Public Health and Promotion Strategies To Reduce Breast Cancer for Women

Assignment Task

Abstract

The study has covered the overall symptoms of breast cancer in women that can degrade the health by a significant margin. The study has highlighted the various risk factors that can increase the chances of breast cancer in women. The study has also pointed out the various foods that can give rise to health issues such as breast cancer. Literature review has discussed the symptoms and causes of breast cancer. It also provides information about stages of tumour, number of lymph nodes and location and spreading ability of the cancer cells. The advanced health strategies for the treatment of breast cancer in women to increase the rate of survival have also been discussed. The study has highlighted the various risk factors that can occur due to the formation of breast cancers among women. The study has highlighted the effective strategies that need to be Implemented by healthcare facilities to mitigate the occurrence of breast cancer among women. The articles have helped to analyse the clinical overview that can help to overcome the consequences of breast cancer. Moreover, the extracted articles have shown light to the various core aspects of breast cancer that has degraded the health of the respective individuals. Within the section of last chapter, there are various factors that can significantly denote the concluding remarks along with proper results from this study. The findings from the previous studies have been summarised in this section along with the linking with research aims. All the required factors in relation to the healthcare strategies of public sectors towards the breast cancer effected women. Therefore, the significance and limitations of this research study have also been included in this research study. On the other hand, the future scope has also been included in this research study for the recommedations for future researchers.

Introduction and background

1.1 Overall epidemiology in recent times

Breast cancer among women is the major cause of mortality and morbidity in recent times. Growing age expects to increase the chances of getting breast cancer as there is a strong relation between cancer and age. Epidemiology on breast cancer or any other cancer suggests that it is a highly avoidable disease by maintaining a healthy lifestyle and following regular follow up. As per the view of Andò et al., (2019), epidemiology has helped to understand the prime reasons which are causing breast cancer. This method is important in the research as it has helped to find, understand and explain the causes behind any form of diseases. As per the idea of Łukasiewicz (2021), for exploring the cause of breast cancer all the methods like descriptive, experimental and analytic techniques are used under the epidemiology. The reason behind the selection of this topic is that despite conducting epidemiology, still the numbers of new cases are increasing each year.

Recent research has found that low and middle-income countries like Bangladesh, Nepal, India, Srilanka and Africa are facing a rise in the number of breast cancer cases each year. About 22.5% of women, per 100000 in Bangladesh are facing breast cancer cases within the age range from 15-44 years (Begum et al., 2019). The major issue faced by these countries is the unavailability of proper treatment for the people living in countries with an average income rate. Moreover, in Nepal and India, the rate of increasing cases of breast cancer varies by 13.7-25.8 % per 100000 women (Antony et al ., 2018). The major issue found in this country is that females have very rare knowledge of breast cancer and the engagement of the government to increase awareness is quite low compared to developed countries.The rate of mortality is nearly about 7.2% in Nepal along with 12.7% in India (Giri et al ., 2018). However, these two neighbouring countries are experiencing rapid growth in the economy still but the cultural aspect is creating barriers in creating awareness and increased participation in the reduction of breast cancer.

Moreover, systematic review has been used to develop this study, so that the analysis of the selected topic can be done on the basis of it. As per the view submited in various literature resources, systematic review provides proper guideline to conduct research associated with the medical field. The systematic review provides the specific tools that are require developing the study associated with the breast cancer. PRISMA is also a part of study that falls under the systematic review; this particular method has been used because identification of associated data base and screening the records can be done appropriately. However, the systematic review takes more time compared to the other review methods for conducting the study.

Data analysis based on the Sri Lanka National Cancer Registry, 24.7% out of 100,000 women are found to have breast cancer. Due to the lack of treatment and availability with the delayed diagnosis, the rate of survival is very low in Srilanka (Wijeratne et al., 2021). The data received from various parts of Africa states that the range of incidence varies from 27.9-48.9% due to the increasing inclination toward the western practices adoption. The rate of mortality is ranging between 15.8-18.4% per 100,000 in Africa, which showcases a link between hereditary breast cancers in African families (Francies et al., 2020). Thus, the epidemiology suggests that the lack of awareness among females about the disease and delayed treatment is the main cause behind the increasing rate of mortality in these low middle income countries.

1.2 - Anatomy of Breast

In order to understand the cause behind breast cancer, it is important that the anatomical structure of the breast needs to be understood first. The outer structure of the breast shows asymmetry in every person and there are other deformities related to this are scoliosis, pectus deformity and kyphosis.

Glands

The mammary glands are developed sweat glands which are consistent with a series of ducts, secretory lobules and fatty tissues. They consist of series of ducts and secretory lobules which are around 15-20 in number. Lobules are the gland that gets infected by the cancerous cells causing breast cancer and causes unusual discharges from the breast. As per the induction of Gaglani et al., (2022), the ratio versus the fatty tissues and the glandular varies upon the age differentiation. This ratio also gets affected during the pre, pregnancy and post pregnancy stages. The glands get also affected due to the decrease of the estrogens level during menopause.

Pectoral fascia

A thin lamina covering the pectoralis major this is attached to the front of the sternum above clavicle. This is the attachment point for the suspensory ligaments which helps to hold the entire structure and keeps it attached to the sternum. The retromammary space is the loose connective tissue between the breast and pectoral fascia. It has been also found that the pectoral fascia can also show signs of breast cancer, without showing any expansion or symptoms. As stated by Cieśla et al., (2020), the axillary fascia’s tail is attached under the armpit which helps in the traction thus it is named as the suspensory ligament of the axilla. The lower level of the pectoral fascia is well developed with continuous fibrous sheaths of the rectal abdominis.

Vasculature and Lymphatics

The nerve that supplies the blood to the breast via internal thoracic artery is also known as the “internal mammary artery” which is a branch of subclavian artery. As per the view of Wysocki, Libondi & Juszczak (2020), the subdermal plexus supplies the bloods, which are small blood vessels that communicate with the arterioles supplying the parenchyma to the breast. The vessels or the arteries are thoracoacromial artery, internal perforators, thoracodorsal artery, some terminal branches of the intercostal perforators and thoracic artery.

The lymphatic drainage system plays an important role in breast cancer due to its role in metastasis. As stated by Santucci et al., (2021), if an unusual growth of a lump or lymph node around the breast area is found then it can be a potential cause of breast cancer. There are three groups of lymph nodes which receive lymph from the breast tissues: axillary nodes comprising 78%, parasternal nodes are 20% and the posterior intercostals nodes are minimum 5%. The superficial lymphatics are constructed with the subareolar and areolar, the latter also receives from the glandular tissues. 

Nerves

The sensory innervations derive from the branches of the “intercostals nerve” which are T3 and T5. The other sensory nerves are “lower cervical plexus” derived from the later coetaneous branch of T4 (Chokroverty & Bhat, 2021). These nerves do not contribute to the production or secretion of the milk. However, the hormones like prolactin and oxytocin are responsible for the construction of the milk secreted from the pituitary gland.

1.3 - Physiology of Breast: Main function of Breast

Basically, the human breast is an integral part of male as well as female “sexual anatomy”. Breasts are mostly functional able in the female body and in terms of female anatomy; breasts are functional for both the breastfeeding and bringing pleasure (Mijwel et al., 2018). The breastfeeding feature of breast has been derived with functional and bringing pleasure is derived with sexual function. The general physiology of breast is based on its functions over the human body. The human breasts generally comprise glandular, fatty and connective tissue in an authentic way. The milk producing cells consist within these cells and these are responsible for the cause of breast cancer.

Physiology

There are no functional and structural differences between male or female before puberty time. In the level of histological factor, in both the male and female body the prepubertal breast has been included with more “rudimentary ducts”. These ducts have been circumferentially arranged to cover surrounding the nipples. The end of each rudimentary duct, the secretory acini has been poorly developed (Lifespan.org, 2022). At puberty time, the initial growth of the female breasts has been affected by a hormone named Oestrogen. This hormone is being included with proliferation as well as branching the duct systems. Besides this, proper prominence of the nipples and maturation has also happened through the proliferation by duct systems (Medicalnewstoday.com, 2022). On the other hand, the proper proliferation and development of acini is considered as the result of combined as well as synergistic actions within two hormones. These hormones have been recognised as Oestrogen and Progesterone as the main responsible hormone for lactation .

The differentiation and division of cells have been influenced by such paracrine factors within the breast tissues. In these paracrine factors, some of them are stimulatory and some of them are inhibitory. There are paracrine regulating factors that include growth factors like insulin and growth factor of epidermis (Miricescu et al., 2020). Apart from these, the “transforming growth factor” has also been included in this section. Thus, it can be observed that the uncontrollable as well as accelerated rate of growing cells in breasts can be responsible for breast cancer.

Functions

The primary and major function of the female breast is all about lactation. In this particular function, proper encompassing of synthesis, secretion as well as ejection of milk are conducted. Besides this, another function of female breast is bringing pleasure in terms of sexual function. The primary function of human and mostly female breasts is mostly about producing milk for the cause of breastfeeding. In the time of pregnancy, the milk production of female breasts has been stimulated through hormone prolactin. However, hormone oxytocin also stimulates the proper release process of milk from the glands (Miricescu et al., 2020). This can be considered as the main function of female breasts that is about feeding milk to their baby.

Apart from this lactation function, another significant function of female breasts is all about sexual functions . In the sexual function of female breast, a proper stimulation of breasts as well as nipples can enhance the sexual pleasure within the female body. However, in the male body, breasts do not have that many functions. Hence, it can be analysed that these aforementioned functions are the main features of human breasts.

1.4 - Common site of Breast tumour

The breast tumour or breast lump has been considered as the main origin of breast cancer. This breast tumour or lump can be located at various sites within the two breasts. More than 18 percent of the breast lumps as well as breast cancer have occurred in the area of the nipple (Mijwel et al., 2018). Almost 11 percent of breast tumours have occurred within the “lower outer quadrant” of breast and approximately 6 percent of breast tumours have occurred within the “lower inner quadrant”.

In terms of the proper location of breast tumour in human breasts, there are two types of location based on the highest frequency. These are “upper outer quadrant (UOQ)” regarding the highest frequency and “lower inner quadrant (LIQ)” regarding the lowest frequency. Among all these, the “upper outer quadrant” or UOQ has been recognised as the most effective and frequent location or site for the occurrence of breast cancer (Ncbi.nlm.nih.gov, 2022). This particular part of the human breast is quite near to the location of the armpit.

In order to get a better understanding of the proper location for cancer lumps of breasts, it can be more helpful if the breasts can be visualised as a clock and nipple as the centre point. In facing the left breast, the “upper outer quadrant” or UOQ can be located in the 12:00 clock position to 3:00 clock position (Healthline.com, 2022). Furthermore, facing to the right breast the “upper outer quadrant” or UOQ can be located within the 9:00 position of clock to 12:00 position of clock. These are the exact position or site of lumps or tumours of breast that is the origin of a severe breast cancer.

There is no specific reason behind this location of breast lumps or breast tumours. On the other hand, it can be observed that the area of the “upper outer quadrant” or UOQ consists of a large number of glandular tissues (Healthline.com, 2022). This can be a significant reason for the location of breast lumps or breast tumours. In terms of breast cancer in male body, the breast tumour has been generally located under the nipple area of men.

Therefore, it can be observed that the locations of breast lumps or breast tumours have been majorly based on the highest frequency. This frequency of breast tumours has been mostly situated in the “upper outer quadrant” or UOQ of human breast or mainly female breast. Breast cancer has been generated from this particular area through its origin of breast tumour.

1.5 - Risk factor of Breast tumour

Breast tumours generally develop due to the abnormal growth of breast cells forming a lump or deicidal mass. As per the views of Kakkar et al., (2020), cells of breast tumour generally grow faster than healthy cells due to the arbitrary presence of lymph nodes. Several risk factors for breast tumour are as follows

Unhealthy lifestyle

Healthy and nutritious lifestyle can eradicate the probability of breast tumours within women. As per the ideas of He et al., (2020), lifestyle changes such as maintaining an unhealthy diet with low vitamin and minerals, less physical activity and unhealthy reproductive activities can cause breast tumours. On the other hand, utilising artificial hormones for reproduction and building muscles can also be major risk factors for the generation of breast tumours. Based on the views of Singh Singh & Soni (2021), regular smoking and consuming abusive drugs for a long time can also increase the risk of breast tumour generation. Hence, maintaining a healthy diet and avoiding the consumption of intoxicants can reduce the risk of breast tumour within women.

Obesity

Obesity can cause several types of breast tumours such as “Infiltrating ductal carcinoma”, “Lobular carcinoma” and “Inflammatory breast tumour”. As opined by Kakkar et al., (2020), weight gain after menopause increases within women can increase the risk of developing breast tumour. On the other hand, oestrogen levels become higher due to the presence of fat issues within women during obesity, which can cause breast tumours. In addition, obesity increases the chances of breast cancer recurrence due to the rising levels of oestrogen within fat receptors. Women after gaining weight of menopause period have 20-60% higher chances of heaving breast cancer in the UK (Digital.nhs.uk, 2020). Hence, maintaining a convenient body weight through incorporating yoga and other fitness exercises can be helpful towards women to avoid breast tumours.

Alcohol consumption

Drinking alcohol is directly associated with increased risk of breast tumour within women. As per the views of Day et al., (2020), consumption of alcohol can also increase the level of oestrogen within women, based on which fat tissues can be generated faster than before. In addition, consumption of alcohol during the postmenopausal periods can trigger the chances of breast tumors within women having breast cancer. On the other hand, cardio protective levels of the human immune system can be impacted through the consumption of alcohol, which can also infuriate the chances of developing breast tumours as well. Hence, maintaining an alcohol free lifestyle can be helpful towards individuals to reduce the chances of breast tumour, which can also restore the immune system as well.

Exposure towards radiation

Exposure towards radiation during the provisions of radioactive therapies can increase the chances of generating tumour cells. Based on the ideas of He et al., (2020), exposure of the neck and chest towards radiation can damage the neuro-active cells present within healthy tissues, which can cause “Brachial Plexopathy”. On the other hand, it has been observed that annual radiation dose rates within women in the UK is 0.5 to 1,0 mSv, based on which Lymphedema can also be seen within women (Data.gov.uk, 2020). However, these physical issues can generate multiple breast tumours within women due to which chances of breast cancer can also be optimised. Hence, adequate shelling and coverage facilities can be utilised during the span of having radiation therapies to eradicate radiation exposure.

1.6 - Symptoms

The shape size and the structure of the breast vary from one another, thus identification of something unusual happening to the breast is difficult for women to understand. However, the primary signals which can help to indicate an early breast cancer in a man or woman are development of new lump in the armpit or breast, irritation or dimpling of the skin around the breast (Reddy & Acharya, 2020). The other related symptoms are redness or flaky skin , unusual discharges , blood discharge during normal or breast feeding, sudden changes in size , thickening or swelling around the area.

Identification of any of these symptoms needs to get a “screening mammography” which can identify the cancer at an early stage and increases the chances of survival. Some of the symptoms can also be caused due to the non-cancerous breast condition. As per the view of Reddy & Acharya (2020), a painless irregular hard mass can also be an early sign of breast cancer. On the other hand this cancer can look and feel normal like soft, round, tender or even painless. Thus it is important to get a “screening mammography” to avoid any chances. Identification of any of these symptoms requires an expert view as it is tough to understand whether the changes are due to any other disease in the body or exactly due to the cancer. Some of the symptomes are also related to the ageing and reduction in the hormonal changes in the body. Such as “ oestrogen, progesterone, prolactin ” are some of the hormones which cause expansion in the breast which is normal during the period of adulteration. Moreover, “ progesterone ” is one of those hormones which are released during the time of period or in the pre or post stages which can cause changes in the breast or growth in the breast duct.

1.7 - Sign

The signs which can help to accurately detect breast cancer are similar to the symptoms, however there is a difference in the behaviour of the bodily changes. These changes occur during a course of time, and the development of the symptom to the accurate signs of cancer takes time. However, as stated by Tokode & Rastall, (2022), breast discharges can be normal but if the discharges continue for a long term then it can be a sign of breast cancer. Such as the unusual discharge in the breast can be caused due to the increase of the lactation producing hormones which can be caused due to some intake of the medication.

Again the redness or flaking around the breast can be caused due to the “eczema, dermatitis, heat rash or insect bite. If these symptoms do not reduce in a few days then it needs to be checked with an expert to confirm that the causes are early symptoms of breast cancer. As per the view of Yamamoto et al., (2020), shrinking of the breast can also be caused due to “lipodystrophy” which causes sudden reduction in the body fat. It is a rare disorder; however it can because huge amounts of body fat shrinkage, furthermore it also has different phases that can seem similar to the disease.

The changes in the thickening of the breast or swelling around the areas can also be caused due to trauma or breast abscess. However, there are other potential reasons behind the swelling or thickening such as clogged or blocked milk ducts, ductal carcinoma in situ (DCIS), fibroadenoma or intraductal papilloma. As per the idea of Barba et al., (2021), the anatomy of the breast and the understanding of the causes that results in breast cancer are still difficult to understand. This is due to the presence of various other diseases associated with the body and can portray the similar symptom of breast cancer. Hence, if the signs persist for a longer period of time then it is required to get checked as early as possible.

1.8 - Breast cancer staging

Breast cancer can be divided into 4 major stages such as stage 0, 1, 2, 3 and 4 based on the size of the tumour. As per the views of Cserni et al., (2018), transitional shape as well as size change of the breast tumour decides the peripheral stage associated with breast cancer. Characteristics of each stages of breast cancer is as follows

Stage 0: In this stage, ducts of the breast tissues can be seen within patients, which can be treated with adequate medicines. Based on the views of Plichta et al., (2018), cancer cells presented within the tumour do not spread to the surrounding tissues of the breast in this stage. Hence, this stage can also be called non-invasive or in-situ cancer, which can be handled with proper immune-based medications and therapies.

Stage 1: Stage 1 can be divided into two parts such as 1A and 1B based on the spread and pain intensity of the breast tumour. As opined by Cserni et al., (2018), the tumour is comparatively small and invasive which has not spread to the lymph nodes and can be staged as 1A. On the other hand, cancer cells have spread toward the lymph nodes in stage 1B and obtained the size between 0.2- 2 mm. However, “breast conserving surgery” (BCS) and “mastectomy” can be considered as treatment options for patients having stage 1 breast cancer.

Stage 2: Stage 2 can also be divided into 2 major sections such as 2A and 2B based on the spread and size of the tumour. Based on the views of He et al., (2020), the cancer cells can spread upto 1 to 3 axillary lymph nodes within the particular stage of cancer with a size between 20 to 50 mm. Besides this, in stage 2B, the size of the breast tumour can be more than 50 mm within an approach towards “N0 and “M0” lymph nodes. Moreover, “sentinel lymph node biopsy” (SLNB) and “axillary lymph node dissection” (ALND) can be prescribed to individuals having stage 2 breast cancer.

Stage 3: Stage 3 can be classified into three major categories such as 3A, 3B and 3C. As per the views of Plichta et al., (2018), the tumour size can be spread up to 4 to 9 lymph nodes in 3A, whereas 9 to 12 in stage 3B. In addition, lymph nodes under the collarbone can be reached within stage 3C, which can cause serious inflammatory pain.

Stage 4: Stage 4 of breast cancer can be classified as metastatic due to the massive size of the tumour. As opined by Day et al., (2020), the tumour at this particular stage has the ability to spread towards any organ such as lungs, brain, and liver and chest wall. Hence, radiation and regional chemotherapy are major treatment conjectures at this stage of cancer, which has less survival chances than the other stages.

1.9 - Health promotinal strategies

 One of the major determinant of breast cancer outcome in any popultion section is based on detection in early stages of clinical manifestation. This factor was also focused in the Breast Health Global Initiative which was held in Budapest, Hungary. The focus of the submit was to reflect upon positive insights to impliment a set of guidelines for breast healthcare and management in low and middle-income countries. The guidelines were also focused on the inlcusion of a multidiscilinary apporach which focused on promoting public awarnesss and education as the first potentail key to early detection and early prevention of the breast cancer amongst individuals. The approch, scope and effetciveness of the screening prograns are also to be exmained from ther perspective of potential social and cultural barriers which might compromise with the efficacy of the programs. The correct method of implemnetation can also be resourceful in establishing the exact metrics of the number of incidents reported for breast cancer along with ongoing positive numbers of vulnerable patient popultion. Another arguable contributory factor of poor clinical management of breast cancer in low and middle-income countries is the low rate of detection of the condition. Due to this limitation there are poor provisions of clinical care management for patients with breast cancer in these countries. However, with the recent inference drawn on the relevane of the concerning subject, more inclusion of treatment interventions can be obsevred in regards with public healthcare models in low and middle-income nations. Public education and awarness is the key to success for such programs and thus, many healthcare setups run by government and non-government funds are being inclusive of free breast cancer screening programs. One of the common limitations of these health promotional plans has been the selection of target population. This can be useful in priortizing the subsets of patient popultion and thus, enabling further effective screening options and strategic intervention for minimsing the potential threat and harm for the vulnerable patient population. Health promotional strategic intervention is also required to be focused on the inclusion of outreach and community-based programs which can support individuals who are out of reach of available treatment options and resources. The focal goal of the health promotional intervention strategies also focused on reduction of morbidity and mortality rates which are being contributed due to breast cancer. Evaluation is the process which systematically attempts at objetcfing the possible relevance and effetciveness of the care plan intervention. Impact of these healthcare plans are also focused on the perspective of enabling predefined objectives which will assist in constant monitoring and intervntion planning execution according to the available of resources. Thereby, focusing on smooth facilitation of rigrous implementation of healthcare and awarness promotional plans for breast cancer management.

1.10 - Justification of the research

I am passionate about health and health care systems. As a doctor I believe that prevention is better than cure had 6 years work experience in a renowned hospital in Bangladesh as a doctor. Personally I have experienced that women are not aware about breast cancer. The purpose for selecting systematic review for this particular research is that this method provides appropriate support to the study by helping to construct the research in an explicit, comprehensive and reproducible manner. The key words for this study include breast cancer, primary care, systematic review and PRISMA. Women are not conscious about early diagnosis, regular examination and screening. Most of the women are coming in 3rd or 4 stages and there is no hope. In our country there is lots of social taboo or norm women are too shy to talk about breast related problem. Illiteracy, lifestyle, lack of proper knowledge, use of some narcotics are one of the reasons for breast cancer. That's why I selected this research because it’s broad, interesting and important for low and middle income country women. So in this topic there is lots of room to identify how to reduce risk of breast cancer in women.

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