Healthsci 1001 final

Team Shan

advocating for breast cancer awareness

• launched 2007, completed 2008

• sunflower symbol

• warns about almond shaped lumps

• campaign theme: young women get breast cancer too

• purpose: to educate the public, health care professionals and young women about early detection, risk reduction and prevention of breast cancer

Team Shan aim and goals

• aim: to reach young women with their breast cancer risk and breast health information 

• goals: to increase early detection of breast cancer in young women  

  to improve outcomes for young women diagnosed with breast cancer 

AYA (adolescent young adult) Cancer Statistics

• globally 1.2 million AYA (15-39 years) are diagnosed each year;  

• 170,000 young women diagnosed with breast cancer;  

• 43,000 deaths due to breast cancer;  

•  9,000 AYA diagnosed yearly in Canada 

Breast cancer

• highest incidence of cancer in young women is attributed to breast cancer;  

•  highest number of cancer deaths and disability adjusted life years (DALYs) attributed to breast cancer;  

• 1,300 young women diagnosed with breast cancer each year in Canada. 

Age disparities

Younger women:

• later stage diagnosis

• hormonal levels cause more aggressive cancer

• higher risk of inflammatory breast cancer

• more frequent recurrence rates

• poorer prognosis

Mammography for younger women

no regular screening opportunities for younger women, mammography screening starts at age 40

• mammography does not work for young women because breast tissue is too dense

BCYW (breast cancer in young women) emerging issue

This “increasing trend in the prevalence of breast cancer in young women, associated with poorer prognosis, more aggressive histologic features, and more frequent recurrence, makes it a rising threat to young women.” (Fernandez et al, 2023) 

Barriers

• contextual barriers e.g., ethnicity; developmental barriers e.g., lack of awareness;  

• emotional barriers e.g., lack of confidence;  

• practical barriers e.g., too busy, and service barriers e.g., no doctor. 

Lorna Larson

• Shan’s mom

• nurse

• advocate for young women

OPHS (Ontario public health services) Foundation

principles:

• need

• impact

• capacity

• partnership and collaboration

Need:

if the incidence of cancer is very low in the general population or in a demographic group (young women with breast cancer) they are often misdiagnosed or ignored (CCS - Canadian Cancer Society)

Reports of cancer in young women

• cancer is the main cause of early death among young adult women

• almost 2/3s of young adult cancers occur in young women (breast cancer most common)

• not much data to support a causation for this

• most cancer in this age group appears to be sporadic and random

• little is known about the risk factors for leading cancers in AYAs

symptoms of cancer

lumps in neck, breast, abdomen, testicle, abnormal pigmented skin lesions

types of AYA cancer

• thyroid

• testicular

• skin cancer

• colon

• kidney

• bones

• oral cavity

_____ young people are diagnosed with cancer per year in Canada, ___% of total cancers ages ____

8600, 10%, ages 15-69 (statistically this represents 30% of potential years of life

Delays in diagnosis

• delays attributed to either patients or physicians inaction

• physicians reluctance to make a diagnosis - assumed age was a protective factor

• reduce delays by seeking prompt medical care

• awareness and suspicion of cancer in AYAs is low

over _____ young women diagnosed with breast cancer in Canada each year, about ____ young women diagnosed with breast cancer in Ontario, incidence of cancer in this age group increase steadily during the past ____ _______

• over 1,200 young women diagnosed with breast cancer in Canada each year  

•  about 400 young women diagnosed with breast cancer in Ontario every year  

•  incidence of cancer in this age group increased steadily during the past quarter century (SEER, 2007)  

prognosis today vs 25 years ago

survival improvements tends a worse prognosis for young adults diagnosed with cancer today than 25 years ago

1 out of ___ women in Canada will face breast cancer in her lifetime, used to be 1 out of ___, and 1 in ___ will die from it

8, 9, 34

Team Shan awareness campaigns

media & marketing strategies, print material distribution, presentations at schools and sporting events

does breast cancer always start as a lump?

no, can be inflammatory, starts as redness and swelling

lumps

• over 80% express with breast lumps

• most lumps are not cancer, can have lumpy breasts all the time, before period, or when breast feeding

• of lump is persistent and unexpected, need to be checked

uncontrollable risks for breast cancer

• Being female 

• Increased age 

• Born in north America or northern Europe 

• Strong family history 

• African heritage 

• Early start to menstruation 

Controllable risks

• Poor diet 

• Unhealthy weight 

• Physical inactivity 

• Tobacco use/second hand smoke 

• Alcohol misuse 

• Use of contraceptives 

• Delayed childbirth/not breastfeeding 

prevention for breast cancer

• Pap tests  

•  HPV (Human Papillomavirus) vaccine  

•  Team Shan website including ‘Skin Deep’ site and other website links  

•  Risk reduction  

•  early detection 

• See ads on print, radio, and TV 

• Skin deep tool – sees if products contain carcinogens 

common signs of cancer in AYA

Signs are unexplained and persistent

• Pain 

• Lump, bumps, swelling 

• Significant weight loss 

• Extreme tiredness 

• Changes in a mole 

breast cancer symptoms

• Breast lumps, most common 

• Breast thickening 

• Dimpling or puckering of breast 

• Breast changes, size shape skin 

• Breast swelling, redness, warmth or pain 

• Nipple changes, ex inverts 

• Nipple discharge/leaking 

• Symptoms that may appear from spread of cancer, ex bone pain, neurological symptoms 

Team Shan marketing

• bus/LRT displays - most successful

• transit shelter posters

• billboard posters

• media: print, radio, RV

• social media: Shanimations, instagram, flashmob video Taylor Swift parody

• #besttocheck marketing campaign

marketing statistics

• 92% of respondents noticed the Team Shan advertisements  

• media/marketing most effective and public transit ads most commonly observed 

• breast cancer knowledge levels increased 

• campaign feedback was very positive and young women appreciated not being left out of breast cancer messaging  

• young women recommended ‘more’ education and awareness for young women 

Conclusions

• responses from over 700 women from campuses

• most common take home message was fact that breast cancer affects young women too

Palliative care

• AYA palliative care issues are like a taboo, we are not supposed to die

• AYAs underserviced for palliative care

greatest avoidable risk factor for cancer

tobacco use

• linked with acute myelogenous lukemia

• pancreatic cancer

• bladder cancer

• kidney cancer

neoplasm

same as a tumor

• mass of tissue that serves no physiological purpose

• can be benign like a wart

• or malignant like most lung cancers

in 2021, cancer predicted to claim lives of _____ Canadians

84 600

primary tumor

original location of cancer

staging

classifying progress or extent of cancer in a patient

• spread of cancer described in 5 stages

• stage 5 describes Wilms tumor, cancer spread to both kidneys

tobacco use is responsible for approx. ___% of cancer deaths worldwide, cancer responsible for 1 out of every ___ deaths in Canada

33%, 1 in 4

top 3 cancers in males

lung, colorectal, prostate

top 3 cancers in females

lung, colorectal, breast

how many Canadians are diagnosed with cancer each week

4396

metastasis

the spread of cancer cells from one part of the body to another, occurs because cancer cells do not stick to each other as strongly as normal cells

lung cancer accounts for around ______% of all new cancer diagnoses

13-14%

polyps

cancer of colon and rectum may arise from polyps, masses that can grow into malignancies

• polyps tendency to form determined by inherited gene mutations

___% of men and ___% of women will develop cancer at some point

44% of men and 43% of women

leading cause of cancer death among men and women

lung cancer

women with immediate family member with cancer

women with an immediate family member, like a mother or sister with breast cancer, have twice the chance of developing it (smoking and genital herpes infection also contribute), if both mother and sister have breast cancer, 3 times as likely

where is the prostate gland located

base of bladder

main cause of cervical cancer

HPV

factors for skin cancer

• family history

• exposure to coal, tar, and arsenic

• exposure to radioactive materials

• UV

types of skin cancer

basal cell carcinoma and squamous cell carcinoma

basal cell carcinoma

found in chronically sun exposed areas (face, neck, hands, arms), appears as pale, waxlike, pearly nodules

Squamous cell carcinoma

found in chronically sun exposed areas (face, neck, hands, arms), appears as red, scaly, sharply outlined patches, often painless although may bleed, crust and form open sore on the skin

lighter skinned people ___x more likely to develop melanoma, there are ________ cases of skin cancer detected each year

10x, 80 000

risk factors associated with testicular cancer

genetics, undescended testicles, taking diethylstilbestrol during pregnancy

• 1.1% of cancer in males is testicular

pancreas

pancreas is a gland behind the stomach that produces digestive enzymes and hormones that regulate blood sugar

• 20-30% of pancreatic cancer cases linked to smoking

stomach cancer

risk factor: helicobacter pylori bacterium converts nitrites in preserved foods into carcinogenic amines, and salt can break down the normal protective stomach coating allowing carcinogens to access stomach wall

• healthy diet decreases risk, no screening test for stomach cancer, only detected after it has spread

proteins function

build cells and make them work, regulators of all chemical reactions, serve as structural material for body 

carcinogen

environmental agent that causes cancer is known as a carcinogen

mutagen

Any environmental factor that can cause mutation, such as radiation, is called a mutagen 

• it usually takes several mutations in a gene for it to start producing cancer cells

oncogenes

convert healthy cells into cancer cells

diet high in fat and meat linked to…

prostate, stomach, and colon cancer

how many cancers could be prevented through behavior changes, including regular PA

4 in 10

microbes linked to cancer

• types of HPV cause cervical cancer

• helicobacter pylori bacterium linked to stomach cancer

• epstein barr virus contributes to Hodgkins disease (pharynx cancer) and stomach cancers

• human herpes 8 virus linked to Kaposi’s sarcoma and Lymphomas

• hep B and C together cause almost 80% of world’s liver cancers

diets high in omega-6-polyunsaturated fats are associated with…

a higher risk of cancers than diets high in omega-3-polyunsaturated fats

overweight or obese increases risks for…

breast and colon cancers

chronic heart burn is…

not a major warning sign of cancer

major warning signs for cancer

• sore that does not heal

• indigestion

• difficulty swallowing

• changes in bladder habits

• nagging cough and hoarseness

• lumps

• blood in urine or stool

complementary therapies for cancer

• prayer

• music therapy

• yoga

• massage

what cancers have early screening tests

• breast cancer

• colorectal cancer

• cervical cancer

most useful cancer treatment

surgery

how does chemotherapy work

works by interfering with DNA synthesis and replication

types of screenings

• MRI = detects hidden tumors by mapping on computer

• biopsy = confirms type of tumor

• CT scans = examine tumors of the brain and other parts of body usin x-rays

angiogenesis

production of new blood vessels, can be stimulated by signals from cancer cells, is implicated in the growth and spread of cancer

ultrasonography

a less expensive method to view tumors

complimentary therapies interference

may interfere with conventional therapies by

• delaying use of proven therapies

• patients may not inform their physician they are using complimentary treatments

stem cell transplants

restore blood forming cells in people who lost their own cells by radiation or chemo

how many Canadians expected to survive cancer over next year

over 1.5 million

addictive behavior

• Defined as: Habits that have gotten out of control, with a resulting negative impact on a person's health 

• Chronic disease 

5 characteristics associated with addictive behavior

1. reinforcement

2. compulsion or craving

3. loss of control

4. escalation

5. negative consequences

reinforcement

can be reinforced positively or negatively, may provide pleasure or causes stress (anxiety, depression) when they disengage from the behavior

compulsion or craving

the need to engage in behavior

loss of control

cannot block the impulse to engage in behavior

escalation

more of substance is required to produce effects, increased tolerance

negative consequences

behaviour has serious consequences, academia, job performance, relationships 

development of addiction

• engaging in such behaviors does not lead to addiction

• behaviors start because they bring pleasure or relieve pain

• If it works and is continuously repeated it can cause dependency and tolerance develops --> behaviour becomes a central focus of the person’s life , tolerance develops due to physical changes in brain cells and reward pathways, making it so person needs more to feel the pleasure or relief 

• there is NO SINGLE CAUSE of addiction

risk factors for addiction

any reinforcement can lead to increase in the behavior (positive or negative)

a combo of factors could influence development of addiction:

• physical factors

• psychological factors

• social factors

symptoms of addiction

• Craving 

• Loss of control over behavior 

• Tolerance  

• Withdrawal 

• Repeating patterns of recovery and relapse 

social media addiction

• not recognized by the DM-5

substance use disorder in the DSM-5

recognizes substance abuse and substance dependence

• Mild substance use disorder = experiencing 2-3 symptoms   

• Moderate substance use disorder = experiencing 4-5 symptoms  

• Severe substance use disorder = experiencing 6+ symptoms

substance use disorder DSM-5 criteria

• impaired control

• social problems

• risky use

• drug effects

impaired control

1) Taking substance in larger amounts or over longer period than was originally intended  

2) persistent desire to cut down or regulate substance use, but being unable to do so  

3) Spending a great deal of time getting the substance, using the substance, or recovering from its effects  

4) Craving or experiencing an intense desire or urge to use the substance 

social problems (of addiction)

5) Failing to fulfill major obligations at work, school, or home  

6) Continuing to use the substance despite having persistent problems caused or worsened by the effects of its use  

7) Giving up or reducing important social, school, work, or recreational activities because of substance use 

risky use

8) Using the substance in situations in which it is physically hazardous to do so  

9) Continuing to use the substance despite the knowledge of having persistent or recurrent physical or psychological problems caused or worsened by substance use  

drug effects

10) Developing tolerance to the substance  

11) Experiencing withdrawal 

drugs

a chemical other than food that affects the structure or function of the body

psychoactive drugs

• Alter a person’s experiences or consciousness  

• Cause intoxication – a state in which sometimes unpredictable physical and emotional changes occur  

• Are most often associated with addiction 

high risk factors for using drugs

• Being male  

• Being a ‘troubled’ adolescent  

• Having frequent exposure to drugs through family members or peers  

• Being disinterested in school  

• Having a risk-taking/thrill seeking personality  

• Low SES- socioeconomic status 

drugs are less common among those who:

• Have positive self-esteem  

• Have strong personal identities  

• Get good grades  

• Are religious  

• Are independent thinkers 

how drugs affect the brain

• act on brain chemistry, affect neurotransmitters

• either increase or decrease NT concentration and actions

• ex. cocaine acts on dopamine by releasing it in the synapse and blocking the reuptake receptors, causing dopamine effect to intensify and increases the period of time the synapse signals to other neurons of this pleasant feeling

5 factors influencing drug effects

1. Pharmacological properties  

2. Dose-response function  

3. Time-action function  

4. Person’s drug use history  

5. Method of use , ingesting, injecting, inhaling etc.