- Aims/ Objectives
- Research question
- Literature Review
- Methodology, methods and analysis
- Ethical considerations
We know the cancer of breast tissue as Breast cancer. It has reported too that breast cancer affects woman ageing of any age at least in the western world. Breast cancer is supposed to be the most fatal cancer for women only to be holding second place after lung cancer.
In general sense, there are about six different forms of breast cancer identified till date. These could be enumerated as Paget’s disease, Ductal Carcinoma in Situ or DCIS, Inflammatory breast cancer, Invasive lobular carcinoma, Invasive ductal carcinoma and Lobular Carcinoma in Situ or LCIS. The fundamental aim of the research is to determine the amount of survival in the context of breast cancer patients.
We know the cancer of breast tissue as Breast cancer. It has been estimated that this form of cancer affects every one out of twelve women worldwide. It has reported too that breast cancer affects woman ageing of any age at least in the western world.
Breast cancer is supposed to be the most fatal cancer for women only to be holding second place after lung cancer. In general sense, there are about six different forms of breast cancer identified till date. (Chan, 2006)
These could be enumerated as Paget’s disease, Ductal Carcinoma in Situ or DCIS, Inflammatory breast cancer, Invasive lobular carcinoma, Invasive ductal carcinoma and Lobular Carcinoma in Situ or LCIS. Thus, it is important to determine the survival rate of the ailment. The fundamental aim of the research is to determine the amount of survival in the context of breast cancer patients.
What is the potential survival rate of the breast cancer patients?
It should be mentioned that the primary cause of breast cancer is still virtually unknown but till date it has been regarded as the malfunction of DNA. Alongside, there are several hypothesized factors that include ionizing radiation exposure, estrogens exposure or result due to enhanced mutation rate, the p53, BRCA2 and BRCA1 genes. (Torosian, 2002)
Alongside, it has been found that Dietary influences offer a negligible cause for breast cancer and it is unable to distinguish between populations. However it has been a proven fact in the perspective of environment and it has been found the ailment of breast cancer differ from country to country and continent to continent.
For example, it has been found that people moving from Japan or Vietnam to United States would be more prone to breast cancer than that of an individual of US background migrating to Japan or Vietnam. In other words population of lower indices would face more risk migrating into population or country of higher indices than that of the vice versa. (Seidman, 1999)
During the early phases of breast cancer, there are no specified or painful symptoms. In today’s era, breast cancer is diagnosed and detected before any symptoms or feeling of pain in the context that modern facilities like mammography or by the feeling of lump in any part of the breast or any permanent lump on the collarbone.
Additionally, there could be evidence of breast discharge or even inversion of the nipple. Change in skin quality or texture can also be reported as possible symptom of breast cancer. (Hirshaut, 2004)
However, the MRI or Magnetic resonance imaging does when mammograms are unable to detect cancer the main source of detection. However, it should be mentioned in the same context that Magnetic resonance imaging has found to have multiple disadvantages.
It has been reported that though the process of Magnetic resonance imaging is about 40 per cent more sensitive mammography has proved to be much more specific that Magnetic resonance imaging. This crucial result ends in several false detections.
It has been estimated that the amount of false detection for Magnetic resonance imaging is about 5 per cent, which is quite high in this context. (Brown, 2006)
Furthermore the affect of this false detection by Magnetic resonance imaging lead to both psychological and financial costs because this procedure of Magnetic resonance imaging is relatively quite costly. Whatever it is in today’s perspective Magnetic resonance imaging is regarded as the prime resort for breast cancer. (Singletary, 2003)
According to the recommendation of U.S. National Cancer Institute a woman must undergo screening of mammography that consists of a baseline mammogram as early as the age of 35. Then onwards the woman must undergo the same procedure every couple of years once she reaches the age of 40 and from the age of 50 a woman must undergo the screening of mammography that consists of a baseline mammogram every year. (Kaelin, 2005)
In the United Kingdom it is mandatory for women with a family history of breast cancer must undergo screening of mammography that consists of a baseline mammogram each year from the age of 40 with the initial screenings at the duration of 5 years starting from the age of 25. (Leis, 2001)
Dr. John Link, the founder and head of Breastlink, a premier medical facility to treat breast cancer, has authored two of the most popular books on breast cancer survival aptly titled The Breast Cancer Survival Manual editions 3 and 4.
He has been one of the leaders of the current era in the field of breast cancer research and Dr. Link has also set up the Breast Cancer Care and Research Fund, a nonprofit charity aimed at educating and helping patients receive the best possible medical supervision.
Whereas the 3rd edition was co authored by Dr. Cynthia Forsthoff and James Waisman, the 4th edition has been co authored by James Waisman, Carey Cullinane and Edgardo Rivera.
Both the editions have been written in lucid terms and are easy to understand and patients can find a wide array of information on the latest medical developments and procedures that can help them in their fight against the disease.
They also have guides and preventive medication prescribed for possible patients who are at a greater risk of contracting the disease. (Link, 2007)
The third edition of the book deals with a general biological explanation of the malady and discusses medical options such as chemotherapy, tamoxifens, herceptin and the significance of Her-2 testing. Not only does it deal with solutions for the problem but in developing ideas in the minds of patients as to what the best possible course of action might be.
It also outlines how it might be possible to be control the growth of cancer further and limit it to its current state by using Sentinel Lymph Node sampling processes.
In this process certain lymph nodes under the arm of the patient is removed to ascertain whether the cancer has spread to the lymphatic system and thus determine the stage of advance of the disease. The sentinel lymph node is the first lymph node into which the tumor drains.
As opposed to the previous medical procedure called axillary dissection where several such cells were removed for study this process is used to target the sentinel lymph node or nodes and remove it specifically for the purpose of studying the extent of growth of the cancer.
The book also deals with use of preventive drugs and prophylactics for people who due to their genetic structure are at greater risk of contracting the disease. (Koroltchouk, 2002)
Prophylactics are agents which can ward off the disease and are generally protective drugs or vaccines. The Her-2 gene or human epidermal growth factor receptor-2 is a gene that helps to control the rate or pattern of cellular growth.
One out of four cases of breast cancer shows a high number of copies of Her-2 gene. Cancers having too many copies of the gene or too many HER2 receptors show a rapid rate of growth. (Levitt, 2000) But they do respond very well to anti-HER2 antibody therapy.
There are three tests which can be conducted viz, IHC or immune histo chemistry test, the FISH or fluorescence in situ hybridization test and CISH or chromogenic in situ hybridization test using the subtraction probe technology or SPoT as it is commonly referred to.
Herceptin is the trade name of a drug called Trastuzumab which can be used to act on the Her-2 receptors and is used in breast cancer treatment. The combination of this treatment along with chemotherapy has shown to improve survival rates in cases of breast cancer patients. Tamoxifen is another drug that can be administered to treat patients. (Hawkins, 2001)
Building on the basic concepts introduced in the third edition, the fourth edition of the book provided readers with updates on latest medical findings and processes. It emphasized the need for getting a second opinion and why it was necessary to ask the relevant questions.
It informed about latest genetic testing procedures and other medical breakthroughs in the field. The book contained information on how to choose the best team of doctors, local and systemic control processes, hormonal therapies, management of side effects, control of diets and vitamins, and also dealt with how to tackle the fear of recurrence. Importantly it informed patients as to why taking a second opinion was necessary.
He reasoned that obtaining a second opinion can help in providing proper diagnostic care to the patients because by adding or conflicting information regarding the matter a “productive dialogue” can be set up which can help in understanding the situation better. The book emphasized that it was essential to understand the situation that one was in and the exact questions were to be asked to collect enough information to proceed with the medication.
All in all both the books provide a lot of information to readers on breast cancer survival. The author succeeds in providing relevant information and professional wisdom to his readers on ascertaining the best plan of action. (Noguchi, 2003)
Another book that is highly regarded as a seminal work in the field is Jeremy R Geffen’s “The Journey Through Cancer”. Dr. Geffen is a leading oncologist and in this book he discusses why it’s necessary to have open discussions between doctors and their patients and the benefits of positive thinking, and other complementary or alternative therapies.
The book is written in a very compassionate tone and readers can find a sense of re assurance in the way he treats his reader. in the book he explains how the journey through cancer is a different experience for different individuals and as to how an integrative approach is necessary in treating cancer and explains how apart from the body both the mind and spirit also needs to be healed by integrating various forms of treatment both conventional and alternative.
In his book he writes “… your intention should be learning to care for the garden of your own unique being — with the help, support, and guidance of your doctor, your family, and your friends — so that the fruits and flowers of health, well-being, and self-knowledge can blossom and grow.” (Geffen, 2006)
He explains as to how alternate treatments such as acupuncture can be used to manage the side effects such as nausea and vomiting caused due to chemotherapy. All in all it’s a good book to read as it provides good moral support and also informs readers about how the ailment can be cured a combination of all the medical solutions available.
For people who might be interested in alternative means of cure, the book A Woman’s Guide To Healing From Breast Cancer- Traditional Chinese Medicine by Nan Lu, provides an alternative solution to the disease. She informs as to how Chinese medicine has been able to help millions of cancer patients and works by identifying the root cause of the disease and then treating that specific cause.
The method can be used by a broad spectrum of patients, ones who are preparing for operation, chemotherapy, survivors who want to prevent re occurrence of the disease or people who want to take preventive measures to ensure that they do not contact the disease ever.
The processes are time tested and totally natural. he explains how the therapy urges one to understand early signs of the disease and use ancient techniques such as specific energy movements to strengthen the body before surgery.
He guides the reader as to how one’s health can be managed during radiation and chemotherapy sessions and also develop a lifestyle to tackle the root cause of the disease. Overall it provides an alternative view to the scheme of things. (Lu, 1999)
Further, the book Healing Outside The Margins by Carole O’Toole, a cancer patient and survivor herself, also is a useful guide on integrative medical practices. Even though she informs the readers about alternative practices she herself maintains that,” the book should serve as a guide to, and not a substitute for, good holistic medical care.” The idea is to empower patients with ideas so that they can choose the best course of action for themselves.
Part 1 of the book deals with her own experiences and how she spoke to her own oncologist and itemize her own plan for cure. She informs her readers and thereby the readers can learn from her own experiences, as to what questions must be asked of the practitioners of alternative procedures.
The readers especially patients can identify with dilemma and mental state of the author and thereby use her experiences to devise their own treatment plan. the book can also be used by regular medical practitioners to introduce and thereby integrate such complementary medical practices with their own conventional healthcare plans. (O’Toole, 2003)
The second part of the book helps in developing in a reader’s mind ideas about alternative healing techniques such as ayurveda, traditional Chinese practices such as energy healing, naturopathy chiropractics, homeopathy and other several practices.
Detailed descriptions are given about treatment sessions, and the author makes an effort to make the reader understand how these practices are attuned with conventional practices. Being a firsthand account of a survivor the book also can create positive ideas in the mind of the reader about such practices and has an added credibility because of it. (Noguchi, 2003)
For people who might be understand the basics of breast cancer, the disease in itself, the causes, the symptoms, the available medical solutions et.al, the book ABC of Breast Cancer by J. Michael Dixon is highly recommended. the book is highly detailed and is written in such way that even a layman can understand what’s written.
The first chapter of the book deals with the symptoms and adequate and proper illustrations are provided to help the reader get acquainted with the symptoms. It provides guidelines as to how one can judge whether the symptoms, if present, in the person is to be analyzed and decide whether it is to be referred to medical practitioners or not.
One interesting detail given in the book is regarding a painting by Rembrandt of Bathsheba and the argument that the abnormality shown in the left breast might indicate a disease. (Harmer, 2003)
The book is interspersed with similar articles and makes the book both highly informative and enjoyable. In a detailed fashion, the author encapsulates the various condition assessment processes for possible patients such as, family history, mammography, magnetic resonance imaging, ultrasonography, fine needle aspiration cytology, core and open biopsies and the accuracy of each of these investigations.
The book also deals with other congenital problems such as accessory breasts, hypoplasia or absence of breasts and other abnormalities such as juvenile or virginal hypertrophy. all in all the book is a treatise in the biological aspects of breast cancer and it serves well to inform. (Noguchi, 2003)
Another book that can be helpful to cancer patients is the “Living Well With Cancer” by Katen Moore, an Oncology Nursing Society Member, and Libby Schmais. The book is an account on how to deal with the side effects of treatment procedures and is very compassionate in its approach.
The book describes how aromatherapy and such processes may be used to deal with the side effects of chemotherapy such as nausea. Chemotherapy sessions can be very stressful and the side effects debilitating both for the body and spirit. The book also informs how psychological negativities can be healed with meditation and yoga. (Moore, 2001)
Another highly informative book would be Taking Care of Your “Girls”: A Breast Health Guide for Girls, Teens, and In-Betweens Marisa C. Weiss, M.D. and Isabel Friedman.
This book which has been based on a survey of over 3000 teenage girls covers a wide area of subjects such as development of breasts, self examination principle and procedures, and other information meant to grow awareness and inform young minds about well being of the breasts. (Weiss, 2008)
The above books may be used by cancer patients to deal with their malady in a more systematic way and can help them achieve overall well being. The books may be used by readers to widen their scope of knowledge also and may help people in avoiding the disease altogether or in the case of survivors avoid the recurrence altogether.
In this context, it can be stated that Breast cancer accounts for about 200 deaths every year in Hong Kong. One of the main reasons is that the patients report the malignancy at an advanced stage to their physicians. If the cases were represented at an early stage then fewer deaths would have occurred. The WHO informs that cases reported per 100,000 population was about 23.8 in developing countries whereas in Hong Kong it was reported to be 47.5.
The Hong Kong Breast Cancer Foundation has announced that there has been a rise in the number of affected women in the recent years and that it has grown from 1,152 in 1993 to 2,273 in 2004. The foundation has observed that women in the area consume large amounts of animal fat, tend to be overexposed to lights in the nights, which in turn suppress melatonin, a sleep regulating hormone known to be repressing for cancer cell growth.
Additionally women tend to delay their pregnancies until after 35. A mix of these factors has led to a rapid rise in the number of breast cancer patients in the area.
The foundation has also observed that there has been a rise in the number of younger women afflicted with the disease. This might have happened due to lack of knowledge among women about the malignancy and the necessity for self-examination and other screening processes that might aid in the early detection of the malady.
The foundation is taking initiatives to raise awareness among women about the disease and steps necessary to curb its recurrence in survivors and the overall well being of the women in Hong Kong. Persons interested in knowing more about the disease or the screening and self-examination processes may refer to the official website of the Hong Kong Breast Cancer Foundation. (Weiss, 2008)
Various researches and reports have been studied that are connected to the area of work. These reports that are supportive and contrary to the hypothesis of the research are taken for consideration. These literatures are analyzed and the results of these analyses are recorded. (Munro, 2005)
Every objective listed is thus ratified with the earlier reports. Literatures that identify appropriate metrics are also identified and these metrics are checked for their validity in the current situation. If they are valid they are identified and used for further analysis.
This will also help in realizing objective. Similarly, every one of the objectives is realized. Further research is then done to check with the real time data whether these theoretical conclusions that are arrived at using the literatures is valid and right. This is tallied with the results obtained during the survey carried out in the specimen industry. (Moustakas, 1990)
Methodology, methods and analysis
It should be noted that reliability for the researcher was achieved in the assurance that only a specified group of men and women were utilized in regard to the research. That group was focused mostly on stakeholders and retails along with administrative personnel.
This gave the research a more focused view of the research goal. The validity was managed as a result of this focus and emphasized in the considerations involved in the data collection, variables, and sampling methods. (Hart, 2002)
As descriptions of statistical methods that will be used it could be stated that in order to isolate the results for this particular study, only a survey questionnaire done would have been utilized. These questionnaires would be delivered to potential patients along with the administrators of different companies.
The results were divided into these same categories to ensure validity and reliability. General information in regard to identifiers was utilized in order to ensure that there would be no bias. (Ryan-Wegner, 1992)
Analysis strategy included a full series of statistical diagrams of all information collected including positive and negative responses, gender variations and marital status. This strategy provided the researcher with a wider spread for the conclusions that became evident in regard to the researcher’s focus. This information was broken down into specific charts for the benefit of visual context. (Gerrish, 2006)
Limitations and ethical considerations to the research would in fact include many different considerations. Those considerations are inclusive of the number of respondents along with the number of health officials in the general vicinity.
Other things that limit this research would in fact be the concerns of other levels of awareness including professionals of various genres that are not attending university. Background information in regard to how the respondents learn health issue is limited within the scope of the research and because of this, the information gained only brings limited reasoning behind the choices in the context. (Brookfield, 1987)
Ethical consideration should be put into consideration and implemented always. In instances where officials are to be deployed to work in the community, they should not misuse the power and authority bestowed on them. This is because some officers by virtue of being in possession of power and authority; they can continue acting in a coercive manner towards the community.
This may damage the public order, which in the first place they were supposed to maintain. Officials should not take positions and start protecting their active supporters even when they are on the wrong since this can lead to bad perception of the officials by the public. (Smith, 1997)
|Activity||Month 1||Month 2||Month 3||Month 4||Month 5||Month 6|
|Preliminary literature review|
|Critical analysis of papers|
|Data extraction grid|
The budget would be kept to minimum and as the basic formulation of the research is based on literature, it is important to gain access to libraries, both online and offline. Thus, it is estimated that online library would cost 100 pounds and offline library would cost 75 pounds.
Brookfield SD (1987) Developing Critical Thinkers. Milton Keynes: Open University Press
Brown, Zora & Harold Freeman, Elizabeth Platt; 2006; 100 Questions and Answers about Breast Cancer; Jones & Bartlett Publishers
Chan, David, Eric F. Glassy, M.D. Frank Stockdale; 2006; Breast Cancer: Real Questions, Real Answers; Marlowe & Co
Geffen, J; 2006; The Journey Through Cancer; GB Press
Gerrish K & Lacey A (2006) The Research Process in Nursing 5th edition. Oxford: Blackwell
Harmer, Victoria; 2003; Breast Cancer: Nursing Care and Management; Whurr, University of Michigan
Hart C (2002) Doing a Literature Review. London: Sage
Hawkins, R. A, M. M. Roberts, A. P. M. Forrest; 2001; Oestrogen receptors and breast cancer: Current status; British Journal of Surgery; 67, 3, 153-169; British Journal of Surgery Society Ltd; Department of Clinical Surgery, University of Edinburgh
Hirshaut, Yashar & Peter I. Pressman; 2004; Breast Cancer: The Complete Guide; Bantam Books
Kaelin, Carolyn M & Francesca Coltrera; 2005; Living Through Breast Cancer: What a Harvard Doctor and Survivor Wants You to Know about Getting the Best Care While Preserving Your Self-image; McGraw-Hill Professional
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Link, John; 2007; The Breast Cancer Survival Manual: A Step-by-Step Guide for the Woman With Newly Diagnosed Breast Cancer; Macmillan
Moustakas C (1990b) Heuristic Research: Design, Methodology & Applications. London: Sage
Munro BH (2005) Statistical Methods for Health Care Research 5th edition. London: Lippincott Williams & Wilkin
Moore, Katen & Libby Schmais; 2001; Living Well with Cancer: A Nurse Tells You Everything You Need to Know about Managing the Side Effects of Your Treatment; Penguin Group (USA) Incorporated
Noguchi, M; 2003; Sentinel lymph node biopsy and breast cancer; British Journal of Surgery; 89, 1, 21-34; British Journal of Surgery Society Ltd; Surgical Center, Kanazawa University Hospital
O’Toole, Carole & Carolyn B. Hendricks; 2003; Healing Outside the Margins: The Survivor’s Guide to Integrative Cancer Care; Regnery Publishing, Incorporated, An Eagle Publishing Company
Ryan-Wegner NM (1992) Guidelines for the critique of a research report. Heart and Lung 21(4): 394-401
Seidman, Herbert; 1999; Cancer of the breast. Statistical and epidemiological data; Cancer; 24, 6, 1355-1378; Department of Epidemiology and Statistics, American Cancer Society, New York
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