Teach early detection for breast cancer
Varied techniques spread word among women
There is no scientific evidence that shows women can prevent breast cancer, although several risk factors are being studied such as alcohol consumption, smoking, dietary fat, and replacement hormones, says Tricia Smith, RN, MS, ANP, clinical nurse specialist in the Comprehensive Breast Center at the University of Wisconsin Hospital and Clinics in Madison.
"Seventy percent of women in the country who develop breast cancer have no obvious risk factors other than the fact that they are aging and they are female," says Smith. Therefore, teaching women about early detection is the best way to save lives, she says. A physical examination, mammography, and breast self-examination make up the conventional early detection approach.
Although a lot of media attention has been focused on breast cancer, there is still a need for continuing education. That’s because there are many barriers to early detection, says Smith. Women often forget to do the monthly breast self-exam. Also, some women’s breasts are so lumpy they don’t know if the tissue they are feeling is normal. Fear is also a deterrent.
"Breast self-exam is a different health behavior than losing weight or controlling fat in your diet. It is a fact-finding mission, and for some people, it is scary and they avoid it," explains Smith. (For details on teaching women about breast self-examination, see story, p. 150.)
Cultural taboos also keep women from examining their breasts, says Kelly Welch, MS, program coordinator for A Gathering of Women, a breast cancer outreach program in Columbus, OH, aimed at minority women. For example, many Asian women believe it is improper to touch themselves.
There are several ways to educate women about early detection of breast cancer. Following are a few examples of outreach programs that you might be able to adapt to your institution:
• Combining screening and education.
The Canscreen program at the Cancer Research and Treatment Center at St. Joseph’s Hospital of Atlanta screens for certain cancers and helps adults determine their cancer risks and how to modify those risks through lifestyle changes.
The screening, which costs $75, is conducted by an oncology nurse clinician and includes an examination of each person’s skin, mouth, thyroid, breasts, and rectum. Women also have a pelvic exam and Pap smear, and men have an examination of the testes and prostate. Women also receive a discount coupon for a mammogram at the hospital.
Teach self-screening when possible
"We have a multidisciplinary oncology program, but we had no screening for the general public, so we started the program in 1990. It is offered to all who want to know the importance of early detection and learn self-examination techniques and get a better understanding of signs and symptoms and prevention of cancer," explains Peggy Watson, RN, OCN, the Canscreen clinician at the hospital.
People who participate in the program are asked to fill out a cancer risk assessment that covers the major types of cancer such as skin, lungs, digestive system, and breasts. Watson uses it to tailor the education portion of the program to the individual. Each appointment is two hours long. It begins with one hour of education, followed by the screening physical.
"We make sure people understand that the screening does not replace their annual physical exam by their physician," says Watson. (To learn Canscreen risk assessment questions about breasts, see p. 151.)
• Targeting a multi-ethnic group of women.
In Columbus, OH, five agencies banded together to create a lay health advocacy program called A Gathering of Women. The program trains women from five ethnic populations to go into their communities and teach women about breast health.
"Each lay health advocate is paid and is responsible for setting up and conducting four workshops with a minimum of five women in attendance," says Welch.
During the workshops, women learn about early detection through clinical exams, breast self-exams, and mammographies and are given resource lists for low-income clinics.
The Columbus agencies that support the program include The Ohio State University Medical Center, the Arthur James Comprehensive Cancer Center, the Ohio Department of Health, Columbus Black Women’s Health Project, and the local YMCA. Welch is an independent consultant hired to run the program by the advisory board that consists of representatives from the five agencies. She recommends banding with other agencies when trying to create a comprehensive program for low-income women.
"For community-based grassroots efforts, you need to use all your resources. Otherwise there are too many gaps to fill," she explains. For example, the YMCA is able to provide child care for people on a low-income who are trying to go to a clinic for a mammogram or exam.
The lay advocates in the five ethnic groups, which included African Americans, Asian Americans, Hispanic, Native American, and Appalachian women, were mailed an invita- tion to participate. About 50 women came to the orientation.
"The main criteria was that the women be willing and able to become a lay health advocate. We did not interview any women; we decided to let them self-select," says Welch.
About 20 women came to the first training session.
• Providing short outreach presentations.
"We do a lot of Lunch and Learn’ programs on breast health, which are quick 30-minute presentations," says Watson.
A video is shown to demonstrate how to do a proper breast self-exam, and Watson discusses how often and when women should have a mammogram. St. Joseph’s Hospital follows the recommendations of the Atlanta-based American Cancer Society to have a baseline mammogram between age 35 and 39 and annually over age 40.
The goal of this program is to provide a valuable service to the women in the community in order to detect breast cancer early and save lives, says Watson.
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