Abstract
Breast cancer is one of the most common cancers amongst women, with the expectation of 1 in 8 women being diagnosed with it (Public Health Agency of Canada, 2019). Genetic makeup is something that influences the prevalence of breast cancer, however there is significant evidence that proves that many other factors such as environment, lifestyle choices, etc. play a huge role in the risks of encountering breast cancer. Although, it is a very complex disease, understanding breast cancer from a social ecological view point may help better prevent and create programs to better support those with the diagnosis.
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Being an Ultrasound technologist, breast cancer is something we deal with on a daily basis. Hospitals will often have departments dedicated to breast imaging due to the dominance of breast cancer, with ultrasound and mammography being integral to the care provided in these areas. “Breast cancer accounts for approximately 25% of new cases of cancer and 13% of all cancer deaths in Canadian women” (Public Health Agency of Canada, 2019). Breast cancer is a life changing disease and it is important to understand the many factors that may influence this diagnosis. Although the prevalence of breast cancer can be associated with genetic makeup, there are many other influencing factors. Urie Brofenbrenner, has created the social ecological model to help understand the relationship between an individual and their social environment with regards to their health (Kilanowski, 2017). These levels of influence are broken down into 5 levels: individual, interpersonal, organizational, community and public policy (Fig. 1).
Fig. 1: Socio-Ecological Model demonstrating the hierarchy of multiple levels of influences
“When investigating the origins of breast cancer or other complex diseases, it is essential to consider the social, cultural, economic, and political environments within which cells, tissues, individuals, and families live” (Schettler, 2013). A social ecological model helps us to understand how these other factors alongside the social determinants of health (gender, genetics, social status/income, etc.) influence the health of individuals and what programs we can create to prevent and better treat these diseases.
Environmental factors play a large role in the potential risk for breast cancer. Breast cancer is known to be more prevalent in industrialized countries (Fig. 2), where chemicals and toxins are found in abundance. Estrogen is a hormone that is known to be linked to breast cancer. “Numerous synthetic chemicals, called “xenoestrogens,” act like estrogen in our bodies, including common weed killers and pesticides, plastic additives or by-products, ingredients in spray paints and paint removers, and polyvinyl chloride (PVC), used extensively in the manufacture of food packaging, medical products, appliances, cars, toys, credit cards, and rainwear” (C., 2014). From the cosmetics we use to the food we consume regularly, there are many daily exposures that influence our risk of developing breast cancer. Social determinants such as income, social status and employment/working conditions also contribute to the environmental toxins we are exposed to on a daily basis. With the western world being highly exposed to toxins, it isn’t something we can just choose to cut out of our daily lives, a regulatory needs to be made.
Fig. 2: Demonstrates the countries with the highest rates of breast cancer (Penguin Atlas of Women in the World, 2009)
Diet is another factor that influences the risk of breast cancer as early as in utero. The way we eat is influenced by our culture, environment, friends and family, and lastly our lifestyle. “Diets featuring higher amounts of fruits and vegetables, particularly those that are darkly colored, traditional soy products, whole grains and less refined carbohydrates, low-fat dairy, with poultry and fish and less red meat are associated with lower breast cancer risk” (Schettler, 2013). Breast cancer is more prevalent in western countries as they consume more meat and fattier diets. Immigration patterns show that the first generation of immigrants tend to have lower risks of breast cancer after spending most of their lives in countries associated with low risks of breast cancers versus their offspring, who were born and raised in a country with higher risk of breast cancer. “Migrants who had lived in the West for a decade or longer had a risk 80% higher than more recent migrants” (Ziegler, et al., 1993). It is evident that the change in diet and environment that comes with migration to a western country contributes to the increase risk of breast cancer.
At a more “interpersonal level”, behaviours such as smoking, alcohol consumption, physical activity and obesity influence the risks of breast cancer. The way we choose to live our daily lives can impact our risks to diseases down the road. Although we may feel as we are making our own choices, we are only limited to choices available to us depending on our family/friends, culture and environment, all impacting our health. Breast cancer is a complex disease with many contributing factors impacting its cause, by understanding the multiple influences we can improve our diagnosis and prevention of breast cancer.
Considering all the risk factors evaluated above, the Canadian government has enforced the Organized Breast Cancer Screening Program(OBSP) in order to help with the diagnosis and treatment of breast cancer among many provinces and territories in Canada. This program is made to screen all women over a certain age, with or without symptoms. As seen in the Table below (Table 1), the OBSP program is universal across Canada, except in Nunavut. Their decision to not adopt the screening program leaves them vulnerable to an increased risk of breast cancer (Breast Cancer Screening in Canada, 2018).
Table 1: Demonstrates the practicing provinces and territories of the OBSP (Breast Cancer Screening in Canada, 2018)
The OBSP has also implemented different outreach techniques to help ensure all Canadian women are participating in the program, making the program more accessible and therefore more effective. With the breast screening program being so readily available to women, it has significantly improved diagnosis and treatment and decreased the mortality rate due to breast cancer in Canada since 1988. Between 1990 and 2012, there has been a decline of 42% in Ontario’s mortality rate due to breast cancer in women (OBSP, 2020).
The prevention and improved prognosis of breast cancer after initial diagnosis has long been a goal in healthcare. However, it is critical to understand the many contributing factors of breast cancer outside of genetics. The complexity of breast cancer can be better explained by following a social ecological model and understanding the disease on a larger scale. This understanding will lead to a better prevention and prognosis. Although the Canadian government may not be able to address all the influencing factors of breast cancer, the organized breast screening program is definitely headed in the right direction.
References:
Breast Cancer Screening in Canada. (n.d.). Retrieved from https://www.cancerview.ca/wp-content/uploads/2019/03/Breast-Cancer-Screening-Environmental-Scan_EN_2018_final.pdf
C., C. (n.d.). Breast Cancer and Environment. Retrieved from https://bcaction.org/our-take-on-breast-cancer/environment/
Kilanowski, J. F. (2017). Breadth of the socio-ecological model. Journal of Agromedicine. doi: 10.1080/1059924x.2017.1358971
Mg. (1970, January 1). World Breast Cancer Rates Map from Ball State University Libraries. Retrieved from http://bsumaps.blogspot.com/2017/10/world-breast-cancer-rates-map-from-ball.html
Ontario Breast Screening Program (OBSP). (2020, February 21). Retrieved from https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-breast-obsp
Public Health Agency of Canada. (2019, December 9). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/chronic-diseases/cancer/breast-cancer.html
Schettler, T. (2013). The ecology of breast cancer: the promise of prevention and the hope for healing. Place of publication not identified: Ted Schettler.
Ziegler, R. G., Hoover, R. N., Pike, M. C., Hildesheim, A., Nomura, A. M. Y., West, D. W., … Hyer, M. B. (1993). Migration Patterns and Breast Cancer Risk in Asian-American Women. JNCI Journal of the National Cancer Institute, 85(22), 1819–1827. doi: 10.1093/jnci/85.22.1819
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