How nurses can use breast cancer risk assignment evolution techniques to evaluate and care for patients?

Question

Task: How nurses can use breast cancer risk assignment evolution techniques to evaluate and care for patients?

Answer

Answer 1
One of the risk factors responsible for breast cancer development and progression identified on this breast cancer risk assignment is the menopausal status of women.

a) Disease outcome: Postmenopausal women were known to have a 52% enhanced risk of breast cancer after adjustment for other risk factors and demographics. In the subsequent section, the exposure will be investigated according to the given case scenario.

Among the pre or peri-menopausal group, the number of cases that were identified to have breast cancer was 1149 and the number of controls was 1550. In the case of a post-menopausal group, the number of breast cancer patients in cases was 1771 and in the control groups, 2,408 women were identified to have breast cancer.

b)

During the breast cancer risk assignment research it was found that a total of 3,683 individuals who were diagnosed with breast cancer, 1771 individuals were in their post-menopausal status, and on the other hand, among 3,980 women who were not diagnosed with breast cancer, 2,408 individuals were in their post-menopausal status.

Odds of exposure among cases and controls
OR = 1771 x 1572 / 1912 x 2408
= 2784012/4,604,096
= 0.604

Therefore, the odds ratio is 0.60 between cases and controls in terms of their menopausal status.
In the given breast cancer risk assignment case scenario a positive association was found between the diseased group and the post-menopausal study. However, in the above-mentioned section of this study, a negative association is identified between post-menopausal status and disease progression in the case group. It is mostly because the total number of participants (cases) in the study was 3,683. However, the bifurcation between post-menopausal groups and non-menopausal groups was identical. Data was not present for 3,683 participants.

Answer 2:
Breastfeeding duration in months is taken as a risk factor for breast cancer in participants.

Casual relationships are based on the 9 criteria proposed by Bradford Hill:
Temporality: The ascertainment of breastfeeding duration (exposure) is accomplished after the outcome. Therefore, there was a lack of temporality in the breast cancer risk assignment study outcome that could have been achieved with a cohort study design (Fedak et al. 2015).

Strength: A strong association between breastfeeding and breast cancer progression was identified in the study. Breast-feeding was shown as a protective factor (e.g. OR= 0.56, negative association). Dose-response: From the given data, dose-response is not possible to identified as no treatment was specified in the experiment (Fedak et al. 2015).

Consistency: Only two duration of breastfeeding was shown in the given breast cancer risk assignment study. Where breastfeeding longer than 12 months was shown to have better protectiveness for breast cancer in comparison with breastfeeding lower than 12 months or no-breast feeding at all.

Specificity: The association between breastfeeding duration and protectiveness was clear and the identification
Experiment: As the given study is a case-control study and findings are not extracted on the experimental ground, there may be a potential bias in the experimental finding of the study in terms of the association between breastfeeding and protectiveness for the development and progression of breast cancer.

Plausibility: The relationship between breastfeeding and protectiveness for mitigating the risk for development and progression of breast cancer is consistent as evident from other experimental studies. Coherence: Breast-feeding has anti-breast cancer developmental protective factors as evident by the given study and other cohort experiments (Fedak et al. 2015).

b) Prospective cohort study would not be an efficient design to examine the association between the risk factors with breast cancer as done by the given case-control study as there is a significant risk of loss of follow-up in a prospective cohort study and there is a requirement for huge time in a cohort study to obtain findings. As in this breast cancer risk assignment case-control study, multiple risk factors are studied as a whole, it is difficult to draw a similar finding in a prospective cohort study due to having this limitation (Song and Chung 2010).

Answer 3
Alcohol intake is chosen as a risk factor for the development of breast cancer. The association between the development of breast cancer and alcohol intake was shown to depend on elevation in the frequency of consumption of alcohol. In the subsequent section of this study, the strength of the inferences from the study will be discussed.

The result as shown in the chosen study is likely to be affected by observation bias. It is most commonly due to having a clear knowledge of the background of the subject. For example, if a subject belongs to the control group, a bias may take place in obtaining the finding in terms of the association between alcohol consumption and risk for development and progression of breast cancer as it is already evident that alcohol consumption increases the risk for breast cancer (Sedgwick 2015). Risk is also there for the potential bias due to inappropriate confounding (Jager et al. 2008). For managing confounding associated risk of biases, the author may follow matching, restriction, and randomization protocol. As the alcohol intake is also attached to some other variables such as junk food consumption and other lifestyle activities, there may be overlapping consequences that may interfere with the consistency or internal validity of the finding. In the given research, no discussion has been presented on the process of randomization, matching, and restriction (Jager et al. 2008). Therefore from the breast cancer risk assignment findings, it seems very definite that the research finding may have a potential bias in terms of the association between alcohol consumption and risk for development and progression of breast cancer.

Reference
Fedak, K.M., Bernal, A., Capshaw, Z.A. and Gross, S., 2015. Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology. Emerging themes in epidemiology, breast cancer risk assignment12(1), pp.1-9.
Jager, K.J., Zoccali, C., Macleod, A. and Dekker, F.W., 2008. Confounding: what it is and how to deal with it. Kidney international, 73(3), pp.256-260.
Sedgwick, P., 2015. Bias in observational study designs: case-control studies. BMJ, 350.
Song, J.W. and Chung, K.C., 2010. Observational studies: cohort and case-control studies. Plastic and reconstructive surgery, 126(6), p.2234.
Tan, M.M., Ho, W.K., Yoon, S.Y., Mariapun, S., Hasan, S.N., Lee, D.S.C., Hassan, T., Lee, S.Y., Phuah, S.Y., Sivanandan, K. and Ng, P.P.S., 2018. A case-control study of breast cancer risk factors in 7,663 women in Malaysia. PloS one, breast cancer risk assignment13(9), p.e0203469.