Boise State University
Review of Literature
The following is a summary of the published literature that examines the scope of screening for breast cancer in high risk women as well as genetic and enviornmental risk factors that contribute to breast cancer. Women, who carry a mutation of the breast cancer gene, known to healthcare providers as BRCA1 and BRCA2, have a 55-87% lifetime risk of developing breast cancer (Ozanne, et al., 2006). A review of the multiple modalities used to detect tumors early before the cancer has metastasized, the efficacy of modalities in diagnosing breast cancer and a brief history of how these modalities can increase awareness of breast cancer for patients and healthcare providers is also discussed. In addition, a review of evidence-based practice gives outcomes of studies done supporting best practice guidelines.
The purpose of the proposed non-experimental research study is to examine a sample of the population of healthcare providers (OB-GYN, Family Practice, mid-levels, e.g. Nurse Practitioners and Physician Assistants) in the Treasure Valley to determine what screening techniques they use most often for their female patients identified as high risk for developing breast cancer. A survey research questionnaire and/or telephone interview would be the methods considered for use. Breast Cancer Screening and Diagnosis
In the United States, breast cancer is the most common cancer among women and the primary cause of death in women between the ages of 45-60 (Ozanne, Wittenberg, Garber and Weeks, 2009). In addition to the emotional and physical costs, there can be tremendous financial costs to patients and their families. Survival has clearly improved during the last decade, mainly as a result of earlier detection by women’s awareness and mammography screening, and also by increase used of chemotherapy (Ozanne, 2009). If a breast cancer is detected in situ (very early stage), the 5-year survival is 98%, compared with 81% with regional spread and with 26% metastases (Sinicrope et al., 2008). Guidelines for breast cancer screening have been under scrutiny, the most controversial area has been annual radiographic screening for women younger than 50 years (Glasziou & Houssami, 2011). Glasziou notes there is controversy with levels of informed consent with potential harm from screenings as well as high rates of false positive and negatives among younger women.
Ozanne, et al. (2009) conducted a study to investigate prevention, decision- making among women at high risk for breast cancer. A prospective interview and survey study was conducted. One hundred and forty six of 217 eligible patients participated. The results indicated that patients typically underestimated their risk of breast cancer and physicians over-estimated the decrease in perceived risk (Ozanne, 2009). Breast cancer risk assessment coupled with risk communication counseling enables the identification of women at increased risk for breast cancer, yet it also demands an understanding of how women at higher risk understand their level of risk and options available (Ozanne et al., 2009). Risk Factors
Fixed factors include personal history, family history, genetics, breast density, reproductive and menstrual history, long-term use of hormone therapy, alcohol and physical activity level (Ozanne et al. 2009). The strongest risk factor for breast cancer is age. Most breast cancers occur in women over the age of 50 (NCI Fact Sheet Probability of Breast Cancer in American Women, 2010). Modifiable risk factors include smoking, use of hormone therapy, alcohol consumption, BMI, diet, physical activity and breast feeding (Dr. Pierson presentation October 11, 2011). Studies have shown that women having a first degree relative with breast cancer are at a 2-3 times higher risk of developing the cancer...