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Breast Health among Women in the U.S. Virgin Islands
– Reported, April 02, 2012
Within the United States Virgin Islands (USVI), breast cancer is the number one cause of cancer deaths among women (USVI Department of Health, 2003). The United States Virgin Islands is an organized, unincorporated territory of the United States in the Atlantic Ocean and the Caribbean Sea, about 50 miles east of Puerto Rico. The manner and extent to which data relative to the breast cancer mortality in the USVI is collected, analyzed, and reported makes it difficult to compare data reflective of breast cancer mortality among women in the USVI with data reflective of breast cancer mortality of women from other states and territories. Nevertheless, the USVI Bureau of Health has identified regional trends in breast cancer mortality among women in the U.S. Virgin Islands to be a priority health concern.
While the exact cause of breast cancer is not known, several factors that influence a woman’s risk of developing breast cancer have been identified (American Cancer Society .The factors known to increase a woman’s risk of developing breast cancer include age, race, reproductive and menstrual history, history or hormone use, personal history of breast cancer, family history of breast cancer, genetic alterations, radiation to the chest at an early age, and certain breast conditions. The factors identified as causing the most significant risk are first-degree family history of pre-menopausal bilateral breast cancer or premenopausal breast cancer, first-degree family history of breast and ovarian cancer, evidence of the susceptibility gene BRCA1/BRCA2, a personal history of lobular carcinoma in-situ, breast atypical hyperplasia, and mammographic density occupying > 75% of the breast volume.
Identifying risk factors that are associated with breast cancer is an essential component of quality breast care. Breast care specialists suggest that, before making recommendations regarding breast cancer screening, health-care providers engage them in discussions about factors that could contribute to their breast cancer risk. Determining the presence or absence of breast cancer risk factors can help health-care providers to make recommendations to women relative to the optimal type of breast cancer screening and to make recommendations relative to managing their breast cancer risk.
Recommendations for women at increased risk for developing breast cancer include semiannual clinical breast examination starting at 25 years of age, annual mammograms starting at 40 years of age or 5 to 10 years prior to the earliest breast cancer in their family (although not before 25 years of age), and, the consideration of investigational imaging and screening studies. Given that research suggests that breast cancer risk may be effectively reduced using preventive drug therapy, prophylactic surgery, and behavioral modification, it is recommended that women at increased risk have discussions with their health-care providers about their risk and the use of breast cancer risk reduction strategies .
The ages of the women involved in the study ranged from 30 to 74 years of age, with a mean of 44.47 years (SD = 10.805). Most of the women were single, high school graduates, employed full-time, and had access to health insurance. While most of the women involved in the study reported annual household incomes greater than $35,000, 46.6% (n = 83) reported that they were “living check to check” and 14.6% (n = 26) reported that they “needed financial help with the costs of living”.several of the women involved in the study had risk factors that could place them at increased risk for developing breast cancer. Twenty-two percent of the women (n = 40) reported that one or more of their maternal or paternal family members had a history of breast cancer. Five percent of the women (n = 9) reported that a maternal or paternal family member had a history of ovarian cancer. Twenty-five percent of the women (n = 44) reported that they had no children or that their first child was born after the age of 30. Twenty-two percent of the women (n = 39) reported that they began menstruating at 11 years of age or younger. Seventeen percent of the women (n = 30) reported having had an abnormal mammogram or breast ultrasound, and twelve percent of the women (n = 21) reported having had breast biopsies
Projected breast cancer risk was estimated for women involved in the study who were 35 years of age and older using the model proposed by Gail. Among the women involved in the study who were 35 years of age or older, 87.9% (n = 116) were projected to have an “average risk” for developing breast cancer, 7.6% (n = 10) were projected to have a “moderate risk” for developing breast cancer, and 4.5% (n = 6) were projected to have a “high risk” for developing breast cancer.
When women involved in the study were asked about discussions they had had with health-care providers about breast cancer screening, 52.8% (n = 94) reported having discussed clinical breast examination and 77.5% (n = 138) of the women reported having had discussions about breast self-examination. Among those under 40 years of age, 28.9 % (n = 22) reported having had discussions with health-care providers about mammography screening. Among those 40 years of age and older, 92.2% (n = 102) reported having had discussions with health-care providers about mammography screening.
The U.S. Virgin Islands, after being “acquired” from Denmark, became an organized territory of the United States in 1917. According to the 2000 Census, there are nearly 108,612 residents in the U.S. Virgin Islands. Approximately 95% of the USVI population lives on the islands of St. Thomas, St. Croix, and St. Johns. Its inhabitants, though they cannot vote in U.S. presidential elections, are citizens of the United States.
The USVI Bureau of Health has identified regional trends in breast cancer mortality among women in the U.S. Virgin Islands to be a priority health concern (USVI Department of Health, 2003). This study provided the investigators, faculty, and students of the USVI School of Nursing, most of which are natives of the U.S. Virgin Islands, an opportunity collect empirical data that could be used to define the breast health, breast cancer detection, and control care needs of women within the USVI. In addition, it provided investigators, faculty, and students with information that could be used in planning future programs to address needs specific to the community.
The results of this study should be interpreted as suggestive rather than strongly conclusive. The small sample size and the use of a purposefully non-probability selected sample of USVI women 30 years of age and older that had never been diagnosed with breast cancer limits the generalizability of the findings of this study. Yet, in spite of these constraints, there are several finding of significance worth noting.
The identification and review of reports of the National Cancer Institute, the American Cancer Society and the National Center for Health Statistics include little data specific to the breast cancer incidence and mortality of women in the USVI. While the data limitations make it difficult to compare breast cancer trends among women in the USVI with women from other states and territories, it calls attention to the need for expanding the scope of systems that are responsible for cancer surveillance within the United States and its organized territories.
Smoking prevalence among native islanders in the USVI is far less than that in the states . Consequently, unlike other states, lung cancer is not the number one cause of cancer death among women . Findings revealed that while a significant proportion of women involved in the study reported risk factors that could place them at increased risk for developing breast cancer, most perceived their breast cancer risk to be “lower than the average women.” Most of the women involved in the study reported that information about their personal health and their family health was collected prior to their last physical examination. While the greater majority reported that they had been asked about a family history of breast cancer, few reported that they had been queried about breast cancer risk factors related to their childbearing history, menstrual history, and medical history. While discussions with health-care providers about breast cancer screening were noted by the women to be common, discussions with health-care providers about breast cancer risk were not.
The greater majority of the women involved in the study reported that they were not in compliance with the recommended breast cancer screening guidelines. However, careful review of the data revealed that women reporting having had discussions with health-care providers about their personal breast cancer risk were more likely to report compliance with breast screening recommendations. In addition, women who reported having had discussions with health-care providers about their personal breast cancer risk were more likely to express an interest in medical strategies for the management of breast cancer risk.
Credits:Sandra Millon Underwood, RN, PhD, FAAN, Edith M. Ramsay-Johnson, RN, EdD, Gloria Callwood, RN, PhD, Edris E. Evans, RN, BSN, Alina Matthew, SN, Casandra Scotland-Brooks, SN, Chantal Hanley, SN, Damali Johnson-Harrigan, SN, Devette LeFlore, SN, Dionne Williams, SN, Harricia Samuels, SN, Jahtara Francis, SN, Jamela Arthur, SN, Jowana Clinkscales, SN, Martha Joseph, SN, Nihjole Heskey, SN, Rachel D’Abreau, SN, Rashima Fleming, SN, Stacey Penn, SN, Tameka A. Browne, SN, Tiffany Donastorg, SN, and Yvette Scarbriel, SN
Sandra Millon Underwood, American Cancer Society Oncology Nursing Professor, Northwestern Mutual Life Research Scholar, Professor University of Wisconsin Milwaukee, School of Nursing, Milwaukee, WI53201
More Information at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205472/?tool=pubmed
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