Changing for the better - Brief Article - Statistical Data Included

AORN Journal, Oct, 2000 by Brenda S. Gregory Dawes

It's all about choices and change. Medical research is offering new information in the perpetual battle against cancer. Breast cancer is the most commonly diagnosed malignancy in American women, although lung cancer and cardiovascular disease surpass the annual death toll from breast cancer. Although strides are being made to change the statistics, every female (and male) is a potential target for the fear, humiliation, and pain associated with breast cancer. Breast cancer occurs approximately 100 times more often in females than males, and although Caucasian women are more likely to be diagnosed with breast cancer, African American women are more likely to die from the disease.(1)

IMPROVEMENTS STEADY BUT EVIDENT

Death rates from breast cancer showed their first significant decline between 1992 and 1996, with a 1.8% decrease each year. Between 1987 and 1997, the number of women age 50 and older reporting having a mammogram increased 42%. A 17% increase was reported between 1989 and 1997 for women 40 and older. Federal funding for breast cancer research grew 600% between 1991 and 1999.(2) The choices and changes being made in lives today will affect the babies born tomorrow who can expect to live active lives into their 80s by making informed decisions about lifestyle factors and health choices.

Discoveries that are increasing the chances for recovery of those afflicted with breast cancer might be related to the increasing age of our population, to new methods of biopsy, to multiple studies, or to a combination of these. Risk factors (eg, aging, genetics, race) cannot be changed, but lifestyle behaviors (eg, hormone replacement therapy, alcohol use, obesity, physical activity) are within an individual's realm of responsibility and control.(3) Drag studies are reporting that breast cancer might be preventable.

THE NURSE'S HEALTH STUDY

Researchers conducting the Nurse's Health Study are playing a part in delaying, preventing, or controlling health problems, but not without the benefit of dedicated participants. The nurse's study is a gold mine of information for women because nurses represent a large group of individuals who are experiencing similar health related problems.

More than 250 health related papers--50% of which are on diet and disease-- have been published from the results of the study. More than 90% of the questionnaires me completed by nurses who dutifully record their answers to pages of questions about dietary habits, choices of condiments, vitamin intake, frequency and type of exercise, and hours of work and sleep.(4) If you are one of those participants, you know what I mean; the first time I received the kit asking for my blood and urine sample, I was taken aback, but the results of that study are reprinted everywhere.

Twenty-two years of information gathering has changed novel ideas into facts. High fiber diets influence three of the most important risk factors for coronary heart disease. Physical activity provides moderate protection against type 2 diabetes and weight cycling affects women's risk of hypertension. In 1999, the association between carotenoids; vitamins A, C, and E; consumption of fruits and vegetables; and breast cancer risk among 83,234 Nurses' Health Study participants was reported.

There was a lack of relationships between the intake of total fat or specific major types of fat in 2,956 participants who developed cancer between 1980 and 1994.(5) These reports and others will continue because funding was approved in 1999 by the National Institutes of Health, guaranteeing at least another five years of support.

Numerous creative talents have been used to fight the psychosocial needs of those with breast cancer. Here are some examples.

* Members of the East Metro group of the Atlanta American Sewing Guild make "Suzy Bags," which are distributed to breast cancer patients (http://www.sweing.org/cares_hare/suzy). Following a mastectomy or lumpectomy, drains and drainage bags can be carried in the pouch.

* Art and humor outlets are available on the Internet for cancer patients and their family members.

* A virtual gallery that contains 65 exhibits of sculpture, paintings, and photography depicts the challenges and personal triumph of those with the disease and can be found at http://www.cancer.med.upenn.e du/psychosocial.

* Breast cancer support is offered through community involvement and outreach programs. One community is focusing on the statistics associated with African American women and is working to overcome barriers to seeking medical care.

* The Sister for Breast Health program offers women an opportunity to get together for an enjoyable evening to learn the importance of early detection of breast cancer.

RAISING AWARENESS

October is National Breast Cancer Awareness month, and October 20 is National Mammography day. In this month's issue of the AORN Journal, two authors present articles on surgical procedures for diagnosing breast cancer, as well as managing the postoperative outcomes associated with disfigurement. Many of us who have been in this profession for years have cared for patients who had limited choices in comparison to patients who are diagnosed today. The reality for the patient I care for today is that it does not matter what improvements are being made--worry and fear belong to the person with the diagnosis. As nurses, it was difficult to offer psychosocial care when the outcome was so mutilating. Today, that difficulty is not lessened, but with heightened awareness and participation in disease management, we can feel that our participation makes a more of a difference.