Cancer Prevention, Detection, and Control: A Nursing Perspective

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Overview: Section I. Fundamentals of Cancer Prevention, Detection, and Control

Suzanne M. Mahon, RN, DNSc, AOCN^®, APNG(c)

Cancer control is defined as the efforts to prevent, detect, and manage the disease of cancer. To ultimately decrease the morbidity and mortality associated with malignancy, effective means to prevent and detect cancer early must be developed and implemented. Section I provides a detailed examination of the conceptual considerations related to cancer control.

Documentation of efforts to treat cancer can be traced back to 5 B.C. In Chapter 1, Rohan and Frank-Stromborg provide a comprehensive history of cancer-control efforts. This chapter highlights the major roles nurses have played in the development of effective means to educate, prevent, and detect cancers early. An understanding of this historical perspective provides insight into the dramatic advances that have been made in the effort to prevent and detect cancer when it is most easily treated. This information can serve as hope to patients and families that cancer control truly can become a reality. Nurses need to share this hope and historical legacy as they provide patient and public education about cancer control.

Much of the progress that has been made in cancer control stems from epidemiologic research that aims to understand environmental, genetic, and population risks for developing specific cancer(s). In Chapter 2, Jennings-Dozier and Foltz provide a detailed discussion and definition of epidemiologic principles and the application of the principles to cancer control. This discussion includes definitions and clinical examples of statistical measures commonly used in epidemiologic studies and reports. The clinical applications of this technical information are enormous. Nurses constantly are challenged to construct and interpret cancer risk assessments to patients and their families. This demands that nurses be able to accurately interpret epidemiologic studies of cancer risk. The information in Chapter 2 provides the framework for understanding epidemiologic reports and the implications of these reports for clinical practice.

Lifestyle factors are also a major risk factor for many cancers. Although many of these risk factors are within an individual's control, getting individuals to change behaviors is a major challenge for nurses who work in the cancer-control arena. All cancers caused by heavy tobacco or alcohol use could be prevented. The American Cancer Society (ACS, 2001) estimated that in 2001, 172,000 cancer deaths were related to tobacco use, and an additional 19,000 deaths were caused by excessive alcohol use. Further, ACS estimated that at least one-third of the 535,400 deaths from cancer this year would be related to nutrition, physical activity, and other lifestyle factors that could be prevented. These figures do not consider the nonmelanoma skin cancers that are a direct result of ultraviolet light exposure.

ACS (2001) also estimated that cancers of the breast, colon, gynecologic organs, prostate, testicles, oral cavity, and skin account for half of all of the new cancer cases that are diagnosed annually. Currently, the relative five-year survival rates for these cancers are 81% (ACS). If regular screenings were implemented, this rate probably would increase to 95%.

Improving lifestyle practices and engaging in cancer-screening activities could significantly decrease the morbidity and mortality associated with cancer. Although the adoption of positive health behaviors and participation in a regular screening program seem very simple and relatively cost effective to implement, getting people to change health-related behaviors is extremely challenging. In Chapter 3, Coyne and Bowie examine the complex issues that surround human behavior and health education, especially as it relates to wellness. Before implementing any program for cancer prevention or early detection, nurses need to consider the health and human behaviors and beliefs of the target audience. After assessing these factors, nurses can choose appropriate and effective means to communicate information about cancer prevention and early detection that hopefully will lead to a decrease in the morbidity and mortality associated with cancer.

Recently, the science and developments in cancer genetics have dramatically affected cancer-control efforts. The ability to identify individuals and families who are at a significantly higher risk for developing cancer because of their genetic backgrounds offers the hope of targeting aggressive screening and prevention to those who stand to reap the most benefit. Many undergraduate and graduate programs provide limited instruction on genetics and human disease. The importance of understanding these complex scientific principles cannot be underestimated, especially in relation to cancer control. These principles lay the foundation for cancer risk assessments. Genetic testing rapidly is becoming an important tool in cancer control. In Chapter 4, Giarelli, Jacobs, and Jenkins review human physiology and genetic concepts in relation to cancer control. These authors address historical landmarks in genetics research, the basic scientific concepts of genetics and inheritance, and the mechanisms of mutation and carcinogenesis of some common cancers, as well as implications for nurses. Nurses need to consider these concepts when interpreting risk assessments to patients and making recommendations for cancer prevention and early detection.

Laboratory science also is playing an ever-increasing important role in cancer control. In Chapter 5, Trapkin discusses how nurses must consider clinical and laboratory findings in relation to cancer control. Nurses should look at the sensitivity, specificity, and predictive value of various laboratory tests used in cancer detection (e.g., Pap smear) or diagnosis (e.g., pathology of a colorectal polyp). An understanding of these concepts is necessary to recommend the appropriate screening or diagnostic testing and assist in the interpretation of the findings. Both patients and the public must receive education about the inherent strengths and limitations of various laboratory and radiological procedures used in cancer control for true informed consent. Nurses have a responsibility to communicate this information to patients in understandable terms. By understanding the limitations of laboratory testing, the nurse is in a better position to correlate the clinical expectations with the laboratory result and educate the patient regarding appropriate follow-up.

Ethical considerations and dilemmas can arise in the area of cancer control. In particular, issues with managed care, allocation of cancer research costs, population diversity and serving at-risk populations, genetic testing, and issues related to confidentiality can be particularly challenging in cancer prevention and early detection. In Chapter 6, Flach provides a detailed examination of these issues and suggests a framework for bioethical decision making. Nurses are challenged to consider these bioethical issues and dilemmas when implementing cancer-control education, prevention, and detection programs.

For nurses to provide effective cancer-control services to the patients and families they serve, they must be knowledgeable about the science and principles that guide the current understanding of cancer control. These principles must be applied to clinical practice consistently and interpreted to patients and families in understandable terms so they can make the best and most-informed choices possible about how to prevent and detect cancer early. For oncology nurses conducting and interpreting research about cancer-control issues, these conceptual considerations provide the framework for future oncology nursing research. Without a background and knowledge about these conceptual considerations and scientific principles, oncology nurses cannot develop effective programs for cancer control. Section I provides a framework to help meet these challenges.

Reference

American Cancer Society. (2001). Cancer facts and figures, 2001. Atlanta: Author.