Breast cancer stands in the second place in regard to causes of death among women who live in the Western nations. This is a disease that needs to be effectively dealt with. It has however been established that this disease can be treated when detected at an early stage. But there is need to have proper and effective procedures in place to realize this. While technology advances, more and more innovative equipment are brought to the market. It is therefore vital to identify these new equipment to be used in breast cancer detection and treatment to overcome the shortcomings that the existing equipment may be having. This was the objective of this study. By the health care providers having the knowledge about the most effective equipment, he or she will be in a better position to make the necessary arrangements to make a purchase. This will serve to help women in the community to get over the problem of breast cancer. The health care facility, as it was established in this study, need to offer “digital mammography, ultrasound, sentinel lymph node biopsy, and stereotactic breast biopsy”.
In this study, it was also established that the health facility administrator is supposed to be able to know the level of awareness of women in the community, belonging to various classes, about breast cancer and its treatment. This is vital because, as the owner of the health care facility, you need to know the nature of your potential patients and their awareness of the disease that may affect or be affecting them. Through this, the administrator will have to come up with appropriate community health programs that facilitate effective handling of the disease (breast cancer).
This is an important project both to the health care administrator and to the women in the community. Following the interviews that were carried out, almost all the respondents showed a positive response towards breast cancer detection and treatment. They did not exhibit much fear about getting involved in such procedures as mammography which they could have otherwise deemed to be having some side effects. This even gives much promise in that the purchase of the newest technology equipment will serve to clear off any potential risks to the patients and any fears in them. More so, since the health care facility will have to offer digital mammography, it will be easier for the physicians to handle a larger number of patients within the shortest time possible without necessarily expanding the facility space since this kind of technology facilitates outpatient procedure. The budget will involve purchasing on the new technology equipment and the implementation of the community health programs to be put in place and following the five year plan that will be put in place; this will turn to be a quite profitable undertaking in the medium and long term.
The cancer disease results from the genetic changes that occurs in one cell, which may be triggered by such external agents as the viruses, radiation as well as chemical carcinogens and may also be triggered by the “inherited genetic factors” (Monoharan & Pugalendhi, 2010). This disease is a communicable disease that stands in the second position (among the communicable diseases) in regard to the contribution to the total number of deaths resulting from these diseases (Monoharan & Pugalendhi, 2010). There are various types of cancer and the common ones include the lung cancer, breast cancer the liver cancer and the stomach cancer.
The focus of this research is on breast cancer, being among the several types of cancers. This type of cancer stands in the second position in regard to causes of death among women who live in the Western nations (Monoharan & Pugalendhi, 2010). In fact, the breast cancer cases in the Asian countries are about 6 times lower than the cases that have been identified in the Western countries. Each year, there are seven million cases of breast cancer that are reported worldwide (Monoharan & Pugalendhi, 2010).
Some cases of breast cancer have been identified to be hereditary. Approximately five percent of the people who have been identified to have breast cancer are said to be having a defective gene which can be detected through carrying out an appropriate cancer test. There is a higher risk of breast cancer for those people who are related to those affected with breast cancer and do have the “defective gene”. Those people who are related to the patients having breast cancer may also go through the test meant to detect the defective gene and this gives room for putting in place preventive measures or early detection measures to curb further development of the cancer.
According to National Institute of Health Consensus Development Panel, there should be performing “breast self-exam at the same time of the month each month” (National Institute of Health Consensus Development Panel, 1997, p.1018). Changes do come in tare triggered by the menstrual cycle, menopause, aging, using birth control pills and also by pregnancy. However, the “self-exam” does not serve as a substitute for the screening mammography, which is carried out on an annual basis and it does not also serve as a substitute for the “clinical breast exam”.
Recommendations have been made by the “National Cancer Institute” that all the women who are forty years old and beyond ought to have a mammogram each year or two year, those that are aged between 50 and 69 years should have a single mammogram annually. Those women who are at a higher risk, beyond the average risk, may get a mammogram at an earlier time before even attaining the age of 40 years. Screening mammography can, in most cases, reveal lumps in the breast even before these lumps can be felt physically.
A large number of experts in the medical field do concur that getting to identify breast cancer early enough is connected to successful treatment of the disease. In this case, screening mammography plays a core role in identifying breast cancer for the reason that this process reveals changes that occur in the breast up to a period of about three years in advance before these changes can be physically felt by the patient or the doctor.
In order to encourage the “decision making” process that is informed in regard to mammography, it is recommended that experts in the medical field give out appropriate and adequate information to the women about breast cancer and screening. According to Harris (1995), the belief that clinicians can successfully pass over information like this to their patients is on the basis of several main assumptions. One of the basic assumptions that are made is that the medical experts as well as the patients hold views about breast cancer and screening that are alike. Given the fact that the clinicians do not have the same “mental models” with the patients concerning these issues, communication turns out to be quite difficult on an increasing level. For instance, a clinician offering counseling services to a person who is 50 years old for her to go through a screening mammography may identify fear in the patient and may as well experience resistance from the patient and this is for the reason that the 50-year old patient holds a belief that there is very minimal chances of having cancer treated. The patient may also be holding a belief that the exposure to the radiation from mammography is substantial, and that the largest number of women who go through screening will come to discover that they are having the breast cancer. This study was set to find out the appropriate equipment that can be effectively used in the breast cancer care and the appropriate community programs that can be put in place to help people in the local society who may be at risk or are infected by breast cancer.
Statement of the Problem
Although many efforts have been made to offer treatment and education to women about breast cancer facts as well as mammography in the community by the health care providers, very minimal attention has been given to make sure that the women have the suitable “conceptual framework” to give meaning to these facts and there has also been lack of appropriate detection and treatment equipment for breast cancer care in the health facilities.. This study was carried out with an intention of identifying the appropriate treatment equipment for breast cancer in the health care facility to ensure effective treatment and also to identify the appropriate programs that can be put in place to help people in the local community by the health care providers in the health care facilities.
The main objective of this research was to identify the newest technology equipment for most effective breast cancer detection and prevention and to acquire knowledge about the level of the women’s awareness about the breast cancer disease and its treatment in order to purchase appropriate equipment and to set up suitable community health programs to help them in dealing with this disease.
In order to meet the objective of the study, the study sought to answer the following questions:
- What are the most effective breast cancer detection and prevention equipment and procedure?
- How do women view the “natural history” of breast cancer?
- How do women view their ‘personal risk” of breast cancer?
- How do women view the value of screening mammography?
- What is the emotional response of women to testing?
- What are some of the mammography recommendations made by women in regard to decision making about breast cancer?
To help answer these questions, a total number of forty women were randomly selected within the local community and interviewed over the telephone. The women were selected basing on their level of income, their age, level of education and race. This was to ensure that the sample selected was representative of the general population of the women in the community. Before carrying out the research, there was a review of the related research in the same field in order to be able to identify some important issues in this field of study. The literature that was reviewed was in relation to the available information about the cancer detection and treatment procedures and the equipment that can be effectively used to do this. The literature was also the one related to women’s awareness about breast cancer and how they have view the disease.
However this study was not without a number of limitations. Among the limitations of this study is the issue concerning sample representation. The women who stayed in the homes that do not have telephones were not encompassed in the sample. The other limitation was that even if the sample represented women across a wide range in terms of the income, level of education, age, there was underrepresentation in regard to those women belonging to the minority group and those having the lowest “socioeconomic indicators” and this group is the one that may need great help.
Significance of the Study
This study is very important because it seeks to identify the most effective equipment that needs to be purchased by the management of a health facility in order to ensure effective treatment of people within the community who might be victims of breast cancer. The significance of the study is also established in the idea that being aware of the level of the effect breast cancer has on women within the community and their view and access to breast cancer treatment (mammography) will serve in enabling the management of the health facility to come up with the appropriate community programs to help in solving this problem.
Definition of Terms Used
- Cancer: This is a disease that “arises from genetic changes in one single cell, which may be started by external agents such as radiation, chemical carcinogens and viruses and inherited genetic factors” (Monoharan & Pugalendhi, 2010, p.2423).
- Breast cancer: Is a type of cancer that starts in the breast tissues
- Mammography: This is a type of imaging in which there is utilization of “low-dose X-ray system” for examining the breast.
- Screening mammogram: An X-ray of the breast that is aimed at detecting a tumor which can not be felt by the affected individual physically.
Apart from the skin cancer, taking the case in the United States, the most common cancer among women is breast cancer and in every three cases of cancer that are diagnosed, one of these cases is a case of breast cancer. According to the American Cancer Society (2008), breast cancer is one of the major causes of cancer deaths among the women in the United States of America. The chances of a woman developing breast cancer at some point in the course of her life is 12 percent or one out of eight (1/8). In the course of time, there has been a decrease in the number of deaths resulting from breast cancer. This decrease has been realized following efforts to have early detection as well as intervention and “postoperative” treatment. According to Dongola (2011), “the use of mammography for screening has largely contributed to early detection, although its use has resulted in a minor increase in the number of in situ cancers detected” (Para, 2).
Mammography is the most desirable method for examining breast cancer and mostly among women who are beyond forty years of age. Those who are more than forty years old form the group with the highest number of cases of breast cancer. There have been some indications from some of the studies that have been carried out that mammography can be of great benefit, especially for those women who are eighty years of age and beyond (Schonberg, Ramanan, McCarthy,& Marcantonio, 2006; Badgwell, Giordano, Duan, Fang, Bedrosian, Kuerer HM, et al., 2008).The initial signs and symptoms of breast cancer is “an abnormality depicted on a mammogram, before it can be felt by the woman or her physician” (Dongola, 2011, para 4). At a time when breast cancer has developed to a level where there is the appearance of physical signs and symptoms, the person who is affected feels a painless “breast lump”.
It has been pointed out that screening mammography has been observed to bring down the number of deaths resulting form breast cancer, and especially among the women who are aged between forty and fifty years and beyond. According to Shapiro, Venet, Strax, et al, “the first randomized, controlled trial to evaluate the benefit of mammogram and clinical breast-exam screening was the ‘Health Insurance plan’ study, initiated in 1963” (Shapiro, Venet, Strax, et al., 1988, p. 96). In this study, about sixty two thousand women aged between 40 years and sixty five years were randomly assigned either a mammography for a period of four years or assigned to a control group. After a period of one decade during which there was follow up, it was found that there was a thirty percent decrease in the number of deaths resulting form breast cancer in the study group as compared to the control group.
More trials (“randomized and controlled”) gave confirmation of the effectiveness of screening mammography in bringing down the level of the number of deaths resulting from breast cancer. In the year 1995, there was reporting of a “meta-analysis” of four “case controlled” studies and nine “randomized controlled” trials. Women in the age bracket of fifty and seventy five years who got screening mammography had a reduced “relative risk” for breast cancer mortality of 0.74 as compared to those who did not get the mammographic screening. There was no observation of a decrease in breast cancer mortality with “mammographic screening” among women who were in the age bracket of between forty and forty nine years after a follow up period of about eight years. However, when there was extension of the follow-up period to about 12 years, a decrease in breast cancer mortality was realized among these women falling in this age bracket who got screening mammography by about 17 percent (Armstrong, Eisen & Weber, 2000).
In the year 1997, there was publication of, as pointed out by Hendrick, Smith, Rutledge, et al (1997), a “meta-analyses of eight randomized trials of screening mammography in women aged forty to forty nine” (Hendrick, Smith, Rutledge, et al., 1997). This one gave a demonstration of breast cancer mortality reduction of 18 percent among the women who fell in the age bracket of forty and fifty years who got a mammographic screening after a period of between ten to eighteen years of follow up (Hendrick, Smith, Rutledge, et al., 1997).
Basing on the above results, it can be clearly seen that those women who are fifty years of age and beyond are actually beneficiaries of yearly screening mammography and they face a reduced risk of dying from breast cancer. However, there exist a controversy in regard to utilization of screening mammography among those women who fall in the age bracket of between forty and forty nine years. An attempt to clear off this controversy was undertaken in the year 1997, in the month of January, at the “National Institute of Health Consensus” meeting but unfortunately, at this meeting there was no reaching at an agreement. Thus, this meeting ended up giving out two separate reports in regard to screening mammography in those women who were between 40 and 49 years old. There was a conclusion among the majority that “screening mammogram was not universally warranted in this age group” (National Institutes of Health Consensus Development Panel, 1997, p.1022). On the other hand, a minority report gave support to the “recommendation for screening mammography based on the survival benefit seen at 10 years and longer after screening is initiated” (National Institutes of Health Consensus Development Panel, 1997, p. 1022). This recommendation is supported by the “American Cancer Society” which points out that every woman who has attained the age of forty years and beyond is supposed to be given a mammogram on a yearly basis (once per year).
Controversies also arise in regard to the “upper age limit” at which screening mammography should cease being performed. No available data exist from “randomized trials” in line with the benefits that are derived from screening mammography among women who are more than eighty years of age and this is for the reason that there is no enrollment among the women who are aged (American Geriatric Society Clinical Practice Committee, 2000). According to the American Geriatric Society Clinical Practice Committee, there is need to have further study, “given that age is the single greatest risk factor for breast cancer and approximately half of the breast cancers occur in women who are over the age of 65” (American Geriatric Society Clinical Practice Committee, 2000). The “American Cancer Society” and the “National Cancer Institute” did not set an upper age limit for mammographic screening. It is pointed out that, “the American Geriatric Society has published a ‘position statement’ in regard to screening mammography among aged women, making no recommendation for having an upper age limit for screening for women having an estimated life expectancy of greater than four years” (American Geriatric Society Clinical Practice Committee, 2000, p. 843).
But at the end, the decision made in regard to screening mammography rests in the hands of the patient herself. This implies that, it is of great significance for a clinician to engage in a discussion with each individual reading the benefits as well as harms that result from screening mammography. The harms that comes out of this kind of screening include “false positive” exam and this brings about more testing, additional cost and increase in the level of anxiety in the patient. According to Armstrong, Eisen, & Weber, “a higher rate of false positive results and false negative results is experienced among the women who are younger”(Armstrong, Eisen, & Weber, 2000, p.567). Moreover, there exists a remarkably minimal risk of breast cancer development because of the exposure to radiation that comes from the mammogram. Indications are given by the “statistical models” that eight women among one hundred thousand women who went through a yearly mammogram for a period of ten years starting from the age of forty years develop breast cancer and subsequently get killed by the disease in the course of their lifetime. Armstrong, Eisen, & Weber points out that, “women having DNA repair mechanism impairment may be at a higher risk of developing breast cancer”(Armstrong, Eisen, & Weber, 2000, p. 568).
Fernandez, palmer, and Leong-Wu emphasize on the point that mammography is associated with reductions of breast cancer mortality and is most effective when women have regular screenings every one to two years” (Fernandez, palmer, & Leong-Wu, 2005, p. 77). But it has been found out that the African American and Hispanic women do not utilize regular “repeat mammography” screening fully. At the present time, “repeat screening” rate in the overall women population in the United States of America is about forty six percent. Two researches that were carried out with “medically underserved” samples established that that the rates of “repeat screening” for these women were five percent and ten percent.
According to Fernandez, palmer, and Leong-Wu the “ENCOREplus program”, which is a program that is put in place with an intention to reach the women who are older, have low income and those that belong to the minority group via the YWCA “community centers” in more than seventy YWCA sites found in thirty states, has attained a remarkable success in boosting mammography screening among those women who were formerly not adhering to the screening guiding principles (Fernandez, palmer, &Leong-Wu, 2005). But on the other hand, in a study that was conducted in the recent times involving women that were originally “screened through the program” and were expected to go through a repeat mammography, just about 28 per cent of them had gotten a “repeat mammography” screening (Fernandez, palmer, & Leong-Wu, 2005, p.77).
Even if there has been identification of factors that are linked to mammography screening through the studies that have been carried out, just a small number of these studies have carried out the examination of those determinants that are particularly linked to “repeat screening”. Indications are given out by these studies that those women who are white, women that receive a higher level of income, those whose place of birth is in the United States, those who have higher levels of education and visit the physicians on a regular basis, those who have, as pointed out by Fernandez, palmer, and Leong-Wu, “a family history coupled with a perceived vulnerability to breast cancer, and receive physician recommendation” have a high likelihood of getting involved in “repeat screening” (Fernandez, palmer & Leong-Wu, 2005, p.77). Moreover, a number of studies give out reports that such issues as the “cost concerns, fear about radiation, anxiety, embarrassment, and low perception of breast cancer risk” serve as barriers against one having a “repeat screening” (Fernandez, palmer, & Leong-Wu, 2005).
Equipment needed for breast cancer detection and prevention
There is need to bring together all the equipment that are required for breast cancer care at a single health care facility. The equipment involves those that are used for early breast cancer detection and prevention as well as those that can be used for the detection and prevention of other breast diseases. The health care facility is supposed to offer “digital mammography, ultrasound, sentinel lymph node biopsy, and stereotactic breast biopsy” (Frankfort Regional Medical Center, 2011, para 1). Bringing together the required equipment makes it possible or easier to have a “wait time” that is shorter on the side of the patients that come to seek the medical attention; from the initial symptom of suspicion to the time the disease is treated.
It is good to acquire a new “digital mammography system” (Frankfort Regional Medical Center, 2011) because this makes the work of the physicians to be easier in detecting and diagnosing the breast cancer disease in their patients with assurance. This innovative system offers excellent quality of the image and the image of the breast that is seen is detail to a high level. In the current day, among the digital mammography system that are quite modern which can be availed to the patients is the “Senographe DS field digital mammography system” (Frankfort Regional Medical Center, 2011, para 3). This system is set up in such a way that it can offer an all-inclusive mammography care to the patients; ranging from screening as a diagnosis of the disease to the measures for intervention. In additional, the Senographe DS field digital mammography system has a “patient-centric design and intuitive controls that allow the technologists who perform the exams to focus on the patients, making a mammogram a comfortable and easy experience” (Frankfort Regional Medical Center, 2011, Para 3). On the side of the physician, the equipment offers higher flexibility while viewing the exam as in the performance of the biopsies.
It can also be quite important for a health facility to have a ‘computer-aided detection system for mammography’. It is pointed out that the “ImageChecker is the first F-D-A approved system of its kind to assist radiologists in the reading of mammograms, pointing out areas of interest that might otherwise go undetected”(Frankfort Regional Medical Center, 2011, Para 4). Such new technology assists the radiologists in the detection of the breast cancer disease.
According to the Frankfort Regional Medical Center (2011), “mammography, ultrasound, or stereotactic breast biopsy – a technologically advanced device, is being used for the early detection of breast cancer”(Frankfort Regional Medical Center, 2011, Para 5). This kind of biopsy has several advantages. One of the advantages of this type of biopsy is that it can be availed as an outpatient procedure. The whole procedure takes a maximum of thirty minutes and the women can go back to work or resume their normal activities in the course of the same day. Under this procedure, there is requirement of just a small incision within the skin which is approximately one sixteenth of an inch. There is no involvement of stitches as well as scars and in case there are, they are just very small ones. Another advantage is that, there can be delivery of anesthetic in to the tissue, “from the tip of the probe to reduce any discomfort” (Frankfort Regional Medical Center, 2011, Para 7). The probe is supposed to be inserted one time only. This probe can get multiple specimens and there is no need to be removed over and over again or inserted again.
Breast cancer is the number two cancer type which causes death among women after lung cancer. Biopsy is the sole means of having a detection of an abnormality in the breast that can be a breast cancer. Biopsies make it possible to diagnose breast cancer at its earliest stage and at a stage when this disease can be effectively treated. At the early stage, treatment of this disease can be effectually carried out by way of surgery that ensures preservation of the breast. It has been established that five years later after diagnosing of the breast cancer at the earliest stage, more than 90 percent of the women who are found to be infected with breast cancer are able to be in a healthy state again (Frankfort Regional Medical Center, 2011).
The procedure involved in the breast biopsy calls for just a local anesthetic that is carried out on the person’s skin and it is involves inserting only one special probe in order to take out a sample tissue. It brings down the level of the potential to remove those tissues that are healthy which are found around the affected one and there is virtual elimination of whatever pain that may result from the procedure. The performance of this procedure can as well be carried out on the outpatient basis. The stereotactic biopsy does have the capacity to sample very small abnormalities in a very accurate manner in the breast and these abnormalities are referred to as microcalcifications. This makes it possible to carry out the diagnosis more easily.
Data presentation and analysis
The major aim of this research was to identify the newest technology equipment and procedures for most effective breast detection and treatment and to acquire knowledge about the level of the women’s awareness about the breast cancer disease and its treatment in order for the concerned health care facility management to purchase appropriate equipment and to set up suitable community programs to help them in dealing with this disease. The “sample strategy” of this study was set out in such a way that there would be identification of a small number of women, in relative terms, across a broad range of demographic variables to go through thorough and “in-depth” interviews. There was random selection of the women from a “commercially maintained sample frame”. Those who were selected were exposed to a phone interview. In this interview, the respondents were asked to give information about their educational background, their age, their income as well as race and whether or not they had suffered from the breast cancer disease. The women who took part in the interview were given 30 dollars after the completion of the interview.
There was utilization of quota sampling in the study in the selection of women and basing on age, the women were put in four categories: less than 40 years of age, 40 – 49 years old, 50 – 69 years old, more than 70 years old. Basing on the income, they were put into two categories: those with an annual income of 25, 000 or less and those with more than 25,000 dollars as their annual income. Basing on race, there were three categories: the white women, black women and those who belonged to any other group.
The total number of women who were interviewed in this study was forty. In this study, there was using of “open-ended protocol” set out in such a way that it could facilitate full expression of the respondent before the interviewer could bring in new concepts or concepts with which the respondent was not familiar. Each interview went on for duration of about one and a half hours. There was audio recording of the interviews and this followed the permission of the respondent in order for it to be used later in the analysis.
Before the commencement of this study, 10 pilot interviews were carried out. The entire interviewing process was carried out by two interviewers and these two were having the master’s level education. The pilot interviews were carried out in order to enable the interviewers to identify any shortcomings that could be encountered during the actual interviews and find a way of overcoming them through having an awareness of the kind of questions that need to be asked and how to go about it in order to obtain relevant answers.
The respondents who were involved in this study included women of the age ranging from 27 years to 80 years old. In regard to race, the respondents included women who were the blacks, white women, Native Americans and those of the Asian and Hispanic origins. On the basis of income, about 50 percent of the respondents were those that had an annual income of below $25, 0000. Education wise, 60% of the responds were those of the education level of high school diploma and above. More so, about 80% of the respondents had had at least a single mammogram.
Personal risk of breast cancer
Basing on how women viewed the personal risk to breast cancer, the respondents were presented with the question “How much of a risk do you regard breast cancer to be?”. Another question was “compared to average women your age, do you think your risk of breast cancer is higher, lower, or about the same?” It was identified that a larger number of women saw other possible risks to their health and the greatly identified one was cardiovascular disease. About forty five percent of the respondents had a feeling that other health risks were more significant as compared to breast cancer. 25 percent of the respondents had a feeling that breast cancer was a representation of the greatest risk to their health. In having thoughts about breast cancer, about 33 percent of the women instinctively related stories of a close friend or relative who had had breast cancer and made expression of the fear of dying young in the same way.
Natural history of breast cancer
The view of women about natural history of cancer was examined in this study. The respondents considered this disease as a consistently progressive health condition which can be cured while at an early stage but which can be fatal when it is discovered at a late stage development. Even if the respondents were able to distinguish between the breast cancer and the “benign breast disease”, there was a tendency of having a recurring idea among some of the respondents that even the “benign breast disease” had a possibility of developing in to breast cancer.
Contrary to this, the breast cancer “biological model” is that of a “heterogeneous disease”, linked to the possibility that some early disease may not go on, or may even possibly stop progressing. Therefore, as on one hand there is remarkable uncertainty in the “medical community” on the “potentially non-progressive” cancers’ natural history, on the hand, it was just a single respondent among the forty women who were interviewed had come across the idea of the existence of “potentially non-progressive” breast cancers.
The Value of screening mammography
All the women who were interviewed, except just one, had a feeling that mammography was of benefit. A common view was that failing to have a mammography is putting oneself at danger of the death that can be prevented. 52 percent of the respondents considered the idea of having a mammography as an avenue towards minimization of the possible regret. To a large number of women, the value of having knowledge about good and bad results was of great significance. They considered this as being an opportunity to take necessary measures, even if some of them did not associate the value of having knowledge with any particular benefit of treatment. More so, to a large number of women, acquiring feeling comfort resulting from a “negative test” was of great value as well.
About 90 percent of the respondents had confidence in how accurate mammography is. About 50 percent had a thought that mammograms were accurate to the highest level possible (100 percent accurate). About 90 percent of them had a feeling that mammography hardly ever missed cancers. The notion that there was a possibility of having untrue negative results was upsetting.
About 60 percent of the women had recognition that untrue positive results do come about. Contrary to the views that have been presented by several authors, putting emphasis on the dangers of untrue positive results, in this study, the women looked at untrue positive results as being a part of screening that is an acceptable one. In a similar manner, the women had an acceptance about the flow of events that might come after a “screening mammogram”. Worry about other possible mammography harms was not outstanding. 50 percent of the respondents instinctively did not agree to the idea that mammography had any “downsides”. However, when women were directed to discuss more about the side effects of mammography, most of them pointed out the physical pain that is experienced during the time a mammogram is being administered. Out of these respondents, 50 percent of them had recognition that there was a certain level of exposure to radiations.
Emotional Response to testing
Even if about 50 percent of the respondents linked going through mammography to anxiety, the feeling of relief resulting from obtaining a “normal result” tended to be more important than any discomfort, be it physical or emotional to them. 90 percent of these respondents pointed out that they would experience anxiety upon getting to learn that going through an abnormal mammography would not essentially mean cancer. This group of women made an assumption that an abnormal mammogram would subsequently bring in more tests or “biopsy”. Forty five percent of the women clearly considered further tests as being desirable and this is for the reason that the feeling of relief as well as a feeling of safety that will ensue from a “negative biopsy” would outweigh any possible “downsides”.
Mammography and decision making
At some point the respondents were asked about the kind of information they felt was important for coming up with decisions in regard to mammography. Following this, over fifty percent of them (52 percent) put their focus on the mechanism of the way a mammogram is carried out. One fifth of the respondents stated that having knowledge about what is being looked by a mammogram was of great importance and a similar percentage of the respondents wanted to have information regarding the benefits that accrue from a mammogram. Only a very small percentage (about seven percent) indicated that they wanted to have knowledge about the mammogram accuracy.
In regard to global recommendations, 49 of the respondents stated that each and every woman ought to have a mammogram and a large number of these women mentioned that they would give encouragement to a close relative or a close friend to have a mammogram. In line with this point, over one third of the women (about 39 percent) went to the extent of commenting that any woman who does not get a mammogram is a “stupid woman”.
In this research, it was established that there are new effective technologies and procedures that can be employed in dealing with the breast cancer disease. It is good to acquire a new “digital mammography system” and this is because it makes the work of the physicians to be easier in detecting and diagnosing the breast cancer disease in their patients with assurance. This innovative system offers excellent quality of the breast image. It was also established in this research that the respondents had some remarkable awareness of breast cancer and the importance of it having to be detected early enough before it goes beyond controllable limits. The majority of the women had confidence in the screening mammography and believed that it was accurate. In regard to personal risk, some of them believed that they were at a higher risk of infection from other diseases than breast cancer, but we still had some who put the risk of the breast cancer infection in the first place. However, in general terms, the women held a joint belief that each and very women need to go for the diagnosis of breast cancer so that she can be able to have it treated in good time before it causes death.
Recommendations for Action
This is a very important project since it will serve to help the community. There are many potential customers; almost all women in the community, basing on the information that was collected during the research. However, the implementation of the project will require some fairly heavy funding to be successful. But on the other hand, this promises to be a very profitable business. By purchasing the newest technology equipment for breast cancer detection and treatment, this will help in serving a large number of the women following its ability to offer outpatient procedure and the shortest time that the customer is served. More so, following the offering of the outpatient procedure when using the new equipment, this will serve to help in dealing with the problem of facility space for this project. The facility may be expanded later in time but at the beginning of the project, there is no problem in this regard.
More so, by putting in place the community health program that is aimed at reaching the low income women who may be uninsured and those with low education level; to educate them about the dangers of breast cancer and the possibility of it being treated while detected at an early stage, this will serve to increase the number of the women that will have to be served by the health care facility. Even if a fairer cost can be charged in order to ensure all the women in the community access the health care, the long term impact is that there will be a larger customer base which will transform in to a larger profit base for the facility.
In the first year, there will be purchasing of a new “digital mammography system” equipment and any other newest technology equipment that can assist in the detection and prevention of the breast cancer. In this first year, there will be need to employ one more staff member to help in the new activities that will be carried out within the health care facility. In the second year, the community health program to reach out to the low income and less literate people will be put in place. During this year, two more staff members will have to be employed in order to walk around educating people about breast cancer. In the third year, the program will be expanded to reach out to even more people within the community and this will be done by employing three more staff members whose work will basically be the implementation of the program. In year four, there will be expansion of the health care facility, since at this point there will be more patients to be served basing on the awareness that will have been carried out within the community by the staff members. In the fifth year, plans will be put in place to extend operations to other areas which would have not been reached, and possibly nationally.
Recommendations for further research
The available time and money was among the limitations of this study. In order to come up with more accurate results in the future, there is need for the research to set aside adequate time and resources in order to carry out a comprehensive research involving a larger sample size to get more accurate results for future policy recommendations.
American Cancer Society. (2008). Breast Cancer: What Are the Key Statistics for Breast Cancer?. American Cancer Society Cancer Resource Information. Web.
American Geriatric Society Clinical Practice Committee (2000). “Breast Cancer Screening in Older Women.” Journal of the American Geriatrics Society 48(7):842–844.
Armstrong, K. Eisen, A. & Weber, B. (2000). “Assessing the Risk of Breast Cancer.” New England Journal of Medicine 342(8):564–571.
Badgwell, B.D, Giordano, S.H, Duan, Z.Z, Fang, S., Bedrosian, I., Kuerer HM, et al. (2008). Mammography Before Diagnosis Among Women Age 80 Years and Older With Breast Cancer. J Clin Oncol. 13 (3)
Dongola, N. (2011). Mammography in breast cancer. Web.
Fernandez, M. E., palmer, R.C, & Leong-Wu, C. A. (2005). Repeat mammography screening among low-income and minority women: A qualitative study. Cancer, Culture and Literacy Supplement, 77 – 83.
Frankfort Regional Medical Center, (2011). Breast care center. Web.
Hendrick, R. E. Smith, R. A. Rutledge, J. H. et al. (1997). Benefit of Screening Mammography in Women Aged 40–49: A New Meta-Analysis of Randomized Controlled Trials. Journal of the National Cancer Institute Monograph 22:87–92.
Harris, R. L. (1995). Clinical strategies for breast cancer screening: weighing and using evidence. Ann Intern Med., 122, 539 – 547.
Monoharan, S. and Pugalendhi, P. (2010). Breast cancer: an overview. Journal of Cell and Tissue Research, 10 (3), 2423 – 2432.
National Institutes of Health Consensus Development Panel (1997). “National Institutes of Health Consensus Development Conference Statement: Breast Cancer Screening for Women Ages 40–49.” Journal of the National Cancer Institute 89:1015–1026.
Schonberg, M. A., Ramanan, R. A, McCarthy, E. P,& Marcantonio E.R. (2006). Decision making and counseling around mammography screening for women aged 80 or older. J Gen Intern Med. 21(9):979-85.
Shapiro, S. Venet, W. Strax, P. et al. (1988). Periodic Screening for Breast Cancer: The Health Insurance Plan Project and Its Sequelae, 1963–1986. Baltimore, MD: Johns Hopkins University Press.