What is the epidemiological concern?
The epidemiological concern is breast cancer which has been considered by the World Health Organization (WHO) as the most common cancer which affects women both in the developed and developing nations. The risk of breast cancer doubles in every decade until menopause and thereafter the increase slows down. Nevertheless, after menopause, the chances of getting breast cancer increases. The rates of people surviving after being diagnosed with breast cancer globally vary, but the rates have been improving. Studies have shown that many of the breast cancer subtypes are related to the hormones. Fitzmaurice et al., (2015) state that breast cancer is the main cause of death in many women across the world. Some of the causes of breast cancer include unhealthy lifestyles and other risk factors include long time fertility, physical inactivity, using hormone replacement therapy, consumption of alcohol, failure to conceive and also using preventive pregnancy hormones.
What population is it affecting?
Globally, the majority of the population affected by breast cancer is women. In the United States, studies show that 1 in 8 women have the possibility of developing breast cancer during their lifetime (Breast Cancer Org, 2018). Approximately, 30% of new women were diagnosed with breast cancer across the United State in 2017. Breast cancer in women aged 45 and below is experienced more in African-American women compared to their white counterparts. In general, African-American women have a high likelihood of dying from this disease. Native-American women, Hispanic, and Asian women have a lower risk of dying and developing from breast cancer (Breast Cancer Org, 2018). The United States records show that there are about 3.1 million who have a history of breast cancer. Globally, WHO (2015) notes that in 2011, 508,000 women died because of breast cancer. WHO (2015) observed that 50% of the cases of breast cancer together with 58% of the deaths occur in the less developed nations and hence not a disease for the developed nations only. In Western Europe, the incident rate of the disease is 89.7 per 100,000 women while in Eastern Africa it is 19.3 per 100,000 women. Many of the African countries have the lowest incidence rates but in the last decade there has been an increment (WHO, 2015). On the other hand, the survival rates vary greatly globally, range from approximately 80 percent or over in Sweden, North America, and Japan to around below 40 percent in low-income countries and 60% in the middle-income nations (Coleman et al., 2008). Low survival rates in some countries can be explained by the lack of early detection programmes in addition to the lack of adequate treatment and diagnosis facilities.
What potential population may be affected if this concern is not addressed?
The risk of a woman being diagnosed with breast cancer doubles if a woman has a first-degree relative, a daughter, sister, or mother who previously has breast cancer. Approximately less than 15% of women diagnosed with breast cancer have a member of the family with the same disease. About 5-10 percent cases of breast cancer have been linked to abnormal changes or gene mutations which are inherited from the father or mother. Nonetheless, 85 percent of the cases of breast cancer occur in women who have no family history of the disease. It occurs because of the genetic mutation happening because of the aging process in the lifestyle rather than the inherited mutations. Therefore, the inability to address breast cancer will lead to more deaths of women globally (World Cancer Research Fund International, 2018). Apparently, men can also be affected by this disease however, few cases are reported. In all cases of breast cancer, only 1 percent affects men. The lifetime risk for a man to be diagnosed with breast cancer is 1 in 1,000.
What are the risk factors associated with epidemiological concern?
The most critical risk factors associated with breast cancer are age and gender, that is growing old and being a woman. As mentioned, a family history related to breast cancer increases the risk of being diagnosed with the disease by two or three. Some of the mutations considered to have a high risk of breast cancer are p53, BRCA2, and BRCA1. Nonetheless, these mutations are rare and are considered to account for a small percentage of the cancer burden. Other risk factors include reproductive factors which are related to long exposure to endogenous estrogens, such as late menopause, early menarche, and the lat giving birth of the firstborn son. In addition, exogenous hormones put a higher risk for this disease (Lacey et al., 2009). Danaei et al., (2005) calculated the contribution of certain modifiable risk factors to the burden of breast cancer and concluded that 21% of deaths globally have been attributed to obesity and overweight, alcohol consumption, as well as lack of exercises. The proportion was recorded high, 27%, in high-income nations where the most contributors were obesity and being overweight. In the middle and low income nations, the percentage of these risk factors associated with causing breast cancer was 18%. The breast cancer incidence differences between the developing and developed nations could be explained by the dietary effects, shorter breastfeeding period, lower parity, and later birth of the first child (Peto, 2001). The adoption of western-lifestyles in the middle and low income nations is a determinant which has lead to the increment in the incidences of breast cancer.
What public health recommendation can you make to alleviate your identified epidemiological concern?
There are two major recommendations which when implemented can help alleviate the breast cancer incidence globally. One of the key strategies is raising public awareness on the problem of breast cancer and the available mechanisms to control the disease together with advocating for the need of appropriate programmes and policies. Thus, the first recommendation is having in place preventive measures which include programs that promotes a healthy diet, less intake of alcohol, physical activity, in addition to obesity and overweight which could lead to the reduction of this disease in the long-term.
The second recommendation is having early detection. While some risk is reduced using prevention, majority of the breast cancers especially in low and middle income nations cannot be eliminated through some of these strategies. Anderson et al., (2008) notes that early detection for improving survival and breast cancer outcome remains the cornerstone of reducing the incidence of this disease. The two common early detection methods include early diagnosis and mammography screening. WHO (2007) observed that compared to early diagnosis, a screening program is more complex. Central to early detection of breast cancer is careful planning and a well sustainable and organized program that targets the right population and has continuity as well as quality during implementation.

References
Anderson BO et al. (2008). Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer, 113, 2221–43.
Breast Cancer Org. (2018). U.S. Breast Cancer Statistics. Retrieved 13th Jan 2018 from Breast Cancer. Org. http://www.breastcancer.org/symptoms/understand_bc/statistics
Coleman MP et al. (2008). Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol, 9, 730–56.
Coleman, M. P., Quaresma, M., Berrino, F., Lutz, J. M., De Angelis, R., Capocaccia, R., … & Micheli, A. (2008). Cancer survival in five continents: a worldwide population-based study (CONCORD). The lancet oncology, 9(8), 730-756.
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WHO (2007). Cancer control: knowledge into action: WHO guide for effective programmes: early detection.
WHO, (2015). Breast cancer: prevention and control. Retrieved 13th Jan 2018 from WHO: http://www.who.int/cancer/detection/breastcancer/en/index4.html
World Cancer Research Fund International, (2018). Breast cancer statistics. Retrieved 13th Jan 2018 from http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics