Breast Cancer Status Report Plan Research Paper
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Breast cancer is a malignancy involving cells in the breast (National Cancer Institute 2014). Weir, Day & Ali (2007: 67) found that risk factors include a past history of the disease, increased breast density, benign or precursor lesions, heavy alcohol consumption, post-menopausal obesity, nulliparity, hormone replacement, current or prior use of oral contraceptives, high calorie intake, and early menarche. Family history, radiation therapy to the chest, and night shift work are also implicated (CDC 2014). Early diagnosis and effective treatment positively influence prognosis as five-year survival is shown to decrease with the progression of breast cancer (American Cancer Society 2014).
Status Report Plan
More importantly, the Registry also disaggregates deaths by individual diseases making it possible to ascertain how many deaths were attributed to cancer and specifically breast cancer (DHIR 2012). Trends can be determined by obtaining data from the reports of prior years in relation to breast cancer. The annual National Mortality Registry report further condenses data in tables that makes it easier to find disaggregated information. It also separates deaths of non-residents that are registered in Malta thus ensuring that data pertains only to the Maltese population (DHIR 2012). In regards to breast cancer mortality rate by gender and age group, the Registry is the most accurate data source given that it derives information from death certificates that report actual deaths in the country.
The DHIR also maintains the population-based National Cancer Registry. The aim of this Register is to gather data on residents diagnosed with cancer and follow them up over time. Another aim is to determine national cancer trends by gender, age, and type of cancer (Malta NCR 2013). The Registry obtains information from several objective sources - clinical notifications from hospital physicians, general practitioners, and others; histology and cytology reports from one state-owned and eight private pathology laboratories; autopsy reports from the state-owned pathology laboratory and general hospitals; death certificates from the National Mortality Registry; and new referrals to the lone oncology centre (Malta NCR 2013). Coding of the site and morphology of cancer is consistent with the International Classification of Diseases (ICD) permitting comparison with regional and international data that use the same system (Malta NCR 2013).
The National Cancer Registry provides disaggregated cancer-related mortality data to the National Mortality Registry. Given that early diagnosis leads to better prognosis, the Registry also generates data on incidence and related trends as well as the typical stage of breast cancer at diagnosis (Dalmas 2007). Effective treatment further contributes to a favourable prognosis. Age, tumour size, nodal status, distant metastasis, laterality, hormone receptor status, localisation, morphology, survival rates, and utilisation of oncology services thus provide information on the nature of breast cancer in the Maltese population and the effectiveness of available treatments (Malta NCR 2005: 4). The Registry is the most reliable data source not only for mortality data but also the characteristics of breast cancer at presentation and throughout treatment as it employs first-hand clinical data from multiple sources collected serially. These data are important prognostic factors as they determine the likelihood of complications or disease progression (Caruana & Dingli 2013).
Another relevant source of data is the European Health Examination Survey pilot conducted in 2010. The report for Malta aimed to ascertain the prevalence of non-communicable disease (NCD) risk factors (Calleja & Muscat 2010: 6). While previous self-report surveys have been conducted, the EHES used interview data which validated prior surveys since self-reports are prone to bias. The EHES survey collected data on smoking, obesity, diet, alcohol consumption, and physical activity, most of which are implicated in breast cancer (Calleja & Muscat 2010: 10). Thus, the EHES survey provides information on the prevalence of several but not all risk factors for breast cancer among Malta residents with the added benefit of using EU-standard instruments associated with a lesser likelihood of bias.
Bonnici (2005) conducted a study to determine the risk factors for breast cancer among Maltese women receiving mammography screening at the St. Luke’s Hospital in Malta. The author employed the interview method using a tool developed specifically for the study and based on the risk factors identified in the Health Vision 2000 document. The results showed that there were participants who did not fit neatly into the risk factor categories laid out in the reference document. In relation to a geographic subset of patients, i.e. the Pieta, Malta area serviced by the hospital, therefore, the study provides accurate data on the risk factors and risk factor categorisations unique to the said subset (Bonnici 2005). The study complements the results of the EHES survey which established general risk factors for cancer.
The European Cancer Observatory (ECO) is another useful data source. It provides an overview of breast cancer incidence, mortality, and prevalence among the 28 member countries of the EU based on national EHES surveys conducted every five years in each country and estimates based on trending data (ECO 2012). It integrates information from three online sources, namely the EUCAN national estimates, the European Cancer Incidence and Mortality (EUROCIM), and the EUREG registry (ECO 2012). Thus, the ECO is a reliable source of data comparing breast cancer incidence, incidence by age, prevalence, and mortality rates with other cancers affecting women in Malta (ECO 2009; ECO 2012), and comparing Malta’s breast cancer profile with the rest of the region. Such comparisons enhance appreciation of the status of Malta in relation to the disease.
Lastly, the European Health for All Database is useful for incidence data on breast cancer per 100,000 population beginning in 1986 up to 2012 (WHO Regional Office for Europe 2014). The figures are based on country reports and reliable international sources when no reports are given. The advantage of this data source is that there is no need to access past local annual reports because the figures are already presented in chronological order in a table format so that the data can be readily used to create graphs depicting trends.
Bonnici, S. 2005. Female breast cancer: An investigation of the risk factors in Maltese women (online). Available at http://staff.um.edu.mt/ista1/MHSRD/MHSRD_A0048.htm. (Accessed: 30 December 2014).
Calleja, N & Muscat, NA. 2010. European Health Examination Survey 2010 – Pilot study (online). Available at https://ehealth.gov.mt/download.aspx?id=7693. (Accessed: 30 December 2014).
Caruana, M. & Dingli, GC. 2013. Breast cancer in Malta – A comparative study between the year 2000 and 2010. Malta Medical Journal. 25.1. pp. 27-30.
Dalmas, M. 2007. The cancer burden of the residents of the Maltese islands (online). Available at https://ehealth.govMinistry of Health, the Elderly and Community Care. (Accessed: 30 December 2014).
European Cancer Observatory. 2009. Cancer incidence, Malta, Female, 2009 (online). Available at http://eco.iarc.fr/eureg/Table.aspx#61. (Accessed: 30 December 2014).
European Cancer Observatory. 2012. Country: Malta – Most frequent cancers in women, 2012 (online). Available at http://eco.iarc.fr/eucan/Country.aspx?ISOCountryCd=470#tabs-women. (Accessed: 30 December 2014).
European Cancer Observatory. 2012. European Cancer Observatory (online). Available at http://eu-cancer.iarc.fr/Default.aspx. (Accessed: 30 December 2014).
Malta National Cancer Registry. 2013. Cancer of the female breast (online). Available at https://ehealth.gov.mt/download.aspx?id=10623. (Accessed: 30 December 2014).
Malta National Cancer Registry. 2013. National Cancer Registry (online). Available at https://ehealth.gov.mt/HealthPortal/Chief_Medical_Officer/healthinfor_research/registries/cancers.aspx. (Accessed: 30 December 2014).
World Health Organisation Regional Office for Europe. 2014. European Health for All Database (online). Available at http://data.euro.who.int/hfadb/. (Accessed: 30 December 2014).
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