Breast Cancer in America: Social Determinants, Epidemiology, and Role of Primary Health Care Nurse

This paper discusses the high prevalence of breast cancer in America population, social determinants of health, epidemiological studies, and the role of primary health care nurse in solving the health issue. It also reflects on the use of cultural competency in Primary health care nurse role in supporting breast cancer.

Running head: BREAST CANCER IN AMERICA
BREAST CANCER IN AMERICA
Name of Student:
Name of University:
Author’s Note:

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Breast cancer in America is one of the significant health issues suffered by the women
and potent reason for high mortality rate since 1990 (Horwitz, 2016). Incidence of breast cancer
is high due to late detection, inappropriate use of mammography and racial discrimination. There
is the requirement for improvement of survival rate of the breast cancer patients in America,
hence needs critical analysis on the identified health issue. Therefore, the main goal of the paper
is to discuss the high prevalence of breast cancer in America population. Firstly, the paper
addresses the social determinant of health, counting social justice and equity by analyzing the
methods through which it has contributed to causing breast cancer. Secondly, the paper
highlights the epidemiological studies that have shown the prevalence of health issue. Thirdly,
the papers have discussed the role and responsibility of primary health care nurse in solving the
health issue, and lastly, it reflects on the use of cultural competency in Primary health care nurse
role in supporting breast cancer.
The social determinant of health studied by the researcher in relation to the incidence of
breast cancer, its diagnosis and survivals which includes unemployment, racial discrimination,
equity and social justice, socioeconomic status and social support (Horwitz, 2016). These social
health determinants have contributed to breast cancer in America. The socio-economic factors
like poor education and low income have led to increasing in the risk of breast cancer. It is
obvious from the recent studies that these factors are positively linked with the high rate of breast
cancer among the racial and ethnic groups (De Maio et al., 2019). Moreover, low socioeconomic
status people do not have access to adequate health service that has contributed to a high rate of
breast cancer in America.
Among the social health determinant, equity and social justice are the primary cause of
breast cancer in America. The survival rate of breast cancer women in America is low due to

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social injustice and health inequity. Data from the study of De Maio et al. (2019) indicate that
there is enormous inequity among the white and high-income women and racial minorities
women in terms of breast cancer care and treatment. Women who belong to the racial and ethnic
minorities groups live in rural areas, and due to inadequate knowledge, they are diagnosed with a
later stage of breast cancer. There is no timely detection and follow up care available to poor
women than the white and high-income groups. It is evident from the study of Otis et al. (2019)
that breast cancer can be treated if it is detected at an early stage and given adequate care.
However, due to health inequity, many racial women are unable to receive timely treatment and
diagnosis as medical resources are mostly available to the white community peoples.
The disparity in breast cancer stems from the interplay of power, racism, economic and
discrimination that has led to social injustice. Research suggests that social injustice among the
American population has led to health disparity, and breast cancer has become a social justice
issue (Momin et al., 2018). Breast cancer is predominant women health issues in the society and
its ending needs amendments at each level of society. Social justice reflects on the fairness and
equal access to health care which is shaped by age, gender, race and colonial relation. However,
in the study of Polite, Gluck and Brawley (2019) it is inferred that in America, there is social
injustice among breast cancer women related to fairness in medical care. As the impact of social
injustice, there is low quality treatment and poor access to health care which has led to
subsequent cancer disparities. The women are not timely diagnosed, and unequal medical
resource allocation in the society has caused breast cancer issue. In America, racism has directed
to social injustice which has led to cause high prevalence of breast cancer and even death.
Researching on the issue of poorer access to breast cancer screening for the American women,
Rust (2017) has focused on women's awareness and language barrier that typically used to

3BREAST CANCER IN AMERICA
describe the basis of breast cancer. The unfair social arrangement linked with class and race
intersects with society in everyday life of minorities. It has put them in disadvantage situation
where breast cancer screening is challenging; hence, leading to breast cancer. Therefore,
epidemiology studies have worked to identify breast cancer as a vital health issue.
There are several studies undertaken that infer the epidemiology of breast cancer in
America. In the study of Tao et al. (2015), pervasiveness of breast cancer has been highlighted
by conducting a literature review of different finding. The author highlighted that breast cancer
in America had been estimated with 1,384,155 new cases with death of 459,000 in the year 2014.
The current statistic and prediction suggest that there are nearly 1.7 million women reported with
breast cancer. According to the American cancer society, it is suggested that out of eight women,
one woman in United States will advance breast cancer in her lifetime. Epidemiological studies
by Tao et al. (2015) also suggest that importance must be paid to socio-economic issue so that all
the women can get equal access to health and medical care from the stage of screening to
treatment.
Lambertini et al. (2016) have conducted meta-analysis and systematic review of the
epidemiological studies related to breast cancer in America. The research has included 15 studies
which include 21,941 breast cancer patient and 864,177 controls. The author has highlighted that
there is a close association between the age at first birth, parity, breastfeeding and risk of
developing breast cancer. These factors have led to a high rate of up to 67% of breast cancer in
America. The reproductive behaviour has shown negative impact on breast cancer. However,
parity has linked with reduced risk of forming luminal subtype of breast cancer.
Winters et al. (2017) have conducted descriptive studies and data suggested that in
America, medical resources are declining, which has caused change in the pattern of early

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detection and treatment. 15% to 40% of overdiagnosis, 6% to 46% of the false screening and
40% of overtreatment is huge concern area for a high rate of breast cancer. The author has found
that due to increasing age, hormone use, alcohol use, poor diet and reproductive pattern has
contributed to 50% of the case of breast cancer. Another epidemiological study by Mariotto et al.
(2017) has done the back-calculation method to estimate breast cancer incidence in the United
States from the epidemiology and result registries. The author has found that by the year 2017,
there will be a total of 154,794 women living with breast cancer in the United States. There has
been an increase in 5-year relative survival among young women. Thus, the studies have
identified that breast cancer in America could lead to a health burden and need relevant steps to
address the health issue. Therefore, there is the requirement to take relevant step to solve the
health issue, which can be addressed by the contribution of primary health care nurse.
It is reported in the study of early detection is essential for the management of breast
cancer. The PHC nurse provides information to the women and instruction related to the self-
examination and awareness of breast cancer (Faithfull et al., 2016). This creates good knowledge
and confidence among the women, and they tend to undertake breast self-examination more than
the women who get guidance from another source. Thus, PHC nurse practice of providing
information has led to early detection of breast cancer in America and contributed to lower the
incidence of health issue.
Cross-sectional study of Nekhlyudov, O'malley and Hudson (2017) has analysed the
knowledge and role of PHC nurse in early diagnosis of breast cancer and treatment. They played
significant role in clinical breast examination and performed once in every six months. Its has
lowered the mortality rate due to breast cancer; as early diagnosis is carried out by the PHC
nurse.

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Early screening of breast cancer is crucial to control the health issue, and this includes
mammography that is regarded as the standard method for screening. The development of these
activities has lain on primary health care and nurse. The primary healthcare nurse adopts basic
family health strategy as the care model, which comprises the initial point for resolving health
issues. Their role in early detection is crucial to inspire adherence of patient, which include
health promotion action, rehabilitation and treatment (Hilder, Gray & Stubbe, 2019).
The main contribution of the PH nurse in control of the breast cancer is the undertaking
nursing consultation, examining the sign and symptom of breast cancer, recommending CEM
test that is based on clinical features and age group. Further, they also request and review the test
depending on the local protocol, refer patient and conduction of follow-ups of the breast cancer
patient after diagnosis and treatment. They also participate in activities of providing education to
the breast cancer patient. All the above-stated example and role of Primary healthcare nurse have
led to solving the breast cancer health issue by acknowledging cultural competency in the care
process.
It is noted in the discussion that the prevalence of breast cancer has risen due to health
inequity and social injustice. It is mainly because of the difference in race and culture of the
people. The disparity in the health has contributed to the cultural barrier in health care sector
regarding breast cancer. The role of primary health care nurse needs to maintain cultural
competency in their practice to address the health disparity, which is the primary reason for the
cause of breast cancer. From the research of Abdallah et al. (2019), it can be said that
establishing cultural competency in practice will help overcome the language barrier and cultural
difference. The women will be able to get equal access to health care. This will promote early
detection of breast cancer and reduce the health burden. The congruent behaviour and attitude of

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primary health care nurse help to maintain cultural competency and execute their effective role in
a cross-cultural situation. The nurses address the inequitable access to primary health care by
providing adequate care to the patient with different beliefs, values and behaviour (McCalman,
Jongen & Bainbridge, 2017). They also understand the communities suffering from breast cancer
and identify the cultural barrier that has led to late detection of breast cancer. Therefore, by the
use of competency, such issue is solved, and the nurse can acknowledge the health issue in a
better way.
Further, it can also be said that cultural competency poses a direct positive impact on the
culturally diverse communities reported with breast cancer. According to the study of Fisher-
Borne, Cain and Martin (2015) nurse has the major role in overcoming the racial discrimination
in health care sector which could be one of the major reasons for improving the health of the
breast cancer patient. Thus, it also promotes the early screening and adequate treatment for breast
cancer, which could lower the health burden in American society. It can be said that the
importance of cultural competence in primary health care, has to improve treatment for breast
cancer that has led to improve the health outcome.
Lastly, from the above discussion, it can be said that breast cancer has become one of the
major health issues in America. The major reason for it is an unhealthy lifestyle and high rate of
racial discrimination. In America, the incidence of breast cancer is basically due to the late
screening, diagnosis and inadequate treatment. From discussion, it is assumed that the crucial
reason for it are social determinants of health where inequity and social injustice are the major
contributing factor. This has been in peak due to racial discrimination among the minority's
groups, poverty, low income and poor education. The epidemiological studies have also
suggested that risk of development of breast cancer in the United States due to the weak health

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care system. There is a need to undertake a vital step to address the issue. The primary health
care nurse plays an essential role in solving the problem of breast cancer by giving education and
adequate treatment. Further, they are also responsible for maintaining cultural competency in the
health care sector that has promoted the health of women.
Reference
Abdallah, K. E., Calzone, K. A., Jenkins, J. F., Moss, M. E., Sellers, S. L., & Bonham, V. L.
(2019). A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical
Decision-Making. Ethnicity & disease, 29(1), 1-8.
https://dx.doi.org/10.18865%2Fed.29.1.1
Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role
for nurses. New England journal of medicine, 375(11), 1015-1017. DOI:
10.1056/NEJMp1606869
De Maio, F., Shah, R. C., Mazzeo, J., & Ansell, D. A. (Eds.). (2019). Community Health Equity:
A Chicago Reader. University of Chicago Press. https://books.google.co.in/books?
hl=en&lr=&id=RfCIDwAAQBAJ&oi=fnd&pg=PR5&dq=De+Maio,+F.,+Shah,+R.+C.,
+Mazzeo,+J.,+%26+Ansell,+D.+A.+(Eds.).+(2019).+Community+Health+Equity:
+A+Chicago+Reader.+University+of+Chicago+Press&ots=d-
ZbpAD4qP&sig=5pZva8bw8XrZd1NA546liOyOZq8&redir_esc=y#v=onepage&q&f=fa
lse
Faithfull, S., Samuel, C., Lemanska, A., Warnock, C., & Greenfield, D. (2016). Self-reported
competence in long term care provision for adult cancer survivors: A cross sectional

8BREAST CANCER IN AMERICA
survey of nursing and allied health care professionals. International journal of nursing
studies, 53, 85-94. https://doi.org/10.1016/j.ijnurstu.2015.09.001
Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural
humility as an alternative to cultural competence. Social Work Education, 34(2), 165-
181. https://doi.org/10.1080/02615479.2014.977244
Hilder, J., Gray, B., & Stubbe, M. (2019). Health navigation and interpreting services for patients
with limited English proficiency: a narrative literature review. Journal of Primary Health
Care. https://doi.org/10.1071/HC18067
Horwitz, R. I. (2016). Equity in cancer care and outcomes of treatment: a different type of cancer
moonshot. Jama, 315(12), 1231-1232. doi:10.1001/jama.2016.2242
Lambertini, M., Santoro, L., Del Mastro, L., Nguyen, B., Livraghi, L., Ugolini, D., ... & Azim Jr,
H. A. (2016). Reproductive behaviors and risk of developing breast cancer according to
tumor subtype: a systematic review and meta-analysis of epidemiological studies. Cancer
treatment reviews, 49, 65-76. https://doi.org/10.1016/j.ctrv.2016.07.006
Mariotto, A. B., Etzioni, R., Hurlbert, M., Penberthy, L., & Mayer, M. (2017). Estimation of the
number of women living with metastatic breast cancer in the United States. Cancer
Epidemiology and Prevention Biomarkers, 26(6), 809-815. DOI: 10.1158/1055-9965.
McCalman, J., Jongen, C., & Bainbridge, R. (2017). Organisational systems’ approaches to
improving cultural competence in healthcare: a systematic scoping review of the
literature. International journal for equity in health, 16(1), 78.
https://doi.org/10.1186/s12939-017-0571-5

9BREAST CANCER IN AMERICA
Momin, B., Wanliss, E., Davis, L., Townsend, J. S., Lopez, K., & Steele, B. (2018). Advancing
health equity through the National Comprehensive Cancer Control Program. Cancer
Causes & Control, 29(12), 1231-1237. https://doi.org/10.1007/s10552-018-1111-3
Moraes, D. C. D., Almeida, A. M. D., Figueiredo, E. N. D., Loyola, E. A. C. D., & Panobianco,
M. S. (2016). Opportunistic screening actions for breast cancer performed by nurses
working in primary health care. Revista da Escola de Enfermagem da USP, 50(1), 14-21.
http://dx.doi.org/10.1590/S0080-62342016000010000
Nekhlyudov, L., O'malley, D. M., & Hudson, S. V. (2017). Integrating primary care providers in
the care of cancer survivors: gaps in evidence and future opportunities. The Lancet
Oncology, 18(1), e30-e38. https://doi.org/10.1016/S1470-2045(16)30570-8
Otis, W., Brawley, M. D., Kimmel, S., Hopkins, J., & St, O. (2019). Ensuring Equity and Justice
in the Care and Outcomes of Patients With Cancer. doi:10.1001/jama.2019.4266
Polite, B. N., Gluck, A. R., & Brawley, O. W. (2019). Ensuring equity and justice in the care and
outcomes of patients with cancer. JAMA, 321(17), 1663-1664.
doi:10.1001/jama.2019.4266
Rust, G. (2017). Perspective: hope for health equity. Ethnicity & disease, 27(2), 117.
https://dx.doi.org/10.18865%2Fed.27.2.117
Tao, Z., Shi, A., Lu, C., Song, T., Zhang, Z., & Zhao, J. (2015). Breast cancer: epidemiology and
etiology. Cell biochemistry and biophysics, 72(2), 333-338.
https://doi.org/10.1007/s12013-014-0459-6

10BREAST CANCER IN AMERICA
Winters, S., Martin, C., Murphy, D., & Shokar, N. K. (2017). Breast cancer epidemiology,
prevention, and screening. In Progress in molecular biology and translational
science (Vol. 151, pp. 1-32). Academic Press.
https://doi.org/10.1016/bs.pmbts.2017.07.002