Screening for Breast Cancer: A Case Study on Measuring Health and Potential Threats

This case study explores the importance of screening for breast cancer and measuring health to identify potential threats. It discusses the impact of breast cancer on physical, mental, and social health, as well as the advantages and disadvantages of mammography as a screening tool.

Population Health
Screening

Table of Contents
INTRODUCTION...........................................................................................................................1
BODY..............................................................................................................................................1
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10
.......................................................................................................................................................11

INTRODUCTION
Screening refers to a process of measuring health of an individual or population,
that might at risk of disease. Early, in 19th century, due to improper sanitation, impure
water and inappropriate diet, were the main leading causes of death, that arise
infectious disease (Woo and et. al., 2017). But today, as per PHE (Public Health
England) analysis, the most occurring diseases that increase death rate and reduce life
expectancy are non-communicable one. It includes cancer, heart disease, stroke,
influence, leukaemia, dementia and Alzhemier's disease etc. Therefore, to improve life
expectancy, it is essential to measure health of an individual and a population group, so
that causes behind same can be reduced to prevent others (Finn and et. al., 2016).
Under the present report, a case study is taken on a 65-year old woman, who is
suffering from breast cancer. For measuring health of this patient, an analysis is done
on regarding potential threat of cancer, by taking a group of population of older age.
This would help medical professionals to find and treat types of cancer early, before it
causes symptoms and lead to death (Lagerlund and et. al., 2015). For this purpose,
Mammography test is used to screen breast cancer, where early detection helps in
reducing death of females over 40 to 74 years. But during ongoing test of screening,
some results shown that a person is having cancer even when they don't have same.
Such tests procedures could be harmful for health of a person as well, that makes them
unnecessarily anxious and stressed.
BODY
Health refers to a state of being free from injury or illness. According to World
Health Organisation (WHO), health can be defined as state of proper mental and
physical condition, not merely any absence of disease. Concerning on this definition of
health, measuring well-being condition of a person early, helps in providing better and
less treatment before a disease spreads (Konerman and et. al., 2017). Along with this, it
would aid professionals in reassuring a person if report is normal. For this purpose,
through national demographic and health surveys, some factors like increasing death
rate at early age due to some disease, infant mortality rate, etc. shows indicators of
health and disease of a population. Similarly, high or low blood pressure, obesity,
1

uneasiness, low birth weight shows signs to measure health before occurrence of a
severe disease (Mavaddat and et. al., 2015). To identify health risks and trends in UK, a
data is taken from health profile of England 2017, that is conducted by PHE, as shown
below –
Leading causes of death rates in England (2015) –
(Major causes of death and how they have changed, 2017)
2
Illustration 1: Major causes of death and how they have changed, 2017

Leading causes of death vary by age in males (2015) –
(Source: Major causes of death and how they have changed, 2017)
3
Illustration 2: Major causes of death and how they have changed, 2017

Leading causes of death vary by age in females (2015) -
(Source: Major causes of death and how they have changed, 2017)
It has been interpreted from the above data, that in 2015, death rates of males
are mainly caused by heart disease, while dementia and Alzheimer disease causes
death in females in England (Grönberg and et. al., 2015). In the youngest group of age
i.e. 1 to 4 years, diseases that leads to death of population are Perinatal & Congential;
Influenza & Penumonia; and other respiratory diseases. While, leukaemia & lymphomas
causes death of both males and female population of age 5 to 19. In addition to this,
majority of deaths mainly occur at older ages, where more than 2/3rd occur at ages 75
and over. This is due to prolonged cancer and heart disease issues, that lead causes of
all deaths occurring in both population of females and males over the age of 65
(Chapter 2: major causes of death and how they have changed, 2017). Along with this,
older age group of 50 to 79, diseases like heart and brain stroke, cancers causes death.
While younger adults are at higher risk of leukaemia and lymphomas (Garg, Boynton-
Jarrett and Dworkin, 2016) .
4
Illustration 3: Major causes of death and how they have changed, 2017

MAIN SECTION
In context with present case, a women of 65 years, having no previous medical
history of breast cancer, has been referred to the medical oncology clinic, due to newly
diagnosed symptoms of metastatic breast cancer. The lady was not having any kind of
past medical background of any associated disease. 3 months back, the lady has
realised breast (Left) pain. For identifying the causes, Mammograph and ultrasound test
was conducted which have later revealed that there is a 6.2 cm breast mass including
large ipsilateral axillary lymph node (Batterham and et. al., 2016). Practitioners have
further recommended her to for biopsy of pulmonary nodules. This biopsy have later
confirmed that the lady is suffering from metastatic breast cancer.
It has been analysed that the patient have initially identified that she is not feeling
good. While asking for the health issue the lady has stated that suffering from any
breathing issues, fatigue or pain (Asaria and et. al., 2015). This lady does not even has
any sort of medication or medical history. Professionally she is a teacher and also has
strong energy record at workplace. None of the family member has past history of
ovarian, breast or other sort of cancer (Mertins and et. al., 2016). In other associated
details she have specified to medical practitioners that her menopause was at 50 and
menarche was when she was 11 years old. Her first pregnancy was at 29 and she has
two children.
Physical health: Influence of this disease on her physical health can be seen in
the form of shortness of breath, fatigue or pain. In context to current stated case, it has
been identified that this disease directly leads to huge fluctuation in weight of the lady,
excessive hair fall, lowered bone density, fatigue, bodypain, breast size of the patient
started changing, also there was the blood discharge from nipple area thrice a week
(Arrossi and et. al., 2015). All of these has influenced physical health of the patient and
unable her perform daily based activities which were performed by her earlier effectively
without any issue.
Mental health: Breast cancer have also placed impact over mental health of this
lady as she was now feeling that this disease have left her dependent on other
because she is not able to perform work like earlier (Tao and et. al., 2015). This leads to
initiation of depression among patient because cancer patient's have to go through
5

numerous of therapies which generates, higher level of depression, some kind of
cognitive impairment, fatigue, mental fog etc. Apart from this, it can also be said that
treatment of cancer also holds emotional influence over patients as it brings fear among
patient that they might die in future. This also creates anxiety among patients.
Excessive concern about future and self image might affect their health condition more
worsely.
Social health: Cancer is now days becoming popular disease across the world.
This disease have numerous of myths which influences interest people in negative
manner towards the one who is suffering from the same. In context to current case, it
has been seen that social impact of breast cancer for this lady was quiet weird as her
hobbies started changing (Turner and et. al., 2015). At the initial time she was highly
devoted towards her work but when she got to know about her illness it left her with
aloneness as patient does feels comfortable in teaching students now. The main reason
behind change in her hobby was that she believes that everyone will stare her due to
cancer. This have dropped down confidence level that leads to change in hobby. While
talking about family and friends, it has been analysed that children of this lady were very
supportive and corporative. This support of family members and close friends have
supported this patient in recovering faster (Turner and et. al., 2015). Friends and
colleagues of this patient have also advised numerous of solutions and ways by which
she can divert her mind from disease and move forward towards recovery in quick
manner.
As per the above specified image, it has been analysed that women belonging to
age group of 60 mainly suffers from cancer that is mostly seen in lungs as well as
breast. Here, lungs cancer are identified as first number disease which has analysed
among women (Tao and et. al., 2015). Whereas breast cancer belongs to 2nd number,
heart disease, chronic lower respiratory diseases, Cirrhosis and liver disease are
ranked later in the same sequential manner. The overall information depicts that cancer
is most identifiable disease among women which is affecting their health negatively.
Apart from this, it has been identified that sequence of disease among male are
completely different as due to gender disorder. While comparing disease list with the
similar age group of male are Heart disease, lung cancer, Cirrhosis and other liver
6

disease, Colorectal and chronic lower respiratory diseases (Arrossi and et. al., 2015). It
has been identified that in males mainly heart disease is identified as the first occurred
disease among males. Whereas, these most lowered ranked disease in this age group
is chronic lower respiratory diseases. This simply states that types of disease and their
occurrence sequence is different among male and female.
With reference to current case scenario, it has been identified that more than 1.5
million of women are suffering from breast cancer among which around 60% are
identified as HR positive. In addition to this, it has been identified that the main problem
with the old lady was that she was aware about the problem (Mertins and et. al., 2016).
This have impacted negatively on her as late recognition about breast cancer has made
her case more severe. It can be said that if this lady has got to know about this
healthcare issue then there are probable chances that her case didn't get that much
severe (Benefits and limitations of regular cancer screening, 2019). This situation
happens with most of female patients. In order to overcome this issue healthcare
practitioners have revealed for detecting breast cancer at earlier stage, it is essential for
individual to go through Mammography test in order to identify this at initial level.
Mammography refers to the procedure of taking use of x-ray machine for diagnosing
human breast (Mavaddat and et. al., 2015). The main purpose of this x-ray machine is
to identify breast cancer at early stage. Advantages and disadvantages of using this
technology are described as below:
Advantages:
Decreases chances of chemotherapy: Screening at initial stage helps women
to allow women to detect cancer at initial stage only (Advantages, Disadvantages and
Limitations of Mammography, 2019). Thus, early detection allows them in securing
themselves from chemotherapy.
Allows individual about the health of their breast: It is helpful for women in
improving their knowledge about the health of breast as if they do additional
examination allows them to know about actual status of breast (Asaria and et. al.,
2015). This simply aware them about any breast related issue at earlier level.
Minimises death of women because of breast cancer: earlier knowledge of
about breast cancer directly secures patients life because they can easily access to
7

treatment in starting time. This ultimately leads to reducing number of death among
women due to breast cancer.
Disadvantages:
The main drawback of this technique is that people who go through this
diagnosis might affect patient health of life because they starts taking stress about
health and its associated consequences from early time only (Finn and et. al., 2016).
(Source: National Cancer Institute, 2018)
CONCLUSION
From the above described report, it has been identified that screening is a
effective procedure that is helpful in measuring health of patient which could affect them
8
Illustration 4: National Cancer Institute, 2018

in future. It has been identified that maximum number of women belonging to the age
group of 50-60 or above majorly suffers from breast cancer which leads to death also.
The main initiative taken by healthcare practitioners to detect this disease is
mammography which supports in detective issue in earlier manner.
9

REFERENCES
Books and Journals
Arrossi, S. and et. al., 2015. Effect of self-collection of HPV DNA offered by community
health workers at home visits on uptake of screening for cervical cancer (the
EMA study): a population-based cluster-randomised trial. The Lancet Global
Health. 3(2). pp.e85-e94.
Asaria, M. and et. al., 2015. Distributional cost‐effectiveness analysis of health care
programmes–a methodological case study of the UK bowel cancer screening
programme. Health economics. 24(6). pp.742-754.
Batterham, R. W. and et. al., 2016. Health literacy: applying current concepts to improve
health services and reduce health inequalities. Public health. 132. pp.3-12.
Garg, A., Boynton-Jarrett, R. and Dworkin, P. H., 2016. Avoiding the unintended
consequences of screening for social determinants of health. Jama. 316(8).
pp.813-814.
Grönberg, H. and et. al., 2015. Prostate cancer screening in men aged 50–69 years
(STHLM3): a prospective population-based diagnostic study. The lancet
oncology. 16(16). pp.1667-1676.
Konerman, M. A. and et. al., 2017. Impact of an electronic health record alert in primary
care on increasing hepatitis c screening and curative treatment for baby
boomers. Hepatology. 66(6). pp.1805-1813.
Lagerlund, M. and et. al., 2015. Health-related lifestyle factors and mammography
screening attendance in a Swedish cohort study. European Journal of Cancer
Prevention. 24(1). pp.44-50.
Woo, S. Y. and et. al., 2017. Prevalence and risk factors for atherosclerotic carotid
stenosis and plaque: a population-based screening study. Medicine. 96(4).
Breast Cancer
Books & Journals
Finn, R. S. and et. al., 2016. Palbociclib and letrozole in advanced breast cancer. New
England Journal of Medicine. 375(20). pp.1925-1936.
Mavaddat, N. and et. al., 2015. Prediction of breast cancer risk based on profiling with
common genetic variants. JNCI: Journal of the National Cancer
Institute. 107(5).
Mertins, P and et. al., 2016. Proteogenomics connects somatic mutations to signalling
in breast cancer. Nature. 534(7605). p.55.
Tao, Z. and et. al., 2015. Breast cancer: epidemiology and etiology. Cell biochemistry
and biophysics. 72(2). pp.333-338.
Turner, N. C. and et. al., 2015. Palbociclib in hormone-receptor–positive advanced
breast cancer. New England Journal of Medicine. 373(3). pp.209-219.
Online
10

Chapter 2: major causes of death and how they have changed. 2017. [Online] Available
Through:<https://www.gov.uk/government/publications/health-profile-for-
england/chapter-2-major-causes-of-death-and-how-they-have-changed>.
National Cancer Institute. 2018. [Online] Available Through:
<https://www.cancer.gov/types/breast/patient/breast-screening-pdq>.
Benefits and limitations of regular cancer screening. 2019. [Online] Available Through:
<https://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/find-
cancer-early/screening-for-cancer/benefits-and-limitations-of-regular-cancer-
screening/?region=on>.
Advantages, Disadvantages and Limitations of Mammography. 2019. [Online] Available
Through: <https://www.quebec.ca/en/health/advice-and-prevention/screening-
and-carrier-testing-offer/breast-cancer-screening/advantages-disadvantges-
and-limitations-of-mammography/>.
11