Breast cancer is of a primary concern in women, although it can occur in men. It is the second leading cause of cancer related deaths amongst women, and it is estimated that roughly 39,840 women will die of this disease this year. Breast cancer occurs across all populations and ethnicities. When African-Americans (AA) present with breast cancer, they usually have poorly differentiated tumors, and are more likely to be diagnosed with an advanced stage tumor. When compared to Caucasian (Cau) women, African-American women also have higher breast cancer mortality. The causes of these differences are not yet definitively known, but it has been suggested that the disparities that are present between African-American and Caucasian women are due to a number of factors. A few which have been mentioned are differences in Body Mass Index (BMI), socioeconomic status, health care coverage, and the level of obtained education that exists between the two ethnic groups. Although these factors may account for a small percentage of the difference seen between the two ethnic groups, the underlying cause that may explain why African-American women are at a greater risk of developing aggressive breast cancer may be due to differences in gene expression. A focus of my research project is the comparison of genome-wide gene expression differences between African-American and Caucasian women. Preliminary results from the comparison of normal breast tissue (obtained from reduction mammoplasty) from Caucasian and African-American women suggest there are marked differences in gene expression patterns. Pathway analysis of differentially expressed genes shows that they are involved in protein folding and the immune response. I am currently expanding this study to include a comparison of 10 AA to 10 Cau normal breast samples. These samples are being LCM dissected to separately compare gene expression in epithelial and stromal tissue. Cross comparisons between ethnic groups and tissue types will provide an understanding of normally occurring differences between AA and Cau women, which may help to explain the observed cancer disparities. Data from the study of normal tissue will be compared to gene expression data from triple negative breast cancer (TNBC) patients from both ethnicities.

Bakgrund: I Sverige är tumörsjukdomar det, som efter sjukdomar i cirkulationsorganen, orsakar flest dödsfall. Det är sedan tidigare känt att människor som lever under sämre socioekonomiska förhållanden löper större risk att insjukna och avlida till följd av cancersjukdom. Likaså visar forskning att det finns skillnader i vårdkvaliteten inom cancervården till lägre utbildades nackdel. Men hur ser det ut gällande sjukdomsupptäckt, väntetider och behandlingsinsatser? Får alla cancerpatienter en jämlik vård och behandling oberoende av socioekonomisk status i Skandinavien?  Syfte: Att sammanställa befintlig litteratur om skillnader i sjukdomsupptäckt, väntetider och behandlingsinsatser för cancerpatienter med olika socioekonomisk status inom cancervården i Skandinavien.   Metod: Litteraturöversikt med 13 kvantitativa artiklar avseende skandinaviska förhållanden. Vid datainsamlingen användes databaserna PubMed och CINAHL. Katie Erikssons omvårdnadsteori om lidande användes som vårdvetenskaplig utgångspunkt, och deduktiv metod valdes för genomförande av resultatanalysen.     Resultat: Resultaten presenteras under tre huvudkategorier; socioekonomiska skillnader i sjukdomsupptäckt, väntetider och behandlingsinsatser, och visar tydliga skillnader. I Skandinavien upptäcks cancer bland individer med hög utbildning och/eller hög inkomst tidigare än bland individer med lägre socioekonomisk status. Individer med hög socioekonomisk status har även avsevärt lägre risk att befinna sig i ett avancerat sjukdomsstadie vid tiden för diagnos, och erhåller oftare, och mer avancerade behandlingsinsatser.   Slutsats: Den skandinaviska, skattefinansierade cancervården är inte jämlik. Alla patienter får inte lika vård och behandling oberoende av socioekonomisk status. Individer med hög utbildning och hög inkomst gynnas, cancer upptäcks i tidigare stadie och de erhåller mer behandlingsinsatser i jämförelse med individer med lägre socioekonomisk status som får stå tillbaka. / Background: After diseases of the circulatory organs, cancer causes most deaths in Sweden. Previous studies indicate an effect of socioeconomic factors on the risk for being diagnosed with, as well as on survival of cancer in general. Furthermore, disparities in the quality of cancer care, related to socioeconomic status, has been exposed. But what is the current situation regarding disease detection, waiting times and treatment within the Scandinavian cancer care? Do all patients receive equal cancer care and treatment, regardless of socioeconomic status?  Aim: To compile existing literature on disparities in disease detection, waiting times and treatment for patients with different socioeconomic status within the Scandinavian cancer care.  Method: A literature review, including 13 articles of quantitative methodology, reflecting Scandinavian conditions. PubMed and CINAHL were used for data collection. The review is based on the nursing theory by Katie Eriksson. Deductive method was used for the implementation of the results analysis.  Results: The results are presented within three main categories; socioeconomic disparities in disease detection, waiting times and treatment. Cancer is detected earlier among patients with higher education and/or income. These patients also have considerably lower risk of being in an advanced stage of disease at the time of diagnosis. Patients with high socioeconomic status also receive more, and more advanced treatment, compared with patients with lower socioeconomic status.   Conclusion: The Scandinavian tax-funded cancer care is not equal. Not all patients receive equal care and treatment regardless of socioeconomic status. Cancer is detected at an earlier stage among patients with high education or high income, and they receive more treatment, in comparison to individuals with lower socioeconomic status, who are being disadvantaged.

Barriers to Colorectal Cancer Screening in People Obtaining Care From Community Mental Health Agencies by Kelly Gardiner MSN, Wayne State University, 1997 BSN, Wayne State University, 1988 Dissertation Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Despite being highly treatable with early intervention and preventative screenings, the overall mortality rate of colorectal cancer is substantially higher in participants with a preexisting mental disorder. Variables affecting the likelihood of completing screening for those with mental illnesses were unknown in people who obtain services from a Community Mental Health agency. Using the Health Belief Model, the proposed study investigated the effects of access to transportation, referral to screening, physical ability to complete the colonoscopy prep, type of procedure, awareness of the purpose of screening, anxiety, embarrassment, gender, race, and age to determine which affect completion of colorectal cancer screening. Significant relationships existed between embarrassment, fear of pain, fear of cancer, anxiety, physical ability to do testing, awareness of screening at age 50, FOBT vs Scope procedures, age of first screening, being told to get screening, knowing someone who had screening, and completion of colorectal cancer screening. In the binary logistic model Anxiety was negatively correlated and being told to get screening was positively correlated to completion of colorectal cancer screening and those choosing Scope were more likely to complete than those choosing FOBT. The results of this study may effect positive social change by providing healthcare providers with an increased understanding of variables that influence colorectal cancer screening completion among persons with a diagnosed mental illness, resulting in a changing agenda for effective mental and physical health care in this population.