PICO Presentation By: Taylor Sand Hello, my name is Taylor Sand. This is my PICO presentation for COHP 450

PICO Question Population: Women of child bearing age “ For women of child bearing age, does breastfeeding compared to not breastfeeding reduce their risk for breast cancer?” Population: Women of child bearing age Intervention: Breastfeeding Comparison: Not Breastfeeding Outcome: No breast cancer I am currently a Nursing student at Ferris State University. I am interested in pursuing my studies within the obstetrics field once graduating. For me, a family member of women diagnosed with breast cancer, I feel that knowing ways to prevent breast cancer are very important. Our bodies are designed to breastfeed our children, knowing that using our bodies as they were designed to work may reduce my risk for breast cancer is very intriguing. My PICO question states, “For women of child bearing age, does breastfeeding compared with not breastfeeding reduce their risk for breast cancer?

Results of the Literature Search Words: Breastfeeding and Breast Cancer, Breastfeeding, Breast Cancer Search Engine: PubMed, CINAHL Results of Search: Included many studies related to the relationship between breastfeeding and breast cancer Read Slide!

Results of Literature Babita, Kumar, N., Singh, M., Malik, J. S., & Kalhan, M. (2012, November 2, 2012). Breastfeeding Reduces Breast Cancer Risk: A Case-Control Study in North India. International Journal of Preventive Medicine, 791-795. Gonzalez-Jimenez, E., Garcia, P. A., Aguilar, M. J., Padilla, C. A., & Alvarez, J. (2013, 25 March, 2013). Breastfeeding and the prevention of breastcancer: a retrospective review of clinical histories. Journal of Clinical Nursing, 2397-2403. Articles that were chosen for this research were: Breastfeeding reduces breast cancer risk: a case-control study in north india Breastfeeding and the prevention of breastcancer: a retrospective review of clinical histories

Results of Literature Article One Worldwide, breast cancer is the most common cancer among women A significant association of breast cancer cases was found with heredity, age at marriage, age at the first pregnancy, number of live births, and lifetime duration of breastfeeding. Breastfeeding has a significant role in reducing breast cancer Read Slide!

Results of Literature Article Two Breast cancer is the most common form of cancer in younger women in Western countries Identified significant differences between the age of the patients at breast cancer diagnosis, smoking habits, and lactation period if the subjects had breastfed their children for more than six months, regardless of whether they had a family history of cancer Nurses play a crucial role in encouraging new mothers to breastfeed their children, and this helps to prevent breast cancer Read Slide!

Findings for Article One Theory Study/ Design: Simple-Random Sample, Case-Control Study Methods: 128 confirmed new cases of breast cancer; 95% confidence interval Findings Theory: to find the association between breastfeeding and breast cancer Study/Design: Simple- Random Sample, Case- Control Study Methods: 128 women with a confirmed new case of breast cancer were interviewed using a pre-tested questionnaire after obtaining written informed consent. Equal numbers of controls were selected by simple random sampling. The categorical data was analyzed statistically using the Chi-square test and odds ratio with a 95% confidence interval. Continuous variables were analyzed using an independent t-test. Findings: Breastfeeding has a significant role in reducing breast cancer, and so information, education, and communication activities for the promotion of breastfeeding and creating awareness about this fatal disease are the needed.

Findings for Article Two Theory Study/ Design: Retrospective study, 504 women diagnosed and treated for breast cancer Methods: Usage of patients contributing factors and a conditional inference tree Findings Theory: To evaluate at what age women were diagnosed with breast cancer. Factors taken into account for these women were whether they had breastfed their children, and if so, the length of the lactation period Study/ Design: A retrospective study Methods: The retrospective study consisted of the clinical histories of 504 women diagnosed and treated for breast cancer, Relevant data used was the age of diagnosis, period of lactation, family history of cancer, obesity, alcohol consumption and smoking habits. This information was collected from the clinical histories of each patient and analyzed. A conditional inference tree was used to relate the age of diagnosis to smoking habits and the length of the lactation period. Findings: This study concluded that breastfeeding for over six months not only provides children with numerous health benefits, but also protects mothers from breast cancer when the mothers are nonsmokers

Ethical Considerations in Research In both articles the main focus was to determine the main cause of breast cancer, and the major effects of breastfeeding. What these articles did not cover was the fact that breastfeeding is being discouraged in societies all around the world. The social norms and cultural differences should be taken into consideration with nursing mothers. The articles stated the importance of nurse/ mother interaction and the importance of educating new mothers about breastfeeding regardless of today’s social norms. Findings of both studies show that regardless of individual lifestyle choices, cultural influences, that breastfeeding was what the female anatomy was designed to do, and breastfeeding should be encouraged by all medical personnel involved along with coping strategies for the hardships they may endure. browngirlnextdoor.com

Strengths Article One Article Two - Addressing breast cancer affects; not just health related In rural countries only those with money and healthcare are being diagnosed Article Two Affects of female hormones Women with a history of breast cancer and those without Article One Not only are the health risks of breast cancer what patients are afraid of when hearing their diagnosis. One of the most feared outcomes in the diagnosis of breast cancer are its psychological impacts. Breast cancer affects the perception of sexuality and self-image to a degree far greater than any other cancer, which is a huge problem in woman today. Most articles over look this aspect. Another major topic in the world today is health care, those without health care in more rural countries are not being diagnosed, and are dealing with those outcomes. Article Two There are major controversies with hormones and their affects on breast cancer. This articles researchers believe that female hormones are major influences on the outcome of breast cancer diagnosis and the duration of cancer tumor growth. Breastfeeding reduces some of those hormones seen in the tumor growth, in turn reducing the risk of breast cancer.

Quality of Studies Article One - Limited Barriers - Controls were matched with 2yr. age range Article Two - Age group finely laid out - Case control was 1:1

Credibility Both articles come from accredited nursing/medical journals. The author from both articles have proper medical degrees from known universities and medical schools

Relevance to Practice Main Focus Evidence Based Practice In both articles the main focus was to determine the affect of breastfeeding on breast cancer. Both articles proved that in fact breastfeeding does reduce the risk of breast cancer in those with pre-disposing factors and that breastfeeding can be used as a way to “prevent” breast cancer. These articles were done along the lines of evidenced based practice to determine this question. I found it extremely rewarding to know that nurses have an extreme impact on new mothers and the rate of breastfeeding. I hope that all nurses take it upon themselves to educate their patients of the benefits of breastfeeding. nursing.med.nyu.edu

Additional PICO Questions “For women of child bearing age, does the media compared to personal beliefs influence breastfeeding?” P: Women of child bearing age I: Breastfeeding C: Media and Personal Beliefs O: Decrease in Breastfeeding Rates

Additional PICO Questions “Do infants benefit from mother child interaction while breastfeeding compared to those who are bottle fed?” P: Infants I: Mother/ child interaction C: Breastfeeding and Bottle feeding O: Infant/ Mother bonding

Conclusion Breastfeeding reduces the risk of breast cancer Those with a family history of breast cancer are more at risk of getting breast cancer Some cultures prohibit breastfeeding, resulting in increased disposition Education is the key to reduction