The Importance of Self Breast Examinations and a Community ...



The Importance of Self Breast Examinations and a Community Assessment of Auburn, ALGroup B: Natalie Foster, Kaley Luna, Montana McGuire, Sarah Moore, Maggie Parker, Christina Rosser, Rachel Smith, Abby Weyant, and Stephanie WorksAuburn University School of NursingThe Importance of Self Breast Examinations and a Community Assessment of Auburn, ALBreast cancer arises from breast cells that have DNA abnormalities causing them to become cancerous. These malignant cells eventually form a tumor that can metastasize (spread) to other organs (American Cancer Society [ACS], 2009). The American Cancer Society (2009) estimates that in 2009 there were over 192,000 new cases of breast cancer and that there were over 40,000 deaths from breast cancer in the United States. Therefore, it is important for women to have regular breast exams because early detection increases the chances for a cure, if breast cancer is detected (Mayo Clinic, 2009). Breast cancer’s prevalence among Americans makes early detection in the treatment of breast cancer critical. “Breast cancer screening has been shown to reduce breast cancer mortality” in the United States (“Cancer Prevention,” 2009). It is recommended by the American Cancer Society that “women begin monthly breast self-examination (BSE) at age 20” (Smith et al., 2002). Between the ages of 20 and 39, women should have a breast examination by their health care provider (clinical breast exam) once every three years (Smith et al., 2002). In addition to the yearly examinations, once a woman is 40 years of age, she should also get an annual mammogram (Smith et al., 2002). Our goal was to do a comprehensive community assessment of Auburn, AL and the surrounding areas of Lee County, in order to most effectively educate a group of community members at the Auburn Housing Authority about the importance of performing self breast examinations. Liu, Xia, Isaman, Deng, and Oakley (2010) validated our teaching plan by conducting a study that showed that nursing education interventions caused a statistically significant increase in breast self examinations (Liu, Xia, Isaman, Deng, & Oakley, 2010).Teaching Plan for Auburn Housing AuthorityWhen our group went to the Auburn Housing Authority, we met multiple specific learning objectives while giving a presentation to the community members about the importance of self-breast exams. Our objectives were:To inform the community members of the importance of early detection and screening in the treatment of breast cancer.To engage the audience in a discussion about breast cancer screening.To give guidelines of what screening certain age groups should do.To describe signs and symptoms of breast cancer in order to be capable of detecting them on one’s own body.To demonstrate a self breast exam on models.To get a return demonstration from the community members of a breast exam on models. To provide a breast model that contains lumps in order for the attendees to feel what a lump could feel like. To explain the necessary steps to be taken if they were to detect a lump.To provide Colleen Alsobrook’s (Breast Health Navigator at East Alabama Medical Center) contact information to the group in order to provide a resource of information.To inform the community members about free mammogram day in October annually.Our methods of teaching included visual presentations, repetition of important information, question and answer opportunities, and finally providing take-home resources for our audience. The visual presentation was carried out by not only showing the community members the steps of a proper self-exam, but also by presenting this information graphically on a large tri-fold board so that the attendees could effectively read and see the instructions of how to do a self breast exam quickly. We also used models of the human breasts so that members of the audience could practice correctly palpating breasts with lumps. Our second method of teaching used was repetition. We repeated the important information multiple times throughout the course of teaching which ensured that the information was delivered effectively to the audience. Also, at the beginning of the presentation, we asked the audience questions to involve them in the discussion, and at the end of the presentation, we provided the audience the opportunity to ask the presenters questions. We also provided the audience with take-home pamphlets and contact information on breast health in order for them to be able to refer back to the key points of our presentation in the comfort of their own homes. We feel that providing our audience with this wide variety of teaching methods enhanced their learning experience and catered to people with audio or visual impairments. One of the materials used was a tri-fold poster with the following information:We also used two different breast models: a chest with normal breasts and a breast with lumps in it. At the end of the presentation we provided many take-home resources to our audiences. These included: “ABCs of Breast Health” (bookmark), “Three Steps to Finding Breast Cancer Early” (pamphlet), and “10 Tips to Getting a Mammogram” (brochure). We also provided each audience member with a business card for Colleen Alsobrook. The following is a display of all of the materials used:We began the presentation by discussing the latest statistics on breast cancer, including its prevalence in the U.S., Alabama as well as the East Alabama region specifically. The statistics given were:In the past year, there were 128 cases of breast cancer diagnosed at EAMC (C. Alsobrook, personal communication, March 22, 2010).The largest diagnosis group in Lee County was within the age group of 50-59 (1/54 women 50-59 will be diagnosed in their life and 1/23 women 60-69 will be diagnosed in their life) (C. Alsobrook, personal communication, March 22, 2010).In the United States, 1 in 8 women will be diagnosed with breast cancer in their lifetime (C. Alsobrook, personal communication, March 22, 2010). One woman in the U.S. will be diagnosed with breast cancer every 3 minutes, and one woman will die of breast cancer every 13 minutes (C. Alsobrook, personal communication, March 22, 2010). African American women have the highest death rate from breast cancer of any racial/ ethnic group in the U.S. (C. Alsobrook, personal communication, March 22, 2010).Our next teaching subject included details about the breast cancer, including both common myths and facts. The myths and facts section included the myth, “There’s nothing I can do to help prevent breast cancer.” The fact given was, “There is something you can do. The primary ways are: stop smoking, limit alcohol consumption, exercise, eat a well-balanced diet, and have recommended scheduled screenings.” The second myth given was, “All lumps can be seen on mammograms.” The fact given was “Some lumps can only be felt and some lumps can only be detected on a mammogram. It is important to do both.” The third myth given was, “Only Women with a family history of breast cancer are at risk.” We provided the fact that, “All women are at risk. 76% of women who are diagnosed with breast cancer have no family history.” At this point in the presentation, we encouraged the audience to be familiar with their family history as having a family history does put you at a slightly greater risk for developing breast cancer. We informed the audience that if their mom and/or grandmother have had breast cancer, they need to start getting annual mammograms 10 years before their family member’s diagnosis age. The last myth given was “All women know how to do a self breast exam and do it on a regular basis.” The fact is, “Surveys show that the majority of women know about self breast exams, but only a third actually perform them. Also, often these women give up because they are unsure of what to feel for.” The exact cause of breast cancer is unknown but certain characteristics can increase a person’s risk of developing the disease. There are several factors that put a person at risk for developing breast cancer that cannot be changed. We informed our audience that these risk factors include being a female, Caucasian, or over the age of fifty-five. Having dense breast tissue, certain genetic mutations, and beginning menstruation before the age of twelve can also increase a person’s risk. Other risk factors can be attributed to things that a person does. These include: smoking cigarettes, consuming alcohol, using oral contraception, lack of exercise, being overweight or obese, and using post-menopausal hormone therapy (ACS, 2009). It is important for women to understand that having certain risk factors does not necessarily mean that they will develop breast cancer. It is also important for women to know that they can still develop breast cancer if they have no risk factors at all. The uncertainty surrounding breast cancer makes screening especially important in early detection and treatment of the disease. We then proceeded to describe that the benefit of catching the disease in its earliest stages is, “when detected early, the survival rate is 95.5%” (ACS, 2009). The American Cancer Society (2009) has developed recommendations to help detect breast cancer in women who have no symptoms of the disease. The recommendations presented to our audience include:Women age forty or older should have a screening mammogram every yearWomen between the ages of twenty to thirty should have a clinical breast exam (CBE) performed by a licensed practitioner at least every three years, and women age forty or older should have a CBE every yearWomen should start performing a breast self-exam (BSE) beginning at twenty years of ageWomen at a high risk for developing breast cancer should discuss screening options with their practitioner to determine the best course of action (ACS, 2009).Our primary goal was to instruct and demonstrate a proper breast self-exam. The following instructions were given: Lie down and place a small pillow or rolled towel under your right shoulder and place your right arm behind your head. American Cancer Society recognizes lying down as the best position to perform a self breast exam because it spreads the breast tissue thin and evenly along the chest wall making it easier to feel abnormalities (ACS, 2009). Use the pads of the 3 middle fingers of your left hand to feel for lumps in your right breast. Move your fingers in a circular motion varying pressures in a vertical pattern over the entire breast. Make sure you examine up to the collarbone, out to the armpit, in to the middle of the chest, and down to the bottom of the rib cage (ACS, 2009). Repeat these steps with the pillow or towel under your left shoulder, your left arm behind your head, and using the pads of your 3 middle fingers on your right hand to examine your left breast (ACS, 2009). While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin (The pressing down on the hips position tightens the chest wall muscles makes any breast changes more easily visible.) (ACS, 2009). It is most important that you are aware of what is normal for your breasts in order to differentiate an abnormality (ACS, 2009). Some women have naturally lumpy breasts, which is no cause for concern. A change in lumpiness or a lump that feels different from the rest of the breast tissue should be further evaluated (Susan G. Komen for the Cure, 2010).One adverse effect caused by breast self-exams is the anxiety caused by finding a lump (Gasalberti, 2002). We taught the audience that most lumps found in their breast are not cancerous, however, they should see their doctor if they do find a lump in order to rule out breast cancer. After palpating (feeling) the lump, the doctor may order a mammogram or a biopsy of the lump to determine if it is benign (non-cancerous) or malignant (cancerous) (Mayo Clinic, 2009).We then allowed the audience to practice a breast self-exam on breast models. We also showed the audience at this time the model of the breast with lumps. Each person had an opportunity to palpate the lumps in the model. Following the demonstration and return demonstration, we taught the audience about when they should see a doctor. We informed them that they should see a doctor if they notice discharge from nipple, a scaly nipple, inversion of the nipple, dimpling of the breast, a bulge in the breast tissue, rapid increase in pain with redness and a rash, rapid increase in the size of one of breasts, a change in shape, any changes in vein patterns, and if they feel a lump while performing a self breast exam.Next, we gave our audience information on “Free Mammogram Day.” “Free Mammogram Day” is provided by East Alabama Medical Center in October annually. Community members can receive a mammogram free of charge from EAMC. This was important to share with our audience, as cost is a concern for many women in Lee County. Evidence of learner readiness was determined by receiving eye contact from the audience to demonstrate that they were paying attention, participation from the audience when questions were asked by the presenters, audience members appearing engaged and interested in the models and demonstrating the proper technique to perform a self breast exam that was taught, receiving questions from the audience that are pertinent to the presentation, and willingness to take pamphlets and extra information offered. These actions show that the audience was eager to learn about the subject. We evaluated the participants by requesting a return demonstration of self breast exam technique on the breast models. Some members of the audience were able to complete this task without trouble as others struggled to use correct hand placement, possibly because of dexterity issues. Those that were unable to correctly demonstrate techniques were showed again individually. We also placed our hand over their hand to show correct technique. As evidenced by the questions that were asked by our audience, their enthusiasm about our informational flyers, and their overall interest in the subject, we feel that our presentation was successful in educating these community members on the importance of screening for breast cancer and the correct technique for performing a self breast munity Assessment of Auburn, AL in Lee CountyLee County was created on December 5, 1866 by the Alabama legislature. It was formed out of parts of Macon, Tallapoosa, Chambers, and Russell Counties. Lee County was named for Confederate General Robert E. Lee. The county seat is located in Opelika, AL (Alabama Department of Archives and History, 2009). Auburn, the largest city in Lee County, is considered an urban area because the population exceeds 1,000 people per square mile (U.S. Census Bureau, 2002). Lee County is situated in East Central Alabama along the Alabama-Georgia border approximately 100 miles southeast of Birmingham, Alabama, 60 miles northeast of Montgomery, Alabama, 100 miles southwest of Atlanta, Georgia, and 30 miles northwest of Columbus, Georgia (Lee County, Alabama, 2005). Auburn is nicknamed “The Plains” because of its surrounding geography (City-, 2010). The elevation of Auburn, AL is 702 feet (City-, 2010). The city of Auburn, the largest city in Lee County has an average annual precipitation is 56.9 inches per year. The average winter temperature in Auburn is 44.0 degrees F and the average summer temperature is 79.0 degrees F ?(City-, 2010). Lee County has a total land area of approximately 609 square miles (Lee County, Alabama, 2005).Many people question the effects of environmental chemicals on our bodies. The pollution that enters the body has been evidenced to affect the prevalence of breast cancer (State of the Evidence, 2006). In the Auburn area, there have been numerous water toxicity reports. Auburn water works is the main filter and supply source of water throughout the city of Auburn supplying over 42,000 residents In 2005, Auburn Water Works was cited when eleven various forms of pollution were discovered in the water; six of these pollutants have been connected to causing cancer development: 1,2, Dibromo-3-chloropropane (DBCP), Atrazine, Bromodichloromethane, Chloroform, Dibromochloromethane and Total trihalomethanes (TTHMs) (Auburn Water Toxicity Home Facts, 2009). In addition to water pollution, ten different corporations and companies were found to have released hundreds of pounds of chemicals in the water and air. For example, Masterbrand Cabinets Incorporated released 50,342 pounds of chemicals in 2008. This is a decrease since the business released 89,511 pounds of chemicals in 2005 (Auburn Polluters Home Facts, 2009). Forty nine leaking storage tanks were also found all over the Auburn area (Auburn Leaking Underground Storage Tanks Home Facts, 2009).Tobacco is one of the leading causes of breast cancer (State of the Evidence, 2006). In Alabama adult residents, 22.1% reported as regular tobacco smokers. Of the 22.1%, 25.2% are male, 19.3% are females and 12% are expecting mothers. Of the 22.1% of the reported high school smokers, 16.8% are girls and 27.1% are boys. The 2009 Auburn City School’s Pride Student Survey showed that 10% of tenth graders and one out of seven twelfth graders reported using smokeless tobacco (Tobacco Prevention and Control, 2009).The City of Auburn Community profile notes the total population of the city of Auburn is 56,088, and the population of Auburn-Opelika area is 129,001 (Economic Development Department, 2009). It is important to include the population of the Opelika area because the major hospital near Auburn is East Alabama Medical Center, which is in fact, in Opelika. The population density of Auburn is 1433 people per square mile. (City-, 2010) There are 4 main types of families, all with subcategories in the city of Auburn; family households family households with the male being the householder and no wife present; family households with the female being the householder and no husband present, and non-family households. The family households include households with their own children under age 18, married couple families, and married couple families with their own children under age 18. There are also single householder families (both male and female). There is almost double the amount of single female householders as single male householders, and most of the single householders have children. These types of families are likely to have women that are either married or have children that might be “too busy” to perform their self-breast exam, or feel they need to spend the money elsewhere (U.S. Census Bureau, 2008).The majority of the population in Auburn is 20-24 years old. The amount of people in this age group is more than double the amount of any other group. The people of Auburn are distributed into the age groups as follows: under 5 (2,275), 5 to 9 years (2,461), 10 to 14 years (2,214), 15 to 19 years (7,214), 20 to 24 years (14,656), 25 to 34 years (6,577), 35 to 44 years (4,900), 45 to 54 years (4,878), 55 to 59 years (1,517), 60 to 64 years (1,535), and 65 and older (3,978). The gender distribution is basically even, but there are slightly more females than males: females encompass 50.1 percent of the population, and males make up 49.9 percent (U.S. Census Bureau, 2008). The ratio between males and females isn’t as important as the actual number of females in the Auburn area: 28, 126. It is significant to develop ways to educate this population since there are tens of thousands. The race distribution is an imperative statistical component to this community assessment because African American women have the highest death rate of any race group in the United States. The African American population makes up the second highest percentage of the population: White, non-Hispanic (77.2%), African American (16.8%), Hispanic (1.5%), Asian (1.4%), two or more races (1.1%), Asian Indian (0.8%), American Indian (0.6%), American Indian (0.6%) (City-, 2010). The vast majority of the Auburn population pulls an income of less than $10k. The mean income for the city of Auburn in 2008 was $34,602, which is less than the Alabama state median of $42,131 (City-, 2010). This could be a factor in fear of the costly of medical bills associated with doctor visits, which become necessary for early detection of breast cancer after age 40 (or before with family history) (ACS, 2009). The major occupations in Auburn (starting with the highest percentage) include education, accommodation and food services, health care, construction, technical and scientific services, public administration, and finance/insurance. The estimated level of unemployment in the Auburn-Opelika area is 6.6% (U.S. Bureau of Labor Statistics, 2010). 38.1% lives below the poverty line, which is a great deal higher than the 16.1% in the state of Alabama (City-, 2010).The majority of the population’s occupation is tied up in education, which is important to know in order to educate the population on the prevention of breast cancer. The education distribution in Auburn is as follows: <9th grade (2.7%), 9th-12th grade, no diploma (6.1%), high school diploma (12.8%), high school graduate and higher (91.2%). There are separate statistics for those with college education: some college, no degree (17.6%), Associate degree (4.8%), Bachelor’s degree (26.7%), Bachelor’s degree or higher (56%), graduate or professional degree (29.3%) (Economic Development Department, 2009). A higher level of education might indicate a better absorption/learning rate and perhaps a better understanding of any prevention methods. There are churches on almost every street of Auburn, indicating an importance of religion in the area. Churches might be a good place for prevention presentations or places to leave informational flyers or pamphlets. There are many religions practiced in churches around Auburn, but the main congregations include Southern Baptist (33.0%), United Methodist (22.7%), Catholic (2.1%), Assembly of God (8.2%), Church of Christ (8.2%), Episcopal (2.1), USA Presbyterian (2.1%), Presbyterian (2.0%), Church of Latter Day Saints (1.0%), other (18.6%) (City-, 2010).There were 18,003 marriages in Alabama from January-June 2009, and 10,078 divorces from January-June 2009. There were 30,368 live births in Alabama from January-June 2009, and 23,786 deaths in the same period (Center for Disease Control, 2010).According to the Centers for Disease Control and Prevention, cancer is the second highest cause of death in the United States (Center for Disease Control and Prevention, 2009). Aside from skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women. More than one in four cancers are breast cancer (Breast Cancer Statistics, 2010). Contrary to popular belief, breast cancer does not only occur among women but also is diagnosed in men. Less than 1% of all new breast cancer cases occur in men (Breast Cancer Statistics, 2010). In 2006, the most current statistic year available to date, 191,410 women were diagnosed with breast cancer, and 40,820 women died from breast cancer in the U.S. (Breast Cancer Statistics, 2010). Not only is it prevalent among U.S. women as a whole, but also breast cancer has the highest incidence rate of any other cancer in Alabamian women (Center for Disease Control and Prevention, 2010). In 2006, 118.5 per every 100,000 women were diagnosed with breast cancer (Center for Disease Control and Prevention). This incidence rate more than doubled any other cancer diagnosis rate among women in Alabama. While breast cancer in Alabama does have the highest incidence rate, it only has the second highest mortality rate (Center for Disease Control and Prevention, 2010). In 2006, the death rate in Alabama was 23.5 per every 100,000 women. This rate was higher than the death rate of the U.S. in the same year (Center for Disease Control and Prevention, 2010). To bring it even closer to home, 128 cases of breast cancer were diagnosed at East Alabama Medical Center in the past year (C. Alsobrook, personal communication, March 22, 2010). Within Lee County alone, the incidence rate from 2002-2006 was 104.5 per every 100,000 women and the average annual count was 54 (National Cancer Institute, 2009). While breast cancer is among one of the top diagnosed cancers among women in the United States, the incidence and prevalence rates have decreased from 1999-2006 (National Cancer Institute, 2009). The incidence rate has decreased by 2.2% and the prevalence rate has decreased by 1.9% (National Cancer Institute, 2009). Both of these rates were significant and “beyond chance” according to the National Cancer Institute and with the teaching of self breast exams, hopefully we will see these rates continue to decrease (National Cancer Institute, 2009). The Alabama state government is currently facing budget cuts that directly affect the population of women needing early detection for breast cancer that may not be able to afford it on their own. The Alabama Breast and Cervical Cancer Early Detection Program (BCCEDP) was created to help low- income, uninsured and underserved women receive access to screening programs that may be life saving. Funding for 2010 BCCEDP was stripped from the Governor’s proposed budget. Without state funding, the program will suffer and dramatically reduce the number of women that can be served. The program has reduced the number of women who can enroll to focus on highest risk women (age 50-64). This will mean 36% of women will not be diagnosed that previously would be. Since October 1996, more than 61,119 women have been served by this program detecting 1,048 cases of breast cancer. There are 84,404 eligible women in Alabama between ages 40-64 that meet BCCEDP requirements. Women’s cancer advocates, such as the Cancer Center at East Alabama Medical Center, are currently lobbying the state government to make sure these important cancer services remain intact to protect the health of those most in need (C. Alsobrook, personal communication, March 26, 2010). East Alabama Medical Center’s Cancer Center has a free cancer library available to the public. It is called Cindi’s Library and offers books, brochures, web site links directly related to cancer options, and support services. Cindi’s Library provides a central location to easily find information and a comfortable atmosphere. The library is funded by charitable donations through the EAMC Foundation and run by volunteers (Cindi’s Library, 2007). There are many shops in Auburn where women affected by breast cancer can purchase bras. East Alabama Medical Center offers a selection of special bras for women that have undergone mastectomies (East Alabama Medical Center, 2010). Also, women can shop at other stores such as Victoria’s Secret, which is located in the Village Mall. Victoria’s Secret offers a broad range of sizes and many different styles. They also offer individualized services to their customers by measuring them to ensure a quality fit, which is important to women who have undergone a mastectomy. Other stores in the Village Mall that women can shop at include Dillard’s and Belk. There are many pharmacies in the Auburn area. Some of these pharmacies include: CVS, Winn-Dixie, Wal-Mart, The Drug Store, Walgreens, and Sam’s club. Auburn University offers a pharmacy for its employees, dependents, and retirees, which is located at 2155 Walker Building on the Auburn University Campus. Some perks of the Auburn pharmacy are that most insurance plans are accepted, there is an emphasis on personalized service, and a pharmacist is available 24 hours a day for emergencies. The Auburn University Pharmaceutical Care Center (AUPCC) is staffed by Faculty, Staff, Residents and fourth year Pharm.D. students (Auburn University, 2010).East Alabama Medical Center is the hospital that services Lee County. It is located in Opelika on Opelika Road near Highway 280. It offers an extremely wide variety of services including ambulance services, cancer services, cardiology services, childbirth services, critical care services, surgery services, imaging services, psychiatric services, emergency services, and many more (East Alabama Medical Center [EAMC], 2010). In fact most of the medical facilities and services in Lee County are a part of EAMC. EAMC is accessible to anyone in the general public and anyone is eligible to utilize its services (EAMC, 2010). One of the services offered by EAMC that is most pertinent to breast cancer is the Cancer Center of East Alabama. The staff of this facility includes surgeons, physicians, medical oncologists, a radiation oncologist, oncology-certified nurses, dieticians, and social workers (EAMC, 2010). The staff also includes a full-time breast health nurse who devotes all of her time to guiding, educating, and supporting women through breast cancer screening, diagnosis, and treatment (EAMC, 2010). The specific breast health services offered by the cancer center include digital mammography, breast MRI, breast-specific gamma imaging, PET scan, biopsy using breast MRI, stereotactic breast biopsy, ultrasound-guided biopsy, and sentinel node biopsy (EAMC, 2010). The East Alabama Medical Center Foundation has a Free Mammogram Program that is available to women with limited or no health care insurance coverage (EAMC, 2010).EAMC offers radiology services which include x-rays, CT scans, ultrasounds, digital mammography, PET scans, and MRI which can all help in the diagnosis of breast cancer (EAMC, 2010). Auburn Diagnostic Imaging also offers all of these radiology services in an outpatient setting (EAMC, 2010). These services are very useful for women as the next step after finding a lump during self-breast examination. Some of the rehabilitation facilities in Lee County include inpatient rehabilitation at EAMC and RehabWorks which are also a part of EAMC (EAMC, 2010). The inpatient rehabilitation services at EAMC offer physical therapy for oncology patients and also offer treatment for acute and chronic pain (EAMC, 2010). RehabWorks is an outpatient rehabilitation service that also offers help for oncology patients (EAMC, 2010). EAMC also has a skilled nursing facility that offers numerous rehabilitation and restoration services (EAMC, 2010). In order to qualify for admission to the facility, a patient must have been in a hospital for 72 hours within the past 30 days and also require skilled daily services of a licensed nurse or therapist (EAMC, 2010). The patients must be referred by one of the physicians on EAMC’s list of credentialed physicians (EAMC, 2010). EAMC also has most of the hospice and home health facilities in Lee County. Some of these include Hospice of EAMC, Bethany House, and HomeMed (EAMC, 2010). Bethany House is part of Hospice of EAMC, and it offers short term care during medical crises and respite care (EAMC, 2010). Hospice of EAMC also offers bereavement services for adults and children to help them get through the grieving process after losing a loved one (EAMC, 2010). HomeMed offers people many medical products and services (EAMC, 2010). For women who are post-mastectomy, it offers post-mastectomy prostheses and mastectomy bras (EAMC, 2010). Lee County also has numerous long-term care facilities. Some of these are Azalea Place, Camellia Place, Magnolia Place, Oak Park, and also some assisted living communities (EAMC, 2010). Azalea Place offers assisted and retirement living (EAMC, 2010). Camellia Place and Magnolia Place both offer specialty care assisted and retirement living (EAMC, 2010). Oak Park offers nursing home and independent living (EAMC, 2010). The Alabama Department of Public Health has a program called The Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP) (Alabama Department of Public Health [ADPH], 2010). This program offers free breast screenings to women ages 40-64 who have a family income less than or equal to 200 percent of federal poverty guidelines and who have limited or no health insurance coverage (ADPH, 2010). The program will also pay for some follow-up diagnostic care including ultrasound, biopsy, and colposcopy (ADPH, 2010). The program will refer women who are diagnosed with breast cancer to Medicaid for its treatment (ADPH, 2010). The Lee County Department of Public Health is located on Corporate Drive in Opelika (ADPH, 2010). The Alabama Department of Human Resources offers a number of services including adult care services, childcare services, family services and family assistance (Alabama Department of Human Resources [ADHR], 2010). The Lee County Department of Human Resources is located on Corporate Drive in Opelika and offers family and child services, child support information, and food assistance information (ADHR, 2010). The social security office that services Lee County is located on Corporate Drive in Opelika across the street from the Lee County Health Department (Social Security of America [SSA], 2010). In order to be eligible for social security benefits, you must be an employee or self-employed worker who is age 62 or older, and you must have earned the required social security credits during your working years (SSA, 2010). There are many voluntary health-related organizations through the United States, in and around Lee County, dedicated to helping the community learn about the importance of self-breast exams and providing information and support for those diagnosed with breast cancer. First of all, the American Cancer Society is a nation-wide organization dedicated to curing and preventing cancer by providing education, information, support, research, and funding to victims, family, and health care professionals. Community based outreach is very important to the Cancer Society; locally, the closest chapter of the Cancer Society serving Lee County is located in Montgomery, Alabama at 3054 McGehee Road. To get involved or to obtain information regarding breast cancer you can contact the Montgomery office at 334-288-5926, or visit their website at <> (ACS, 2010).Though the American Red Cross does not directly help those diagnosed with breast cancer or provide information regarding breast self-exams, it does provide many services in support of those patients in need of help and education, even blood transfusions. They oversee all disaster relief, military relief efforts (especially providing services for military families), obtaining and processing blood products for transfusion purposes, and providing education programs about health and safety. The local Lee County chapter is located at 206 26th St. in Opelika, AL (American Red Cross, 2010).Being diagnosed with any type of cancer, even breast cancer, can be a traumatic time for any person. If thoughts or signs of depression are becoming apparent, it is important to recognize and try to fix them. In Lee County, organizations such as the Crisis Center of East Alabama serve as advocates for suicide prevention, providing a listening ear and caring words to those suffering from suicidal thoughts. The Crisis Center’s phone number is 334-821-8600; the volunteers available are eager to help and are available 24 hours a day, seven days a week (Crisis Center, 2010). Catholic Charities USA is a Christian, nationwide organization made of a network of local agencies focused on providing care for those in need by aiming to reduce poverty, supporting families, and empowering communities. This agency could be helpful for one diagnosed with breast cancer, providing support and assistance for the patient and family. Though there is no Catholic Charity agency in Lee County, there is an office in Birmingham, Alabama. The agency may be contacted through local Catholic churches in Lee County or at 205-776-7125 (Catholic Charities USA).The Lee-Russell Aging Foundation, part of the Lee-Russell council of governments, runs the four local senior centers in the area. These centers provide social activities, nutrition and health counseling, hot meals, information and referrals if need be. This is a great organization, and for those who have felt a suspicious lump while performing a self-breast exam can use this agency to receive a referral for evaluation. For more information about this organization call (334) 749-5264 (Lee-Russell Council of Governments, 2010). Though there is no Healthy Communities Access Program in Lee County, the Montgomery Area Community Wellness Coalition, located in Montgomery, Alabama, is a community-based, non-profit organization that provides the uninsured patient with health care advice and referrals when needed. It was created to enhance chronic disease prevention by attempting to reduce economic and health problems associated with common diagnoses such as diabetes, hypertension, COPD for the uninsured. More information can be found at or dial 2-1-1 to find out if one qualifies for Wellness Coalition services (The Volunteer and Information Center, 2010).ReferencesAlabama Department of Archives and History (2009). Lee County, Alabama history. Retrieved from Department of Human Resources. (2010). Retrieved from Department of Public Health. (2010). Retrieved from Cancer Society (2009). How to perform a breast self-exam. Retrieved from Cancer Society (2009). Cancer prevention and early detection facts and figures. Retrieved from Cancer Society. (2009). Learn about breast cancer. Retrieved from Cancer Society (2009). In My Community. Retrieved from Polluters (2005). Retrieved from Home Facts: environmentalhazards/ alabama/ lee-county/ auburn.htmlAmerican Red Cross of Lee County (2009). About Us. Retrieved from University (2010). Pharmaceutical care center pharmacy. Retrieved from Water Works (2005). Retrieved from Home Facts: alabama/ lee-county/ auburn/ auburn-water-works.htmlBreast Cancer Statistics. (2010). Retrieved from Charities USA (2010). About Us. Retrieved from for Disease Control (2010). Births, Marriages, Divorces, and Deaths. National vital statistics report, 58(3). Retrieved from for Disease Control and Prevention (2010). Breast Cancer Statistics. Retrieved from for Disease Control and Prevention (2009). Deaths and Mortality. Retrieved from for Disease Control and Prevention (2010). United States Cancer Statistics. Retrieved from ’s Library. (2007). Retrieved from (2010). Auburn, Alabama. Retrieved from (2010). Auburn, Alabama (AL) income, earnings, and wages data. Retrieved from Center of East Alabama (2010). Retrieved from Alabama Medical Center. (2010). Retrieved from Alabama Medical Center (2010). Home Meds. Retrieved from Development Department (2009). City of Auburn community profile. Retrieved from , D. (2002). Early Detection of Breast Cancer by Self-Examination: The Influence of Perceived Barriers and Health Conception. Oncology Nursing Forum, 29(9), 1341-1347. Retrieved from Academic Search Premier database.Lee County, Alabama (2005). Lee County – about us. Retrieved from Council of Government Area Agency on Aging (2010). Retrieved from , C., Xia, H., Isaman, D., Deng, W., & Oakley, D. (2010). Nursing clinical trial of breast self-examination education in China. International Nursing Review, 57(1), 128-134. doi:10.1111/j.1466-7657.2009.00756.xMayo Clinic. (2009). Breast exam: definition, why it’s done, risks, how you prepare, what you can expect, and results. Retrieved from Cancer Institute (2009). Incidence and Mortality. Retrieved from Cancer Institute (2009). State Cancer Profiles. Retrieved from , R. A., Cokkinides, V., von Eschenbach, A. C., Levin, B., Cohen, C., Runowicz, C. D., . . . Eyre, H. J. (2002). American Cancer Society guidelines for the early detection of cancer. A Cancer Journal for Clinicians, 52, 8-22. doi: 10.3322/canjclin.52.1.8Social Security of America. (2010). Retrieved from of the Evidence (2006). Retrieved from G. Komen for the Cure (2010). Breast self-exam. Retrieved from Prevention Center (2009). Retrieved from Alabama Department of Public Health: tobacco/ default.asp?id=778U.S. Census Bureau (2008). ACS Demographic and Housing Estimates. Retrieved from . Census Bureau (2002). Census 2000 urban and rural classification. Retrieved from . Census Bureau (2008). Selected Social Characteristics in the United States. Retrieved from . Bureau of Labor Statistics (2010). Economy at a glance: Auburn-Opelika, AL. Retrieved from Volunteer and Information Center (2010). Montgomery Area Community Wellness Coalition. Retrieved from ................
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