for women across the nation. A
preventive program as an opportunity to offer low income African
American women additional screening services.
http://www.hhs.gov/asl/testify/t020425.html
http://www.cdc.gov/cancer/nbccedp/about.htm

20. Intervention
Program Failure
 Although the NBCCEDP Program provided screening services to over a
half-million low-income, uninsured women for mammography, it served
a small percentage of those eligible. Given that in 2003 more than 2.3
million uninsured, low-income, women aged 40-64 did not receive
recommended mammograms from this program or other sources, there
remains a substantial need for services for this historically underserved
population.
 Community demographics influence the ability to reach minority women,
although more than half of all women screened through the program are
non-white. Most African American women felt mammograms were
unpleasant and very uncomfortable.
 Mammography are still underused by many African-American women
and those who immigrated to the United States within the past 10 years.
 Still many African women do not participate in screening programs
because of high cost, lack of the program awareness, fear of breast cancer,
and the concern about being used as “guinea pigs”.
http://ww.cdc.gov/cancer/nbccedp/about.htm

21. Secondary Level
intervention Program
Success
Secondary Level Program Success:
 Since 1991, the NBCCEDP has served more than 2.7 million women,
provided more than 6.5 million screening examinations, and diagnosed
more than 26,000 breast cancers, 88,000 precursor cervical lesions, and
1,700 cervical cancers.
 In 2004, the NBCCEDP 1) screened 391,968 women for breast cancer
using mammography, 2) found 3,970 breast cancers, and 3) screened
12.6% of all American women eligible to participate in the NBCCEDP
for breast cancer.
http://ww.cdc.gov/cancer/nbccedp/about.htm

22. Tertiary resources/efforts
 Over the past five years, Susan G. Komen for the Cure Affiliates - working
with local organizations to help fund breast cancer survivorship screening,
treatment and clinical research programs over the past five years, and have
awarded more than $160 million in needs-based community grants.
 Sisters Network Inc. a national African-American survivor advocate
organization that has provided health awareness rehabilitation program and
clinical trial support to thousands of women in the African-American
community since its inception in 1994.
http://wwwcms.komen/publicPloicy/AccesstoQualityCare/index.htm
http://theoncologist.alphamedpress.org/cgi/content/full/10/1/1

23. Tertiary Level Program
resources/efforts Success
 Since its inception in 1982, Susan G. Komen foundation have awarded more
than 1,000 breast cancer research grants totaling more than $180 million.
They remain the nation's largest private provider of funds for breast cancer
research and community outreach programs
 In addition to funding breast cancer research, Komen and their Domestic
Affiliate Network fund non-duplicative, community-based grants that
translate the findings from research into breast health education and seek to
enhance the availability of breast cancer screening and treatment for the
medically underserved.
 The survivorship advocates, social networks, and church-based support
groups appears to be quite valuable in achieving
their goals. Especially Sisters Network supporting thousands of African-
American breast cancer survivors.
http://www.cms.komen/publicPloicy/AccesstoQualityCare/index.htm
http://theoncologist.alphamedpress.org/cgi/content/full/10/1/1

24. Tertiary Level Program
resources/efforts failure
 Current budgetary climate leading states to reduce or eliminate funding for
important treatment program. This is because medical care expenses for cancer
patients and survivors add up to over $60 billion annually, above 5% of all dollars
spent on health care in the U.S.
 Socioeconomic factors, low income, lack of knowledge about cancer treatment and
lack of medical insurance for post-treatment.
 Geographical variation, African-American women in the rural areas have less access
and knowledge about these programs.
 Fatalistic beliefs – cancer is inevitable/untreatable.
 Program reach less than 20 percent of eligible women due to funding constraints.
 External locus of control
http://www.plan2003.cancer.gov/inbrief/highlights.htm

25. Effect of Exercise on
Breast Cancer Patients and
Survivors
 Physical exercise has been identified as a potential intervention
to improve quality of life in women with breast cancer. Exercise
is an effective intervention to improve quality of life,
cardiorespiratory fitness, physical functioning and fatigue in
breast cancer patients and survivors.
http://www.cmaj.ca/cgi/content/full/175/1/34

26. A Solution/Resolution to Address Concerns
and Level of Prevention
Support Breast Cancer Legislation –
 Target changes toward passage of Breast Cancer Treatment Act, which
will secure Medical coverage for low income, uninsured women
through a federal screening program – “Access to quality
care for all”
 The main goal is to achieve a longstanding commitment to advancing
uncompromised evidence-based medicine and training consumers to
strive toward system change. (This must include meaningful access to
evidence based interventions that study environmental factors that are
believed to contribute to breast cancer.) The health care system must
have methods for measuring what is and is not working in order for
quality of care to continuously improve. Re-Evaluation!!!
Retrieved from: http:// www.natlbcc.org

27. Potential Social Primary
Implications and Solution
 Integrated low literacy Cancer Education program for the AA
community.
• Patient literacy influences access to curial information about
the right healthcare, where it involves following instructions
for care, taking meds and comprehending information related
to information give
• Education and material resources will help to increase
knowledge and awareness among AA
Retrieved from: http:// www.cdc.gov.

28. Lesson Learned – Early Prevention
works, it’s much cheaper and save
lives!
 What we don’t want is advanced stage of breast cancer
African-American women present with stage IV
cancers at the rate of 6.5%, while White African women
present at a rate of 3.6%
 African-American women are more likely to be
diagnosed at later stages of the disease, making the
cancer more difficult to treat resulting in worse
prognosis.
http://www.utoronto.ca/ois/SIA/2007/Breast%20Cancer/Breast%20Cancer.pdf.

29. Funmilayo Whitaker ‘s future Plan As
Advanced Practice Nurse…
 Patients and families, who cope with cancer, face many challenges. The more patients know
about their cancer and its treatment, the more equipped they are to actively participate in their
care. So, creating many services and programs will help them during this time.
 This program will involve planning, developing, and implementing cancer awareness activities
with lay and professional African Americans to reduce cancer incidence and mortality rates,
increase survival rates, address risk behaviors, and improve screening use and early detection
rates within the U.S. Black American community
 Set up educational parties, or “home health parties “ to promote breast health awareness and
screening for this group.
 The hostesses for parties can be recruited through patients, referring agencies, and health
clinics in the community, as well as flyers and invitations distributed or posted at health fairs,
beauty and nail salons, sporting events, churches, and community organizations. The hostesses
serve as “connectors” or informal community leaders not only known to the targeted women
but also assisting by participating in a word-of-mouth campaign to communicate the
importance of messages relayed at the events

30. Educational Parties as a Strategy to Promote
Breast Health Awareness and Screening in
Underserved Female Populations
 The APN developed a draft lesson plan for the project to include
presenters and recognized the hostess, review purpose of the party,
conducted ice-breaker activities, and used three gaming strategies
to increase participants’ knowledge related to prevention and early
detection of breast cancer.
 The plan incorporated a demonstration of breast self-examination
by the APN or RN facilitator, encouraged participant palpation of
breast models, and announced an opportunity to schedule
appointments with hospitals or health clinics for screening services.
Time was built into the format of the 60- to 90-minute program for
participant evaluation, networking, and refreshment.

31. What we don’t want to see
happen…
 Dear future Advanced Practice nurses!
 The following pictures speak for themselves
 Early intervention is the answer! See next five slides (please
hold on to your seats!).

32. Advanced Breast Cancer
(stages III and IV)
http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00003.JPG.

33. Advanced Breast Cancer
(stages III and IV)
http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00151.JPG

34. Advanced Breast Cancer
(stages III and IV)
http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00106.JPG

35. Advanced Breast Cancer
(stages III and IV)
http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00640.JPG.

36. Advanced Breast Cancer (stages
III and IV
http://www.ptolemy.ca/members/archives/2007/BreastCancer/DSC00007.JPG

37. Current Debate on screening
 Ambassador Nancy G. Brinker, founding chair of
Susan G. Komen for the Cure, will address the
controversy over new federal breast cancer screening
recommendations.
 Brinker, a breast cancer survivor, will challenge the
just-released guidelines by the U.S. Preventive
Services Task Force that suggest self breast
examinations and annual mammograms for women
in their 40s are unnecessary. She will also discuss the
need to improve screening procedures, especially in
vulnerable populations.
http://www.newscom.com/cgi-bin/prnh/20080917/NPCLOGO)

38. Interpreting the U.S. Preventive Services Task Force Breast
Cancer
Screening Recommendations for the General Population
 What are the new recommendations from the U.S. Preventive Services Task
Force (USPSTF)?
• The USPSTF recommends against routine screening mammography in women
aged 40 to 49 years. The decision to start regular, biennial screening
mammography before the age of 50 years should be an individual one and take
patient context into account, including the patient's values regarding specific
benefits and harms. (grade C recommendation)
• The USPSTF recommends biennial screening mammography for women aged
50 to 74 years. (grade B recommendation)
• The USPSTF concludes that the current evidence is insufficient to assess the
additional benefits and harms of screening mammography in women 75 years
or older. (grade I statement)
• The USPSTF recommends against teaching breast self-examination (BSE).
(grade D recommendation)
• The USPSTF concludes that the current evidence is insufficient to assess the
additional benefits and harms of clinical breast examination (CBE) beyond
screening mammography in women 40 years or older (grade I statement)
www.acog.org/from_home/Misc/uspstfInterpretation.cfm

39. References
Adams, M. L. (2007). The African American Breast Cancer Outreach Project:
Partnering With Communities. Family & Community Health. 2007:30 (1): S85 – S95.
Retrieved November 15, 2009 from
http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=692
001.
American Cancer Society. Cancer Facts & Figures for African Americans 2007-2008.
Atlanta: American Cancer Society: 2007 Retrieved November 12, 2009 from,
http://www.cancer.org/downloads/STT/CAFF2007AAacspdf2007.p
Centers for Disease Control and Prevention. National Breast and Cervical Cancer
Early Detection Program. (2007). Retrieved November 12, 2009, from
http://www.cdc.gov/cancer/nbccedp/about.htm
Chilton, J.A. DrPh, Jones, L.A. PhD (2001). Impact of Breast Cancer on African
American Women: Priority Areas for Research Within the Next Decade. American
Journal of Public Health. Retrieved November 11, 2009 from
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1447112/

40. References
Cornelius LJ, Smith PL, Simpson GM. What factors hinder women of color from
obtaining preventive health care? American Journal of Public Health.
2002:92(4):530–534.
Kinney AY, Emery G, Dudley W, Croyle RT. Screening behaviors among African
American women at high risk for breast cancer: do beliefs about God matter?
Oncology Nursing Forum. 2002;29(5):835–843.
Lewis et al (2004). Medical Surgical Nursing. Assessment and Management of Clinical
Problems. 6th Edition, Mosby: St Louis.
McNeely, M.L, et al (2006). Effect of exercise of breast cancer patients and Survivors:
A Systematic review and meta-analysis. CMAJ, Retrieved November 11, 2009
from http://www.cmaj.ca/cgi/content/full/175/1/34
Rochman, S. (2006). African American Women and Breast Cancer. Dr. Susan Love
Research Foundation. Retrieved November 12, 2009, from
http://www.drsusanloveresearchfoundation.org/pdfs/african_american_bc.pdf

41. References
Russell, K.M., Parkins, S. M., Zollinger, T. W. and Champion, V. L. (2006).
Sociocultural context of mammography screening use. Oncology Nursing
Forum, 33 (1) 105-112.
Spurlock, W.R. & Cullins, L. S. (2006). Cancer fatalism and breast cancer screening
in African American women. The ABNF Journal, 17 (1) 38-43.
Sykes, R. J. (2003). Eliminating health disparities among African American
women with breast cancer: An Analysis of Options. Retrieved November 12,
2009 from
http://askew.fsu.edu/current/masters/actionreport/sp2004/Josette%20Syke
s%20%20Eliminating%20Health%20Disparities%20among%20African.pdf