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What is the issue?
Being overweight or obese is associated with an increased risk of breast cancer diagnosis in postmenstrual women.  Breast cancer after menopause is the most common obesity-associated cancer among women.  (CDC, 2021)

Who is affected?
Any women can be affected of these issues women after menopause are especially vulnerable.

Where?
This is a global problem that can affect any women. In the US disparities of obesity and cancer risk exist between rural and urban populations. The prevalence of obesity is significantly higher among adults living in rural areas than those living in metropolitan areas. (National Cancer Institute, 2020)

How?
Obesity contributes risk of developing breast cancer through long-lasting inflammation, higher than normal levels of insulin, insulin like growth hormone and sex hormone.

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Breast cancer is a disease in which cells in the breast grow out of control. It can originate in different parts of the breast and can be multiple kinds depending on the cells involved. The most common types are invasive ductal carcinoma, and invasive lobular carcinoma. Several less common breast cancers are Paget’s disease, medullary mucinous, and inflammatory breast cancer. It can spread outside of the breast through the blood and lymph vessels. ( CDC, 2021)

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Many peer review studies are examining the correlation between obesity and risk cancer in postmenstrual women. I have looked closely at three of them.

According to Iyengar (2019), in postmenstrual women with normal BMI the high body fat is associated with an increased risk of invasive breast cancer. It found a 56% increase of developing ER-positive breast cancer per 5 kg increase of trunk fat.

According to Khan (2017), high BMI and waist to hip ratio of more than 0.9 are both risk factors associated with the development of carcinoma of the breast.

According to Gravena (2018), there is a positive association between obesity and increased chances for developing breast cancer in postmenstrual women. Meta-analysis showed that BMI more than 30kg/m is associated with increased risk compared to women with normal weight.

Over all the three studies I examined agreed that increased body fat is risk factor for developing breast cancer in post menstrual women.

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Nurse’s involvement is crucial in addressing this issue. They have a unique position to access a large variety of individuals and populations. They can engage these communities and individuals in prevention through education.  This allows more women to better understand breast cancer and the factors that influence the disease. Overweight and obesity is a modifiable factor and addressing it will reduce to incidence of developing breast cancer and improve patient outcomes.

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Breast cancer is one of the most common cancers in women not only in the USA but around the world. In recent years the death toll has been declining but it remains the second leading cause of death.  One of eight women in the United State will develop invasive breast cancer during her life.

Only in 2021 there will be  approximately 281,550 new cases, and 43,600 women are expected to die from the disease (Breastcancer.org, 2020) The chances of women dying from breast cancer is 1 of 39 (2.6%).

Obesity is a very concerning problem in the US. More than 2 out 3 women are considered overweight or obese (Office of Women’s Health, 2019) Extra fat is related to multiple chronic diseases, diabetes, and especially cancers.

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Breast cancer is one of the leading causes of death for women around the world. Obesity is also a serious public health problem.  Multiple peer-reviewed studies agree that there is a positive correlation between both and seriously impact women after menopause. This population is already at higher risk of developing chronic diseases. Nurses are involved in battling both of these issues through education, support, and coordination of care. Although these are all steps in a positive direction more emphasis on prevention is needed. Nurses have the unique opportunity to reach a wide variety of individuals and communities. Barriers preventing further nursing involvement on the issue including socio-economic factors, culture, language, and fear. Through continuous education, the creation of behavior modification strategies and advocacy these barriers can be overcome. Obesity in this population needs to be addressed so the incidence of breast cancer can be reduced.

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·   Education – Nurses must continue to emphasize education. They should be more involved in educational programs promoting:

- Healthy body weight and physical activity - women who increase their physical activity after menopause lower the risk for breast cancer by 12 -21%.(National Cancer Institute, 2020)

- Yearly breast cancer screening for women over 50 – United States preventative task force recommends women that are 50 to 74 years old and have an average risk for breast cancer to get a mammogram every two years (CDC, 2021)

- Self -breast awareness- teaching women should familiarize themselves with both the appearance and feel of their breasts and report changes to a health care professional.

·     Behavioral Strategies – Research to develop and test individual and community based behavioral interventions that help to improve overall health as well as prevent cancers. The goal is to develop a strategy where individuals not only will lose weight but sustain the loss over time. (National Cancer Institute, 2020)

·    Get involve in advocacy – Support legislation that addresses obesity like, Treat and Reduce obesity act of 2019; legislations that ensued access and coverage to preventative services; funding for research that better understand the correlation between obesity and cancer

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Community health – Obesity is a public health problem and a modifiable factor affecting the chances of developing breast cancer.

- Prevalence of obesity in adults 40-59 is 44.8% and adults older than 60 is 42.8%

-Among women obesity is lower in the highest income groups than in middle- and lowest-income group.

- More than 90% of obesity-related cancers occur in men and women after 50 years old

(CDC, 2021)

According to the CDC, obesity is a public health problem that is impacting more than 42% of adults. The impact of this crisis does not impact communities equally and there are a variety of factors. The incidence of obesity is affected by low socio-economic status, age groups, ethnicity, and rural areas. Primary prevention is essential for the health of the community.

Leadership role – This circular concept prepared me to gain a better understanding of public health issues. It makes me better equipped to recognize the needs of a particular population segment and the complex factors that influence them. It helped me to develop critical thinking to solve clinical problems of large diverse groups. It gives me the tools to take the lead in primary prevention to improve the health of my community.

Patient education – It is imperative for the patient to be educated about their disease and the factors that influence it.

-Provide one-on-one education to patients about the risk of breast cancer, obesity, and the importance of screening. The education can be face to face or over the phone

- Education can be performed in multiple settings -clinical, homes, or workplaces

- The education can address the general population or be tailored to the individual needs

- Education can be supplemented by brochures, videos, and demonstration

(CDC,2021)

Education is a great nursing responsibility. It helps patients and their families to better understand the importance of prevention, disease process, and treatment. It empowers patients to get an active role in their health and improve their outcomes.

Leadership role – This circular concept is from the particular importance of taking the leadership role after graduation. It helped me to develop better communication skills and assertiveness. It also made me further research topics I was not familiar with and become more confident in my knowledge so I can pass it to my patients. Education helps to establish rapport with patients and their families. They can take a more active role in their health and improve their outcomes.

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Multiple challenges are affecting the nurse’s involvement in this issue. Barriers include socio-economic factors, lack of awareness, fear, cultural differences and language.

·         Socio- economic factors:

-          Lack of healthcare access: many rural areas lack easy access to services or providers. The prevalence of obesity in these areas is also higher than in urban areas (CDC, 2021)

-          Lack of insurance – women who do not have health insurance are less likely to get screened for cancer. In 2018 among women 50-74 only 39% of uninsured women had a mammogram in the past 2 years vs 75% insured (Komen, 2021)

-          Lack of time off from work – employed women often do not have paid time leave and which could leave to significant economic loss

·         Lack of awareness – not understanding breast cancer, symptoms and factors that can increase the risk. Also not knowing about the existence of preventative measures and programs

·         Fear – Some women are hesitant to participate in prevention programs and screenings due to the fear of pain, discomfort or possible breast cancer diagnosis

·         Culture – diet and lifestyle are part of culture and some women, especially elderly, are not willing to change them to reduce their weight.

·         Language – Language barriers may be related to lack of understanding of care and prevention.

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Nurses take active role addressing issues concerning obesity and breast cancer.
- Educate patients on nutrition, healthy lifestyle choice and provide obesity screenings
-Nurses provide support, education and information for women with breast cancer, their families and those who care for them
- Provide coordination of care including information and referral to support services and recourses available to hospital and community
- Inform people for research, clinical trials and weight loss programs
- Manage symptoms and hospital care
Unfortunately, this involvement, although in a positive direction, does not impact the issue significantly. The incidence of obesity and postmenstrual breast cancer continue to rise.