Abstract
Being diagnosed with breast cancer is one of the most traumatizing experiences any person can undergo in life. The claim follows since such a diagnosis, for most people has a reverberating echo of ‘fatalism’ ringing in the background. The media and the health sector have tried to increase awareness of breast cancer, its symptoms, treatment procedures, and survival coefficient.
The result of these campaigns is that more people talk about it nowadays, and more women go for regular testing. However, a large portion of the society still cringes at the mention of this incurable condition, and they do so with good cause, because the time, costs, physical discomfort and psychological distress associated with having cancer are too expensive a price for most to pay.
Research has proved that most people are willing to talk openly about getting tests done to allay fears over identified suspicious symptoms, when it is friends or relatives suffering these signs. However, the same people are fast to decline such tests for themselves, preferring not to know about the condition of their health, in case they discover that they have it.
The paper gives a general review of the current standing of cancer and its effects on the society. This includes the causes, and possible preventive measures.
It then places particular focus on the testing and treatment of breast cancer, the effects and conditions associated with it, from a financial point of view, and the possible improvements worth making in service or treatment provision, to cater for the patients who cannot afford the expensive procedures necessary for managing cancer.
It also provides an evaluation scheme that can be instrumental in gauging the effectiveness of such reformed policies.
Introduction
Breast cancer is just one of the various types of cancer that a person can suffer from. It mostly affects women. However, recent studies have discovered that men too are vulnerable to this type of cancer, and that they are least likely to survive it because chances of early detection or any detection at all prove rare.
This stands out as one of the detrimental attitudes to the efforts made by health care professionals to increase the awareness of breast cancer normalizing its discussion in the society (Jemal,Thomas, Murray, & Thum, 2002, p. 37).
The other issue that needs management is the costs associated with prevention and treatment of cancer, and in particular, mammography. People have vetted mammography as the most accurate and proximate means of making early detections of cancerous cells, hence enabling one to get sufficient treatment, and increases his/her chances of survival.
Despite the margin of error associated with the devices, as in the case of false positives, which occur when the results are abnormal but no cancer present or false negatives, which show that no cancerous cells are present, yet they are present thus giving the person a false sense of security, these tests are very expensive.
They range from several hundreds of dollars to several thousands of dollars, yet women above 40 years are encouraged to take them at least once in every two years. The costs are likely to keep off most people, and ignorance is likely to keep off even more.
There is therefore a need to standardize the costs further spreading awareness in ways that are more effective. Interested people have coined various government policies with the sole purpose of increasing the affordability of mammography (Vilholm, Cold, Rasmussen, & Sindrup, 2008, p. 605).
These include measures by various entities such as Centers for Disease Control and Prevention, the National Breast and Cervical Cancer Early Detection Program, the National Cancer Information Services and several legislative reforms with the same purpose.
Data
Breast cancer is not a new aspect, and neither is mammography. Breast cancer refers to the uncontrollable replication of cells in the breast at inappropriate times. This results in the blockage of lymph nodes, which ultimately disrupts the normal functioning of an organ, and the body at large. People have identified several risk factors having the capacity to make a person more susceptible to breast cancer.
Age is at the top of the list because ageing makes people susceptible to all sorts of illnesses and breast cancer is not exempted (Brownson, Baker, Leet, & Gillepsie, 2003, p. 67). Other factors include a personal history of breast cancer. A person diagnosed with it before can as well suffer from it again.
A family history of breast cancer, particularly a diagnosis among first-degree relatives (mother, father, sister, or daughter) or second-degree relatives (grandmother or aunt) have a high chance of suffering from breast cancer especially if they were diagnosed before they cloaked 50.
Deleterious (harmful) inherited or acquired genetic mutations of DNA traits also increase one’s chances of having breast cancer. The most common of these mutations affect BRCA1 and BRCA2 genes, but other genes’ mutation may also cause the condition. These include ATM, CHEK2, TP53, PTEN, MLH1, STK11/LKB1, and MSH2 (Thompson, Easton, & The Breast Cancer Linkage Consortium, 2002, p. 1364).
Breast density is the other factor that increases the risk of having breast cancer. This is mostly because the denser the breasts the more difficult it is to identify the presence of cancerous cells early enough. Certain breast changes found on biopsy can also increase the chances of cancer development especially atypical hyperplasia, lobular carcinoma in situ (LCIS), and ductal carcinoma in situ (DCIS).
These conditions do not indicate presence of cancer but denote a risk for its development if not managed. A woman’s reproductive and menstrual history is also consequential when assessing susceptibility to cancer. If she had her menarche before the age of twelve, had her menopause after 55, or had her first child after 30, she is more likely to develop breast cancer.
Another factor is the extended use of menopausal hormone therapy, which normally entails the combined use of estrogen and progestin for over 5 years. Exposure to radiation therapy on the chest and breast area before 30, including during treatment of Hodgkin Lymphoma raise the probability of breast cancer occurrence throughout the life of an individual.
Consuming alcohol, inhaling tobacco, lack of physical exercises, and a poor diet or nutritional habits also increase a person’s chances of developing cancer.
Finally, women upon whom diethylstilbestrol was administered during pregnancy to prevent miscarriage have also been found to be more susceptible to breast cancer than their counterparts who were not treated thus. However, no study has proven whether the same applies to their daughters who were in the womb at the time.
Mammography, clinical breast exams and breast self-exam are the main testing procedures currently in use to detect the growth of cancerous cells. Of the three, mammography is most accurate and it includes both a screening (check for cancerous cells in the absence of symptoms) and diagnostic (check for extent of spread, and viability of ‘symptoms’) mammograms.
If diagnosed with breast cancer, there is an elaborate follow-up procedure for radiologists and breast surgeon to follow, and this is contained in the Breast Imaging, Reporting, and Database System (BI-RADS) which enables them to measure and describe results, as well as to match them with the concurrent follow-up procedure, linked to a specific category of mammography results.
Other new methods of testing and diagnosing breast cancer include digital mammography which uses FFDMs, and is quite similar to the conventional film mammography, except that the images obtained are recorded and stored in a computer file and can be adjusted, retrieved, and analyzed using computer applications (Vilholm, Cold, Rasmussen, & Sindrup, 2008, p. 609).
The method is advantageous because it enables long distance file sharing between healthcare professionals for instance between radiologists and breast surgeons.
It makes it easier to identify minute differences between normal and abnormal tissues due to the high resolution capacity as well as ‘magnification’ option, it reduces the number of follow-up procedures necessary after a mammography, and it requires fewer repeat images, thus reducing exposure to radiation.
Another method is the Magnetic Resonance Imaging (MRI), which uses gadolinium as a contrast fluid to produce images of breast tissue. Sonography or the use of ultrasounds (taking pictures using sound waves) is also an option and it is much cheaper than the other procedures.
Finally, new inventions are being made such as Positron Emission Tomography (PET) scanning or tomosynthesis, and scintimammography (molecular imaging) (Thompson, Easton, & The Breast Cancer Linkage Consortium, 2002, p. 1361).
Literature Review
There is extensive literature on breast cancer, treatment procedures, risk factors, and effects on society based on the many studies carried out in that field. However, on the issue of affordability of breast cancer procedures, no exclusive studies seem to exist. The resource base on that area occurs within the existing research as recommendations made by researcher on cost management.
Eadie and MacAskill (2008) suggest that more health care practitioners adopt the use of ultrasounds in checking for cancer, as this method is cheaper (p. 337). This will result in more affordable services to the patients seeking such examinations. Another study proved that patients could indeed be having money to pay for mammography and other expensive procedures.
Nevertheless, it is their attitudes that need to be worked on. People focus on the fatalism of cancer, and the inability of the medical field to come up with a cure for it. “Given the fears and limited readiness to change, great awareness and sensitivity is required when developing interventions which seek to engage people in the prevention of cancer” (Jemal, Thomas, Murray, & Thum, 2002, p. 33).
The inability to deal with risk and uncertainty results to people advising other to go for check-up while not daring to visit a medical practitioner for one’s own health review.
The fear leads to irrational responses. Sarkar (2009, p. 364) suggests the importance of normalizing discussions about breasts, promoting breast awareness, countering misconceptions about breast cancer and advocating for breast screening by promoting free screening campaigns.
Another study on the legislative policies that inform the cost of cancer prevention and treatment procedures came up with statutes such as the Mammography Quality Standards Act (MQSA), the Food and Drugs Administration Certification and Accreditation, and the Breast and Cervical cancer Prevention and Treatment Act (Jemal, Thomas, Murray, & Thum, 2002, p. 45).
Program Options / Alternate Solutions
Instead of continuing with the prevailing conventional mammography, health practitioners should consider adopting digital mammograms, also referred to full-field digital mammograms (FFDMs) which are easier to manipulate and interpret.
Consequently, they will stand a chance to analyze the information or results obtained from mammograms much faster, which will make them more efficient. Since these devices do not require as much effort or time as the conventional mammograms, the services rendered should also reduce in costs.
Moreover, in cases of transporting patients to other states for procedures such as breast surgeries, part of the increased costs resulted from the need to transport physically the films that had the results of the mammography. With the use of these digital mammograms, such unaccounted expenses, the services rendered will prove cheaper and more affordable to patients.
Digital mammograms also produce more accurate and detailed results whose manipulation reduces the need for repetitive exposure to radiations during more tests, as well as the need for more follow up procedures to certify or clarify the first results (Jemal, Thomas, Murray, & Thum, 2002, p. 39). This stands out as a double benefit in terms of reducing costs because patients necessarily need no further radiation.
The radiation, in itself is carcinogenic. Therefore, it can actually cause cancer. Secondly, a patient need not to pay for more procedures as ‘follow-up’, since the capturing of all the information required for the entire testing procedure, in terms of images, occurs at once. Another cost effective measure involves the use of Sonography, especially during follow up.
Sonography or using ultrasound is not very accurate as a screening procedure (Thompson, Easton, & The Breast Cancer Linkage Consortium, 2002, p. 1359). However, after a positive diagnosis, one can use it to measure the rate of spread of cancerous cells. This applies to the use of magnetic resonance imaging as well.
People ought to look into government policies, aimed at regulating and standardizing costs. The first in this category is the Breast and Cervical Cancer Prevention and Treatment Act (Bardach, 2000, p. 45). Currently, this act provides for Medicaid by catering for the expenses accrued during post-diagnosis procedures.
Whereas that is a noble move, the government can do more than that. It need to first spread awareness of breast cancer including testing and treatment procedures, available insurance policies, survival coefficient of those diagnosed with breast cancer, and the available medical measures for such patients.
Armed with this information, the society it then go ahead and introduce measures such as that which it has going with Medicaid. However, it should also increase the scope of its participation to incorporate other insurance organizations as well.
The current statistics of breast cancer diagnosis indicate that almost 300,000 remain diagnosed annually with 60,000 of these dying due to either late diagnosis or inability to afford treatment (Brownson, Baker, Leet, & Gillepsie, 2003, p. 78).
By government standards, in terms of expenses, providing funds to cater for this number of patients annually should not be too deep a dent in its pockets and the plan can fit well within its budget.
Another act that is related is the Mammography Quality Standards Act (MQSA). This act specifically provides for the safety and reliability of mammography in the country. The issue of affordability falls under the reliability provision.
It is the responsibility of policy makers to ensure that they make clear provisions highlighting on the importance of making mammography affordable to everybody in need of these services (Bardach, 2000, p. 98). Even with the current lack of provisions, 75% of the people diagnosed with cancer every year manage to afford these expensive procedures somehow.
This leaves out a meager 25% only who would require financial support. Surely, the government has economists who can make the necessary calculations to incorporate these people into its budget without going hungry!
The Food and Drug Administration is another authority in the matter of costs. It provides accreditation to mammography equipment, which is tested periodically, institutions with trained personnel who both administer and interpret tests and test results, and provides the system for following up on abnormal results. In short, it is a quality assurance body.
To manage the costs better, all this body needs to do is set up ‘expense’ as one of the various issues it checks to validate a health institution.
After the government has passed whatever policies that are necessary for medical practitioners to standardize costs, this would be the perfect body to execute those policies it imply need to deny certification to any organization that does not provide affordable health procedures, particularly those related to breast cancer and mammography.
Implementation
To produce quality of life results for patients diagnosed with breast cancer, the expenses related to treatment procedures need proper management. They need thorough standardization and regulation. The parties responsible for these processes include the government, medical practitioners, and insurance policymakers.
It is not possible to remove completely the costs of acquiring medical procedures but it is possible to alleviate some of it (Sarkar, 2009, p. 363). It would therefore prove wise to reduce insurance premiums so that more of the society can own medical insurance.
The spreading of awareness of breast cancer too seems crucial, as more people will understand the importance of regular testing and early detection in terms of increasing their chances of survival. Finally, it seems necessary to amend the existing acts that relate to the costs of breast cancer procedure to incorporate provisions that will make the services rendered more affordable and more reliable simultaneously
Evaluation
Such drastic changes require an evaluation scheme that will measure the effectiveness or the implementation of the new rules. Therefore, more bodies like the Food and Drug Administration need to be created, to give such a body authority and credibility, it would help to form it under provisions of acts or statutes passed in parliament (Bardach, 2000, p. 56).
The role of such a body would be to ensure that all related entities adhere to the provisions of its parent act. More specifically, that all the stakeholder, and in this case these are hospitals, ministries of health and finance, insurance organizations, mammogram suppliers, private medical practitioners, and the society in general.
All these publics should adhere to the cost regulation policies established for them to follow (Bernstein, 1994, p.18). Another regulation that will need evaluation is the public awareness campaign. The people responsible for this should work closely with healthcare professional to ensure that they are up to date on the information with which they are providing the community.
Results will come when the number of people reporting to healthcare institutions for testing and treatment services increases, which will in turn increase the number of diagnoses but reduce the rate of death.
The ultimate aim of all these practices is to yield quality of life for the entire society by preventing the development of breast cancer as well as providing treatment for those diagnosed with the same (Brownson, Baker, Leet, & Gillepsie, 2003, p. 76).
One can carry out evaluation through interviewing patients for the affordability and reliability of the services they are receiving as well as administering questionnaires within the community.
This helps to establish people’s attitudes and inclinations towards breast cancer, and conducting multiple researches on the general effectiveness of the various programs that have been put in place, both to spread awareness on cancer, and to standardize the costs of procedures, thereby making them more affordable.
Conclusion
The paper has provided a comprehensive study on breast cancer, the procedures associated with testing and treatment of the same as well as their reliability and affordability. It has listed various recommendations for future research, especially concerning matters of standardizing the costs of procedures and spreading awareness of breast cancer in particular.
Breast cancer is a condition that affects most people, either because they have it, are likely to develop it in future, or have close relation to people who have suffered from it. It is therefore necessary that everybody make an effort to build on their knowledge base concerning this disease, as well as taking the necessary precautions to avoid developing it.
Some preventive practices that medical professionals have proposed include increased intake of vitamins, reducing one’s dietary fat, engaging in regular physical exercise, breastfeeding for more than 36 months, having more than four children, conceiving before the age of 19, lowering alcohol and tobacco consumption, having an organic diet, and eating more soybean and soybean related content. In addition to this, it would help to have medical insurance in case of any eventualities.
References
Bardach, E. (2000). A Practical Guide For Policy Analysis. New York: Chatham House seven Bridges Press.
Bernstein, L. (1994). Physical exercise and reduced risk of breast cancer in young women. Journal of the National Cancer Institute ,1(1), p.18.
Brownson, R., Baker, E., Leet, T., & Gillepsie, K. (2003). Evidence Based Public Health. New York: Oxfor University Press.
Eadie, D., & MacAskill, S. (2008). Symptom awareness and cancer prevention: exploratory findings from an at-risk population. Douglas Eadie and Susan MacAskill , 3 (2), pp.332-345.
Jemal, A.,Thomas, A., Murray, T., & Thum, M. (2002). Cancer statistics 2002. Cancer Journal for Clinicians , 10 (5), pp. 23-47.
Sarkar, S. (2009). POPs in breast milk: women’s breast cancer risk. Nutrition & Food Science, 5 (3), pp. 360-369.
Thompson, D., Easton, D., & The Breast Cancer Linkage Consortium. (2002). Cancer incidence in BRCA1 mutation carriers. Journal of the National Cancer Institute, 1 (1), pp. 1358-1365.
Vilholm, O., Cold, S., Rasmussen, L., & Sindrup, S. (2008). The postmastectomy pain syndrome: An epidemiological study on the prevalence of chronic pain after surgery for breast cancer. British Journal of Cancer, 4 (4), pp. 604-610