Identify and describe a theory from nursing or from another discipline that provides the framework for your Evidence Based Practice proposal (Low income African Americans have higher risk for colorectal cancer). Explain your rationale for picking this theory.
Statistics
For the modern civilized world, colorectal cancer is quite prevalent type of cancer and is the fourth largest among the others types of cancers. Every year in the global database 800 new cases of the disease are recorded, half of which are fatal. Interestingly, about 133 thousand of the victims are residents of the United States of America (American Canser Society, 2016).
The main percentage of incidence of colorectal cancer are accounted for economically developed countries. This is due mainly to the quality of food intake (abuse of animal fats, low intake of fruits and vegetables), late diagnosis and obesity. But for some time the disease in the US camp was divided into the camp of light-skinned and dark-skinned people. Caucasoid population in an effort to improve the quality of life, started to look after themselves, thus turning the growth of colorectal cancer and other diseases around, but it is not same for African Americans. Dynamics of registration of new cases continues to grow inexorably.
Conduct a literature review on the topic that you have chosen (Low income African Americans have higher risk for colorectal cancer) and summarize the knowledge on your topic using a minimum of 5 and a maximum of 10 different and current nursing articles, textbooks or websites (current within 5 years).
Several major forms of cancer associated with chronic infections (including cancer of the stomach and cervix) are common when countries are economic development, while the incidence of cancers associated with tobacco smoking and the western way of nutrition, physical inactivity, and low reproducibility (especially such as lung and bronchus, breast and colorectal cancer), increases with economic development.
Among the factors contributing to the differences in the forms of cancer or its spread, including regional differences in the incidence of major risk factors, are the availability and use of medical methods such as cancer screening, the availability and quality of treatment, completeness of medical records and the age structure. Currently, two of the three leading cancers in men (stomach and liver cancer) and in women (cervix and stomach cancer) in developing countries are related to infection. Gastric cancer remains the most common form in the world related to the infection, followed by liver cancer and cancer of the cervix. Approximately 15% of all cancers in the world appears due to infection (Medical Xpress, 2012). This percentage is approximately three times higher in developing countries than in developed countries. The incidence of the most common forms of cancer and deaths from them also varies depending on the geographic region within countries and regions of the country. For example, the most commonly diagnosed form of cancer in eastern and southern Africa is cervical cancer, in Central Africa - Kaposi's sarcoma, in North and West Africa - breast cancer.
The diagnosis and treatment of colorectal cancer is gaining importance in recent years. This is primarily due to an increase in the amount of incidences. Colorectal cancer incidence among malignant tumors is approximately 10% (Medical Xpress, 2012).
The possibility of appearing of some cancers may depend on the color of skin. For example, African Americans have a higher risk of developing cancer of the colon or rectum. African Americans are more likely to develop bowel cancer than white-skinned people. This was stated by American experts from the University of Illinois at Chicago, as presented in the portal Medical Xpress (Medical Xpress, 2012).
They conducted a study involving nearly 1.8 thousand African American volunteers. Among them were people with various bowel cancers, and the health department. Researchers evaluated 39 nucleotide polymorphisms - changes in the DNA sequences of the genes responsible for the synthesis and breakdown of vitamin D in the body. It turned out that African Americans tend to its deficit, which is a risk factor for certain cancers. In particular, it is a cancer of the colon and rectum.
"Since the pigmentation of the skin is increased, the amount of ultraviolet radiation necessary to produce of vitamin D, are lower. You play the role of genetic differences, "- said one of the authors of the study, Ph.D., of the University of Illinois Fabio Pibiri (Medical Xpress, 2012). At the same time most cancers occur in African Americans on the right side of the intestine. Other risk factors for GI cancers include poor diet, along with a lack of exercise.
According to the latest medical articles, colorectal cancer is a malignant tumor that starts in the colon or rectum. The colon and rectum cancers have many features in common. In most cases, colorectal cancer tumor begins with a polyp - education, coming from the mucosa of the colon or rectum and growing into the lumen of the gut. Most polyps are benign. Only certain species polyps, adenomas called may become cancerous. You can prevent cancer, if you remove a polyp in a timely manner, when it is small. Over 95% of colorectal cancer - is adenocarcinoma. This tumor develops in the glandular cells, which are located in the mucosa of the colon and rectum (Fred Hutch, 2016).
Risk factors
Age: age increases the risk of cancer;
Colorectal cancer or polyps in the history of a certain type;
Ulcerative colitis or Crohn's disease history;
Colorectal cancer in the immediate family;
Race or ethnicity (African Americans and Jews);
Type two diabetes;
Lynch syndrome.
The risk of developing colorectal cancer increases some of the factors related to lifestyle. These include:
A diet with a high amount of raw or cooked meat may increase the risk of colorectal cancer;
Sedentary lifestyle;
Overweight (or obese);
Smoking;
Alcohol abuse.
Any person can become ill with cancer. However, the risk that it can be diagnosed, increases with age. In economically developed countries, 78% of all newly diagnosed cancer cases occur between the ages 55 and older, compared with 58% in developing countries (Fred Hutch, 2016). This difference is due mainly to the difference in the age data structure populations. The population of developing countries is younger and has a smaller share of elderly people who have cancer occurs most often.
Do low incomes African Americans have higher risk for colorectal cancer?
Statistical studies of the problem of colorectal cancer show a higher overall incidence rate in the world, and statistics for the countries highly developed in economic and industrial terms, more threatening than the Third World countries. This is partly explained by the fact that in the diet of people in the camps of developed economies due to the high yield and inherent traditions supply most of the meat products, fatty and fried foods, than in countries with low levels of development and income, where people are mostly satisfied with plant foods, easy for preparation. Foods containing large amounts of animal fat and protein, refined carbohydrates and contain little plant component, and, consequently, tissue, stimulates the development of cancer, and, above all, colorectal cancers. It is still unknown how this destructive mechanism works. There is speculation that this food contains a large number of carcinogenic substances which, getting into the body, and lingering in the large intestine, have a negative impact on it. In addition, this food is also a breeding ground for the development of carcinogens intestinal micro flora (Mississippi Department of Health, 2016).
Despite the fact that with the help of prevention a reduction of disease risk can be achieved, such a policy cannot prevent most cases of colorectal cancers in low- and middle-income countries, where it was diagnosed at a very late stage. Therefore, the cornerstone in the fight against colorectal cancers is its early detection in order to improve the results of treatment and survival.
Recommended strategies for the early detection of low- and middle-income countries are to ensure awareness of the early signs and symptoms and screening by clinical examination. It is estimated that more than half of all new cancer cases and cancer deaths around the world are potentially preventable.
The forms of cancer associated with smoking, excessive alcohol consumption and obesity can be most effectively prevented by a combination of education and social policies that promote a healthy lifestyle and condemn unhealthy behavior (O’Keefe at al, 2015). Prevention of certain cancers associated with infectious agents such as hepatitis B (HBV), human immunodeficiency virus (HIV), human papillomavirus (HPV), helicobacter pylori (H. pulori), can be carried out using known measures, such as vaccines, antibiotics, sanitation and education. Some forms of cancer (colorectal and cervix) can be prevented by identifying and removing precancerous lesions with regular screening examinations performed by qualified specialists.
Early detection of cancer is important, which provides a better chance that treatment will be successful. The following forms of cancer can be detected at an early stage by screening:
breast cancer,
cervical cancer,
colorectal cancer,
prostate cancer,
oral cavity,
skin cancer.
It is proved by the scientists that screening is effective in reducing disease severity and reducing mortality for all of these locations except prostate and skin. Screening and early treatment are not available in developing countries because of limited resources.
As in the prevention of any other disease, there are primary and secondary prevention methods of colon cancer. Primary prevention of colon cancer involves the identification of risk factors for the disease and the implementation of measures to reduce this risk. Secondary prevention refers to the detection of the disease in its early stages, when treatment is most effective and causes minimal damage to the patient's health. Many publications have been devoted to the influence of diet on the increase in the risk of colon cancer. Reducing the risk of developing colon cancer is possible while adhering to the so-called "healthy" diet, which is based on the exclusion from the diet of fatty foods and increase consumption of fiber.
The presence of the first-degree relatives of cancer or polyposis colon cancer significantly increases the risk of developing colon cancer. In these cases, it is necessary to start early screening (O’Keefe at al, 2016).
Methods of mass screening are still controversial. In this regard, it may not be common recommendations, since in different countries there are different possibilities for the organization of a wide screening of people. The American Cancer Society recommends an annual rectal examination of all people who have reached 40 years of age. Screening reduces mortality from colorectal cancer, not only because of its detection in the early stages, but also through the identification and removal of adenomas, of which in the future may develop cancer.
Conclusion
Colorectal cancer is the fourth most common type of cancer diagnosed in men and women in the United States. It is proven that colon cancer can be inherited.
It is well known that a diet with a lot of red meat or meat products increases the likelihood of developing the disease. It is known that smokers are significantly more likely to develop cancer and heart disease. In people, who do not pay enough attention to adequate sport loads, the likelihood of cancer increases. Some gastrointestinal diseases are considered to be the base for the development of colorectal cancer, for example, Crohn's disease, as well as such inherited diseases, like FAP (familial adenomatous polyposis), HNPCC (hereditary nonpolyposis colorectal cancer), and others. African Americans have the highest predisposition to oncological diseases of the intestine, than other racial groups in the United States, like Jews of Eastern European origin.
The risk of colorectal cancer increases with age. In developed countries, more than 90% of cases are diagnosed in people over 50 years old. The risk also increases with inheritance of certain genetic mutations (FAP and HNPCC), a personal or family history of colorectal cancer and / or polyps or chronic inflammatory bowel disease. However, lifestyle factors are decisive in the risk of colorectal cancer. Modifiable factors associated with increased risk of colorectal cancer are obesity, physical inactivity, smoking, excessive alcohol consumption, food rich in red or tinned meat, inadequate intake of fruit and vegetables. Studies indicate that men and women are overweight with a greater likelihood can get sick and die from colorectal cancer.
Preventive measures against colorectal cancer include maintaining a healthy body weight, regular physical activity and minimizing the consumption of red meat and alcohol. Colorectal cancer screening can lead to the identification and removal of colorectal polyps before they become cancerous, as well as to the identification of colorectal cancer at an early stage. Thus, screening reduces mortality from colorectal cancer by reducing the incidence and identifies a greater number of cases of cancer at an early, more treatable stage. Despite these advantages, few countries have implemented to organize a national or regional program for colorectal cancer screening. Many other countries are currently undertaking pilot tests or consider the possibility of organized colorectal cancer screening programs.
What is the existing literature on the topic? What is already known and understood? What is the state of the science on this problem? Are there gaps in the literature? Will your study fill those gaps?
There is a lot of different literature sources connected with the topic of colorectal cancer: articles in magazines, scientific works etc. For example works of Fred Hutch scientists team (African Americans and Cancer) that were used during the creation of this essay describes the reasons of cancer appearing and gives the general information about this type of cancer. O’Keefe, B., Meltzer E., P., J., & Bethea, T. works on researches about race predisposition to some type of cancers (Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States). Already known is that African American are more sensitive to this type of cancer that the other races. Also it is know the methods of diagnosing the colorectal cancer, prevention methods and treatment methods. It is still unknown why some people races are more sensitive to this cancer. The state of the science on this problem is further researching of reasons of the cancer appearing and finding more successful treatment methods. There are gaps in literature and they are closely connected with problems that science tries to solve.
What theory guides the project? Why? How does it relate?
This project is guided by the theory that low income African Americans has higher risk for colorectal cancer. The focus on social and personal criteria will allow finding the determinants of higher risk of the given type of cancer among this particular group. It is actual because according to the international medical statistics and researches in that field some types or groups or races of people more often get sick with some disease that the others. Topic of this essay describes the actual knowledge about the problem of colorectal cancer between African Americans.
Literature Review on the Topic
American Cancer Society in the work “Colorectal cancer risk factors” named the main risk factors that can lead to the colorectal cancer appearance. As a result the list of the most frequent reason was created with detailed description of each point.
Medical Xpress in the work “Genes involved in vitamin D generation and destruction may influence colorectal cancer risk in African-Americans” explain the theory that African-Americans are more sensitive to the colorectal cancer that the other races because of vitamin D deficiency. The article provides a scientific view of this problem.
Fred Hutch and his scientific team in their work “African Americans and Cancer” describe different types of cancers in general and provide the disease statistics among African Americans due to each type of cancers.
O’Keefe, B., Meltzer E., P., J., & Bethea, T. in the work “Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States” describes not only the types of cancers, but also shows the relation of different races to their own healthcare.
O'Keefe, S., Chung, D., Mahmoud, N., Sepulveda, A.,R., Manafe, M., Arch, J., Adada, H., & van der Merwe T. in the work “Why do African Americans get more colon cancer than Native Africans” provide a scientific view on the problem of cancer appearance between African Americans and describes theories of it.
References
American Cancer Society. (2016). Colorectal cancer risk factors. Cancer.org. Web. 17 Mar. 2016. Retrieved from http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-risk-factors
Medical Xpress. (2012). Genes involved in vitamin D generation and destruction may influence colorectal cancer risk in African-Americans. Medical Xpress 2011 - 2016, Science X network. Web. 17 Mar. 2016. Retrieved from http://medicalxpress.com/news/2012-10-genes-involved-vitamin-d-destruction.html
Fred Hutch. (2016). African Americans and Cancer. Fred Hutch.org. Web. 17 Mar. 2016. Retrieved from https://www.fredhutch.org/en/events/cancer-in-our-communities/african-americans-and-cancer.html
Mississippi Department of Health . (2016). Comprehensive Cancer Control Program. What African Americans need to know about Colorectal Cancer. (1st ed.). Web. 17 Mar. 2016. Retrieved from http://msdh.ms.gov/msdhsite/_static/resources/2043.pdf
O’Keefe, B., Meltzer E., P., J., & Bethea, T. (2015). Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010. Front Public Health, (3: 51.).
O'Keefe, S., Chung, D., Mahmoud, N., Sepulveda, A.,R., Manafe, M., Arch, J., Adada, H., & van der Merwe T. (2012). Why do African Americans get more colon cancer than Native Africans?. Division of Gastroenterology and Pathology, University of Pittsburgh, Pittsburgh. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17182822
