Detection and Prevention of Cancer
Nurses and physicians have traditionally been involved with ter-tiary prevention, the care and rehabilitation of the patient after cancer diagnosis and treatment. In recent years, however, the American Cancer Society, the National Cancer Institute, clini-cians, and researchers have placed greater emphasis on primary and secondary prevention of cancer. Primary prevention is con-cerned with reducing the risks of cancer in healthy people. Sec-ondary prevention involves detection and screening to achieve early diagnosis and prompt intervention to halt the cancer process.
By acquiring the knowledge and skills necessary to educate the community about cancer risk, nurses in all settings play a key role in cancer prevention. Assisting patients to avoid known carcino-gens is one way to reduce the risk for cancer. Another way in-volves adopting dietary and various lifestyle changes that epidemiologic and laboratory studies show influence the risk for cancer. Several clinical trials have been undertaken to identify medications that may help to reduce the incidence of certain types of cancer. Recently, a breast cancer prevention study sup-ported by the National Cancer Institute was conducted at multi-ple medical centers throughout the country. The results of this study indicated that the medication tamoxifen can reduce the in-cidence of breast cancer by 49% in postmenopausal women iden-tified as at high risk for breast cancer (Fisher et al., 1998). Nurses can use their teaching and counseling skills to encourage patients to participate in cancer prevention programs and to promote healthful lifestyles.
The evolving understanding of the role of genetics in cancer cell development has contributed to prevention and screening efforts. Individuals who have inherited specific genetic mutations have an increased susceptibility to cancer. For example, individuals who have familial adenomatosis polyposis have an increased risk for colon cancer. Women in whom the BRCA-1 and BRCA-2 genes have been identified have an increased risk for breast and ovarian cancer. To provide individualized education and recom-mendations for continued surveillance and care in high-risk pop-ulations, nurses need to be familiar with ongoing developments in the field of genetics and cancer (Greco, 2000). Many centers across the country are offering innovative cancer risk evaluation programs that provide in-depth screening and follow-up for in-dividuals who are found to be at high risk for cancer.
Numerous factors, such as race, cultural influences, access to care, physician–patient relationship, level of education, income, and age, influence the knowledge, attitudes, and beliefs people have about cancer. These factors also influence the type of health-promoting behaviors they practice. For example, Phillips, Cohen, and Moses (1999) examined beliefs, attitudes, and practices re-lated to breast cancer and breast cancer screening in African American women (Nursing Research Profile 16-1). They found that cultural, spiritual, and socioeconomic factors seen in the women studied could be identified as barriers to breast health screening behaviors. Nurses can use this type of information in planning education, prevention, and screening programs.
Public awareness about health-promoting behaviors can be in-creased in a variety of ways. Health education and health main-tenance programs are sponsored by community organizations such as churches, senior citizen groups, and parent–teacher asso-ciations. Although primary prevention programs may focus on the hazards of tobacco use or the importance of nutrition, sec-ondary prevention programs may promote breast and testicular self-examination and Papanicolaou (Pap) tests. Many organiza-tions conduct cancer screening events that focus on cancers with the highest incidence rates or those that have improved survival rates if diagnosed early, such as breast or prostate cancers. These events offer education and examinations such as mammograms, digital rectal examinations, and prostate-specific antigen blood tests for minimal or no cost. Programs of this nature are often tar-geted to individuals who lack access to health care or cannot af-ford to participate on their own.
Similarly, nurses in all settings can develop programs that identify risks for patients and families and that incorporate teach-ing and counseling into all educational efforts, particularly for patients and families with a high incidence of cancer. The Amer-ican Cancer Society has developed a public education program, “Taking Control,” that integrates diet, exercise, and general health habit tips that people can follow to reduce their risk for cancer (Chart 16-2). Nurses and physicians can encourage individuals to comply with detection efforts as suggested by the American Cancer Society (Table 16-3).