Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 7/2012breast cancer, dietary habits, increasing life expectancy, lack of screening plan, low healthcare facilities, socio-cultural barriers, as well as traditional alternative medicine that generatesa higher mortality rate (cf. also Agarwal et al., 2011; El Saghir et al., 2011). Lakkis et al.(2010, pp. 223-224), analyzing Lebanon, find that the proportion of breast cancer is 38.2% oftotal cancers in women and show an interesting comparison of this country with other geoeconomicareas. In particular, in Lebanon the breast cancer is lower than US, West Europeand Israel, though is higher than Arab regional area, Iran and Malaysia. According to theseauthors the causes can be the awareness of this cancer among Lebanon women, theimplementation of screening programs and the modernization in the reproductive patters ofwomen. Some researches claim that mammographic screening is an apt and cheap strategy todetect the breast cancer in the early stages and improves a management of this disease,though some barriers can be due to socio-economic and cultural features within developingcountries (Yip et al., 2011). Mittra (2011) argues that the most important aspect fordeveloping countries is to assure the minimum level of cancer care to these populations inorder to sharply reduce the incidence and mortality of breast cancer. In addition, other mainissues of developing countries are the higher rate of illiteracy and cultural barriers, associatedto lack of funding, health infrastructures, public health schemes of prevention, etc.Breast cancer research has also investigating the main causes across populations, consideringcultural, social and economic profiles. Botha et al. (2003) show that the incidence of breastcancer tends to be higher in advanced socio-economic countries in North and West Europedue to some factor risks such as “avoidance of childbearing” (p. 1727). Cogliano et al. (2005)argue that combined oral contraceptives (OCs) have been associated to an increased risk ofbreast cancers among users. Ursin et al. (1998) show: “breast cancer risk is elevated amongwomen with long duration of use which began at an early age. . . . before age 20” (p. 182).Oh et al. (2010), investigating the causes of breast cancer, have carried out an interestingresearch about the breast cancer seasonality. They argue that breast cancer is more diagnosedin spring and fall, this seasonality is higher across population distant from equator and thisresult is pronounced among women living in rural areas. Moreover, the overall incidence ofbreast cancer, over 2005-2006, increases as the latitude of population residence increases (p.233, passim). The relationship latitude and breast cancer, according to these authors may bedue to the complex season sunlight mediation of Vitamin D and of nocturnal peak level andduration. This finding could be the basis to analyze the biological rather than socialdeterminants of breast cancer patterns. Klassen and Smith (2011), instead, review with6
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 7/2012accuracy the scientific literature about the main relationship between social class and breastcancer, since the “breast cancer in women has historically been seen as a ‘cancer ofaffluence’ ” (p. 217). They confirm the high association between breast cancer incidence andhigher social class groups, though some variation of risk is due to modernization based onphysical activity and changes of reproductive habits. Klassen and Smith (2011, p. 219ff) alsolist some breast cancer risks factor that are difficult to isolate in individual effects, such as:greater weight by women is associated with an higher risk for post-menopausal; estrogen inoral contraceptive and hormone therapy, alcohol and smoking, etc. In addition, they note thataffluent western populations have rate of breast cancer higher than Africa and Asia. Socialclass is not a direct determinant of breast cancer, but some social classes in several countiesare an indicator of behavior and style of life that contribute to increase the breast cancer riskof woman. This result is important because breast cancer of younger women can be due togenetic risk factors, whereas in post-menopausal woman is associated to lifestyle of socialclass (Klassen and Smith, 2011, p. 230). In addition, higher incidence of breast cancer inhigher social class is associated to higher mortality of women of lower social class (andcountries dominated by these social structure) that, vice versa, do not have access toadvanced treatments and effective anticancer drugs.This theoretical background shows that breast cancer has a heterogeneous diffusion betweenand within countries. It is important to analyze the relationship between diffusion of thebreast cancer and wealth of nations in order to pinpoint systemic drivers and provide vitalbest practices to design fruitful health policy across countries for a better prevention, vast andaccurate screening programs among women, diagnosis at early stages, and more effectiveanticancer treatments. Before discussing the results, we describe the methodology ofresearch.3. MethodThe critical hypothesis (Hp) of this study is:Hp 1: The breast cancer tends to be higher across richer countries.In fact, richness and modernization may spur behavior and style of life that contribute toincrease the breast cancer risk of woman.The purpose of the present study is to see whether statistical evidence supports thishypothesis, in order to analyze the main determinants and support an accurate prevention andhealth information plan across populations. The structural indicators used are:7
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