The Importance of Self Breast Examinations and a Community by cuiliqing


									Running head: THE IMPORTANCE OF SELF BREAST EXAMS                               1

              The Importance of Self Breast Examinations and a Community

                            Assessment of Auburn, Alabama

   Group B: Natalie Foster, Kaley Luna, Montana McGuire, Sarah Moore, Maggie Parker,

           Christina Rosser, Rachel Smith, Abby Weyant, and Stephanie Works

                          Auburn University School of Nursing
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                       The Importance of Self Breast Examinations and a

                         Community Assessment of Auburn, Alabama

       Breast cancer arises from breast cells that have DNA abnormalities causing them to

become cancerous. These malignant cells eventually form a tumor that can metastasize to other

organs (American Cancer Society [ACS], 2009). The American Cancer Society (2009) estimated

in 2009 over 192,000 new cases of breast cancer were diagnosed and over 40,000 deaths resulted

from breast cancer in the United States. Therefore, it is important for women to have regular

breast exams because early detection increases the chances for a cure, if breast cancer is detected

(Mayo Clinic, 2009).

       Breast cancer’s prevalence among Americans makes early detection in the treatment of

breast cancer critical. “Breast cancer screening has been shown to reduce breast cancer

mortality” in the United States (“Cancer Prevention,” 2009). It is recommended by the American

Cancer Society that “women begin monthly breast self-examination (BSE) at age 20” (Smith et

al., 2002). Between the ages of 20 and 39, women should have a clinical breast examination by

their health care provider once every three years. Yearly examinations should begin once a

woman is 40 years of age, along with an annual mammogram (Smith et al., 2002).

       Our goal was to do a comprehensive community assessment of Auburn, Alabama and

Lee County, in order to most effectively educate a group of community members at the Auburn

Housing Authority about the importance of performing self breast examinations. Liu, Xia,

Isaman, Deng, and Oakley (2010) validated our teaching plan by conducting a study that showed

nursing education interventions caused a statistically significant increase in breast self

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                        Teaching Plan for Auburn Housing Authority

       When our group went to the Auburn Housing Authority, we met multiple specific

learning objectives while giving a presentation to the community members about the importance

of self-breast exams. Our objectives were:

   1. To inform the community members of the importance of early detection and screening in

       the treatment of breast cancer.

   2. To engage the audience in a discussion about breast cancer screening.

   3. To give guidelines of what screening certain age groups should do.

   4. To describe signs and symptoms of breast cancer in order to be capable of detecting them

       on one’s own body.

   5. To demonstrate and a self breast exam on models that simulated what healthy breasts

       should feel like and what a lump in the breast may feel like.

   6. To get a return demonstration from the community members of a breast exam on models.

   7. To explain the necessary steps to be taken if they were to detect a lump.

   8. To provide Colleen Alsobrook’s, the Breast Health Navigator at East Alabama Medical

       Center, contact information in order to provide a resource of information.

   9. To inform the community members about free mammogram day in October annually.

   10. To provide a questioning and answering session to further educate the audience on points

       that needed to be made clearer.

   Our methods of teaching included visual presentations, repetition of important information,

question and answer opportunities and providing take-home resources for our audience. The

visual presentation was carried out by not only showing the community members the steps of a
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proper self-exam, but also by presenting this information graphically on a large tri-fold board so

that the attendees could effectively read and see the instructions of how to do a self breast exam

quickly. We also used models of the human breasts that allowed members of the audience could

practice correctly palpating breasts. One breast model included lumps and the other did not in

order to simulate what a lump may feel like in their own breasts.

   Another method of teaching used was repetition. We repeated the important information

multiple times throughout the course of teaching which ensured that the information was

delivered effectively. At the beginning of the presentation, we asked the audience questions to

involve them in the discussion, and at the end of the presentation, we provided the audience the

opportunity to ask the presenters questions. The audience was provided take-home materials that

included “ABCs of Breast Health” (bookmark), “Three Steps to Finding Breast Cancer Early”

(pamphlet), and “10 Tips to Getting a Mammogram” (brochure). . This allowed a review of

materials to refer back to the key points of our presentation in the comfort of their own homes.

Colleen Alsobrook’s contact information was provided for a further educator as well as a contact

if breast cancer is suspected. Providing the members of the community with a wide variety of

teaching methods enhanced their learning experience and catered to people with audio or visual

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       We began the presentation by discussing the latest statistics on breast cancer, including

its prevalence in the United States, in Alabama, then in the East Alabama region specifically.

The statistics given were:

       1. In the past year, there were 128 cases of breast cancer diagnosed at EAMC (C.

           Alsobrook, personal communication, March 22, 2010).

       2. The largest diagnosis group in Lee County was within the age group of 50-59. 1 in 54

           women in this age group will be diagnosed, and 1 in 23 women 60-69 will be

           diagnosed (C. Alsobrook, personal communication, March 22, 2010).

       3. In the United States, 1 in 8 women will be diagnosed with breast cancer in their

           lifetime (C. Alsobrook, personal communication, March 22, 2010).

       4. One woman in the U.S. will be diagnosed with breast cancer every three minutes, and

           one woman will die of breast cancer every thirteen minutes (C. Alsobrook, personal

           communication, March 22, 2010).

       5. African American women have the highest death rate from breast cancer of any

           racial/ ethnic group in the U.S. (C. Alsobrook, personal communication, March 22,


       Our next teaching subject included details about breast cancer, including both common

myths and facts. The myths and facts section included the myth, “There’s nothing I can do to

help prevent breast cancer.” The fact given was, “There is something you can do. The primary

ways are: stop smoking, limit alcohol consumption, exercise, eat a well-balanced diet, and have

recommended scheduled screenings.” The second myth given was, “All lumps can be seen on

mammograms.” The fact given was “Some lumps can only be felt and some lumps can only be

detected on a mammogram. It is important to do both.” The third myth given was, “Only Women
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with a family history of breast cancer are at risk.” We provided the fact that, “All women are at

risk. 76% of women who are diagnosed with breast cancer have no family history.” At this point

in the presentation, we encouraged the audience to be familiar with their family history as having

a family history does put you at a slightly greater risk for developing breast cancer. We informed

the audience that if their mom and/or grandmother have had breast cancer, they need to start

getting annual mammograms ten years before their family member’s diagnosis age. The last

myth given was “All women know how to do a self breast exam and do it on a regular basis.”

The fact is, “Surveys show that the majority of women know about self breast exams, but only a

third actually perform them. Also, often these women give up because they are unsure of what to

feel for” (C. Alsobrook, personal communication, March 22, 2010).

       We discussed that the exact cause of breast cancer is unknown but certain characteristics

can increase a person’s risk of developing the disease. There are several factors that put a person

at risk for developing breast cancer that cannot be changed. These risk factors include being a

female, Caucasian, or over the age of fifty-five. Having dense breast tissue, certain genetic

mutations, and beginning menstruation before the age of twelve can also increase a person’s risk.

Some risk factors, however, can be controlled. These include: smoking cigarettes, consuming

alcohol, using oral contraception, lack of exercise, being overweight or obese, and using post-

menopausal hormone therapy (ACS, 2009).

       It is important for women to understand that having certain risk factors does not

necessarily mean that they will develop breast cancer. It is also important for women to know

that they can still develop breast cancer if they have no risk factors at all. The uncertainty

surrounding breast cancer makes screening especially important in early detection and treatment
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of the disease. We proceeded to describe that the benefit of catching the disease in its earliest

stages is a 95.5% survival rate” (ACS, 2009).

   The American Cancer Society (2009) has developed recommendations to help detect breast

cancer in women who have no symptoms of the disease. The recommendations presented to our

audience include:

      Women age forty or older should have a screening mammogram every year

      Women between the ages of twenty to thirty should have a clinical breast exam (CBE)

       performed by a licensed practitioner at least every three years, and women age forty or

       older should have a CBE every year

      Women should start performing a breast self-exam beginning at twenty years of age

      Women at a high risk for developing breast cancer should discuss screening options with

       their practitioner to determine the best course of action (ACS, 2009).

       Our primary goal was to instruct and demonstrate a proper breast self-exam giving the

following instructions:

       1.         Lie down and place a small pillow or rolled towel under your right shoulder

                  and place your right arm behind your head. American Cancer Society

                  recognizes lying down as the best position to perform a self breast exam

                  because it spreads the breast tissue thin and evenly along the chest wall making

                  it easier to feel abnormalities (ACS, 2009).

       2.         Use the pads of the 3 middle fingers of your left hand to feel for lumps in your

                  right breast. Move your fingers in a circular motion varying pressures in a

                  vertical pattern over the entire breast. Make sure you examine up to the
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                 collarbone, out to the armpit, in to the middle of the chest, and down to the

                 bottom of the rib cage (ACS, 2009).

       3.        Repeat these steps with the pillow or towel under your left shoulder, your left

                 arm behind your head, and using the pads of your 3 middle fingers on your

                 right hand to examine your left breast (ACS, 2009).

       4.        While standing in front of a mirror with your hands pressing firmly down on

                 your hips, look at your breasts for any changes of size, shape, contour, or

                 dimpling, or redness or scaliness of the nipple or breast skin (The pressing

                 down on the hips position tightens the chest wall muscles makes any breast

                 changes more easily visible.) (ACS, 2009).

       It is most important that you are aware of what is normal for your breasts in order to

differentiate an abnormality (ACS, 2009). Some women have naturally lumpy breasts, which is

no cause for concern. A change in lumpiness or a lump that feels different from the rest of the

breast tissue should be further evaluated (Susan G. Komen for the Cure, 2010).

       One adverse effect caused by breast self-exams is the anxiety caused by finding a lump

(Gasalberti, 2002). We taught the audience that most lumps found in their breast are not

cancerous, however, they should see their doctor if they do find a lump in order to rule out breast

cancer. After palpating the lump, the doctor may order a mammogram or a biopsy of the lump to

determine if it is benign or malignant (Mayo Clinic, 2009).

       We then allowed the audience to practice a breast self-exam on breast models. We also

showed the audience at this time the model of the breast with lumps. Each person had an

opportunity to palpate the lumps in the model.
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       Following the demonstration and return demonstration, we taught the audience about

when they should see a doctor. We informed them that they should see a doctor if they notice

discharge from nipple, a scaly nipple, inversion of the nipple, dimpling of the breast, a bulge in

the breast tissue, rapid increase in pain with redness and a rash, rapid increase in the size of one

of breasts, a change in shape, any changes in vein patterns, and if they feel a lump while

performing a self breast exam.

       Next, we gave our audience information on Free Mammogram Day. Free Mammogram

Day is provided by East Alabama Medical Center (EAMC) in October annually. Community

members can receive a mammogram free of charge from EAMC. This was important to share

with our audience, as cost is a concern for many women at the Auburn Housing Authority and

many other women in Lee County.

       Evidence of learner readiness was determined by receiving eye contact from the audience

to demonstrate that they were paying attention, participation from the audience when questions

were asked by the presenters, audience members appearing engaged and interested in the models

and demonstrating the proper technique to perform a self breast exam that was taught, receiving

questions from the audience that are pertinent to the presentation, and willingness to take

pamphlets and extra information offered.

       We evaluated the participants return demonstration of self breast exam technique on the

breast models. Some members of the audience were able to complete this task without trouble as

others struggled to use correct hand placement, possibly because of dexterity issues. Those that

were unable to correctly demonstrate techniques were showed again individually, placing our

hand over their hand to show correct technique. As evidenced by the questions that were asked

by our audience, their enthusiasm about our informational flyers, and their overall interest in the
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subject, we feel that our presentation was successful in educating these community members on

the importance of screening for breast cancer and the correct technique for performing a self

breast exam.

               Community Assessment of Auburn, Alabama and Lee County

       Lee County was created on December 5, 1866 by the Alabama legislature. It was formed

out of parts of Macon, Tallapoosa, Chambers, and Russell Counties. Lee County was named for

Confederate General Robert E. Lee. The county seat is located in Opelika, AL (Alabama

Department of Archives and History, 2009). Auburn, the largest city in Lee County, is

considered an urban area because the population exceeds 1,000 people per square mile (U.S.

Census Bureau, 2002). Lee County is situated in East Central Alabama along the Alabama-

Georgia border approximately 100 miles southeast of Birmingham, Alabama, 60 miles northeast

of Montgomery, Alabama, 100 miles southwest of Atlanta, Georgia, and 30 miles northwest of

Columbus, Georgia (Lee County, Alabama, 2005). Auburn is nicknamed “The Plains” because

of its surrounding geography (, 2010). The elevation of Auburn, AL is 702 feet

(, 2010). The city of Auburn, the largest city in Lee County has an average annual

precipitation is 56.9 inches per year. The average winter temperature in Auburn is 44.0 degrees

Fahrenheit and the average summer temperature is 79.0 degrees Fahrenheit (,

2010). Lee County has a total land area of approximately 609 square miles (Lee County,

Alabama, 2005).

       Many people question the effects of environmental chemicals on our bodies. The

pollution that enters the body has been evidenced to affect the prevalence of breast cancer (State

of the Evidence, 2006). In the Auburn area, there have been numerous water toxicity reports.

Auburn Water Works is the main filter and supply source of water throughout the city of Auburn
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supplying over 42,000 residents In 2005, Auburn Water Works was cited when eleven various

forms of pollution were discovered in the water; six of these pollutants have been connected to

causing cancer development: 1,2, Dibromo-3-chloropropane (DBCP), Atrazine,

Bromodichloromethane, Chloroform, Dibromochloromethane and Total trihalomethanes

(TTHMs) (Auburn Water Toxicity Home Facts, 2009). In addition to water pollution, ten

different corporations and companies were found to have released hundreds of pounds of

chemicals in the water and air. For example, Masterbrand Cabinets Incorporated released 50,342

pounds of chemicals in 2008. This is a decrease since the business released 89,511 pounds of

chemicals in 2005 (Auburn Polluters Home Facts, 2009). Forty- nine leaking storage tanks were

also found all over the Auburn area (Auburn Leaking Underground Storage Tanks Home Facts,


         Tobacco is one of the leading causes of breast cancer (State of the Evidence, 2006). In

Alabama adult residents, 22.1% reported as regular tobacco smokers. Of the 22.1%, 25.2% are

male, 19.3% are females and 12% are expecting mothers. Of the 22.1% of the reported high

school smokers, 16.8% are girls and 27.1% are boys. The 2009 Auburn City School’s Pride

Student Survey showed that 10% of tenth graders and one out of seven twelfth graders reported

using smokeless tobacco (Tobacco Prevention and Control, 2009).

         The City of Auburn Community profile notes the total population of the city of Auburn is

56,088, and the population of Auburn-Opelika area is 129,001 (Economic Development

Department, 2009). It is important to include the population of the Opelika area because the

major hospital near Auburn is East Alabama Medical Center, which is in fact, in Opelika. The

population density of Auburn is 1,433 people per square mile. (, 2010) There are

four main types of families, all with subcategories in the city of Auburn; family households,
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family households with the male being the householder and no wife present; family households

with the female being the householder and no husband present, and non-family households. The

family households include households with their own children under age 18, married couple

families, and married couple families with their own children under age 18. There are also single

householder families, both male and female. There is almost double the amount of single female

householders as single male householders, and most of the single householders have children.

These types of families are likely to have women that are either married or have children that

might be “too busy” to perform their self-breast exam, or feel they need to spend the money

elsewhere (U.S. Census Bureau, 2008).

       The majority of the population in Auburn is 20-24 years old. The amount of people in

this age group is more than double the amount of any other group. The people of Auburn are

distributed into the age groups as follows: under 5 (2,275), 5 to 9 years (2,461), 10 to 14 years

(2,214), 15 to 19 years (7,214), 20 to 24 years (14,656), 25 to 34 years (6,577), 35 to 44 years

(4,900), 45 to 54 years (4,878), 55 to 59 years (1,517), 60 to 64 years (1,535), and 65 and older

(3,978). The gender distribution is basically even, but there are slightly more females than males:

females encompass 50.1 percent of the population, and males make up 49.9 percent (U.S. Census

Bureau, 2008). The ratio between males and females is not as important as the actual number of

females in the Auburn area: 28, 126. It is significant to develop ways to educate this large

population. The race distribution is an imperative statistical component to this community

assessment because African American women have the highest death rate of any race group in

the United States. The African American population makes up the second highest percentage of

the population: White, non-Hispanic (77.2%), African American (16.8%), Hispanic (1.5%),
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Asian (1.4%), two or more races (1.1%), Asian Indian (0.8%), American Indian (0.6%),

American Indian (0.6%) (, 2010).

       The vast majority of the Auburn population pulls an income of less than $10k. The mean

income for the city of Auburn in 2008 was $34,602, which is less than the Alabama state median

of $42,131 (, 2010). This could be a factor in fear of the costly of medical bills

associated with doctor visits, which become necessary for early detection of breast cancer after

age 40 (or before with family history) (ACS, 2009). The major occupations in Auburn starting

with the highest percentage include education, accommodation and food services, health care,

construction, technical and scientific services, public administration, and finance/insurance. The

estimated level of unemployment in the Auburn-Opelika area is 6.6% (U.S. Bureau of Labor

Statistics, 2010). 38.1% lives below the poverty line, which is a great deal higher than the 16.1%

in the state of Alabama (, 2010).

       The majority of the population’s occupation is tied up in education, which is important to

know in order to educate the population on the prevention of breast cancer. The education

distribution in Auburn is as follows: <9th grade (2.7%), 9th-12th grade, no diploma (6.1%), high

school diploma (12.8%), high school graduate and higher (91.2%). There are separate statistics

for those with college education: some college, no degree (17.6%), Associate degree (4.8%),

Bachelor’s degree (26.7%), Bachelor’s degree or higher (56%), graduate or professional degree

(29.3%) (Economic Development Department, 2009). A higher level of education might indicate

a better absorption/learning rate and perhaps a better understanding of any prevention methods.

       There are churches on almost every street of Auburn, indicating an importance of religion

in the area. Churches might be a good place for prevention presentations or places to leave

informational flyers or pamphlets. There are many religions practiced in churches around
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Auburn, but the main congregations include Southern Baptist (33.0%), United Methodist

(22.7%), Catholic (2.1%), Assembly of God (8.2%), Church of Christ (8.2%), Episcopal (2.1),

USA Presbyterian (2.1%), Presbyterian (2.0%), Church of Latter Day Saints (1.0%), other

(18.6%) (, 2010).

       There were 18,003 marriages in Alabama from January-June 2009, and 10,078 divorces

from January-June 2009. There were 30,368 live births in Alabama from January-June 2009, and

23,786 deaths in the same period (Center for Disease Control, 2010).

       According to the Centers for Disease Control and Prevention, cancer is the second

highest cause of death in the United States (Center for Disease Control and Prevention, 2009).

Aside from skin cancer, breast cancer is the most commonly diagnosed cancer among U.S.

women. More than one in four cancers is breast cancer (Breast Cancer Statistics, 2010). Contrary

to popular belief, breast cancer does not only occur among women but also is diagnosed in men.

Less than 1% of all new breast cancer cases occur in men (Breast Cancer Statistics, 2010). In

2006, the most current statistic year available to date, 191,410 women were diagnosed with

breast cancer, and 40,820 women died from breast cancer in the U.S. (Breast Cancer Statistics,

2010). Not only is it prevalent among U.S. women as a whole, but also breast cancer has the

highest incidence rate of any other cancer in Alabamian women (Center for Disease Control and

Prevention, 2010). In 2006, 118.5 per every 100,000 women were diagnosed with breast cancer

(Center for Disease Control and Prevention). This incidence rate more than doubled any other

cancer diagnosis rate among women in Alabama. While breast cancer in Alabama does have the

highest incidence rate, it only has the second highest mortality rate (Center for Disease Control

and Prevention, 2010). In 2006, the death rate in Alabama was 23.5 per every 100,000 women.
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This rate was higher than the death rate of the U.S. in the same year (Center for Disease Control

and Prevention, 2010). To bring it even closer to home, 128 cases of breast cancer were

diagnosed at East Alabama Medical Center in the past year (C. Alsobrook, personal

communication, March 22, 2010). Within Lee County alone, the incidence rate from 2002-2006

was 104.5 per every 100,000 women and the average annual count was fifty-four (National

Cancer Institute, 2009). While breast cancer is among one of the top diagnosed cancers among

women in the United States, the incidence and prevalence rates have decreased from 1999-2006

(National Cancer Institute, 2009). The incidence rate has decreased by 2.2% and the prevalence

rate has decreased by 1.9% (National Cancer Institute, 2009). Both of these rates were significant

and “beyond chance” according to the National Cancer Institute and with the teaching of self

breast exams, hopefully we will see these rates continue to decrease (National Cancer Institute,


         The Alabama state government is currently facing budget cuts that directly affect the

population of women needing early detection for breast cancer that may not be able to afford it

on their own. The Alabama Breast and Cervical Cancer Early Detection Program (BCCEDP)

was created to help low- income, uninsured and underserved women receive access to screening

programs that may be life saving. Funding for 2010 BCCEDP was stripped from the Governor’s

proposed budget. Without state funding, the program will suffer and dramatically reduce the

number of women that can be served. The program has reduced the number of women who can

enroll to focus on highest risk women (age 50-64). This will mean 36% of women will not be

diagnosed that previously would be. Since October 1996, more than 61,119 women have been

served by this program detecting 1,048 cases of breast cancer. There are 84,404 eligible women

in Alabama between ages 40-64 that meet BCCEDP requirements. Women’s cancer advocates,
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such as the Cancer Center at East Alabama Medical Center, are currently lobbying the state

government to make sure these important cancer services remain intact to protect the health of

those most in need (C. Alsobrook, personal communication, March 26, 2010).

       East Alabama Medical Center’s Cancer Center has a free cancer library available to the

public. It is called Cindi’s Library and offers books, brochures, web site links directly related to

cancer options, and support services. Cindi’s Library provides a central location to easily find

information and a comfortable atmosphere. The library is funded by charitable donations through

the EAMC Foundation and run by volunteers (Cindi’s Library, 2007).

       The Lee County area has many resources available to its inhabitants. The Auburn

University campus is partly to thank because it provides many radio stations and newspapers that

cover community and county events, news, and information. Newspapers include the Lee County

Eagle, the Opelika-Auburn News, the Auburn Bulletin, Lee County Bulletin, the Wire Eagle, the

Villager, and the on-campus Plainsman. These cover weather, sports, and local news intended to

keep the community up-to-date. Many of these also feature student-led or citizen-led interest

articles on editorial subjects, especially the Villager, which even features student research

articles on particular health promotion topics monthly. These papers would be ideal in such

communities as Auburn and Opelika to raise awareness about breast cancer. Lee County is home

to all age groups, but most abundantly to young adults and middle-aged families who would be

most at risk for developing breast cancer and would be more likely to read an article on the topic.

       Many radio stations are available in the Lee County area. WEGL 91.1, which broadcasts

in the greater campus area and the Auburn Network are also available among the traditional

music stations. WEGL is often open to discussions on-air, sharing news information throughout

the day, as well as interviews. As far as television goes, Lee County has many stations to choose
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from. The most notable news stations are WTVM, WSFA 12, WRBL, and ABC

( These stations feature important stories not only from the Lee County area, but

also from Alabama at large. These provide the largest-reaching outlet for a health promotion

program or story.

       Influential decision makers for the community include Commissioners Harris, Smith,

Holt, Long, and Lawrence, along with Judge English and Governor Bob Riley. The Lee County

official government website serves as a liaison between the people and these officials (Lee

County, 2005). The website also offers contact information as well as information on recent

reforms, bills, and county happenings.

       One of the community’s largest resources is the church population. First Baptist Church

of Opelika, Auburn First Baptist Church, Lakeview Baptist Church, Church of the Highlands,

Auburn United Methodist Church, Cornerstone Church, and Holy Trinity Episcopal Church are

only a few of the 149 churches listed currently on public record (AL HomeTownLocator, 2010).

This provides ample opportunity for community members who are faced with or overcoming a

cancer diagnosis to seek religious counsel or the companionship and support of a church group.

Services like the Wesley Foundation in Auburn and the Chi Alpha Christian Fellowship offer

smaller subgroups for community members to be involved in and seek comfort (Auburn Wesley

Foundation, 2007; Chi Alpha Campus Ministries, 2010).

       The Auburn-Opelika area offers many outlets for information on the topic of breast

cancer awareness such as teaching sessions and scholarly discussions. Local papers and

magazines often run public-service-announcement type articles. A topic as widespread and

important as breast cancer would certainly find its place in those mediums.
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       There are many shops in Auburn where women affected by breast cancer can purchase

bras. East Alabama Medical Center offers a selection of special bras for women that have

undergone mastectomies (East Alabama Medical Center, 2010). Also, women can shop at other

stores such as Victoria’s Secret, which is located in the Village Mall. Victoria’s Secret offers a

broad range of sizes and many different styles. They also offer individualized services to their

customers by measuring them to ensure a quality fit, which is important to women who have

undergone a mastectomy. Other stores in the Village Mall that women can shop at include

Dillard’s and Belk.

       There are many pharmacies in the Auburn area. Some of these pharmacies include: CVS,

Winn-Dixie, Wal-Mart, The Drug Store, Walgreens, and Sam’s club. Auburn University offers a

pharmacy for its employees, dependents, and retirees, which is located at 2155 Walker Building

on the Auburn University Campus. Some perks of the Auburn pharmacy are that most insurance

plans are accepted, there is an emphasis on personalized service and a pharmacist is available 24

hours a day for emergencies. The Auburn University Pharmaceutical Care Center (AUPCC) is

staffed by faculty, staff, residents and fourth year Pharmacy students (Auburn University, 2010).

       East Alabama Medical Center is the hospital that services Lee County. It is located in

Opelika on Opelika Road near Highway 280. It offers an extremely wide variety of services

including ambulance services, cancer services, cardiology services, childbirth services, critical

care services, surgery services, imaging services, psychiatric services, emergency services, and

many more (East Alabama Medical Center [EAMC], 2010). In fact most of the medical

facilities and services in Lee County are a part of EAMC. EAMC is accessible to anyone in the

general public and anyone is eligible to utilize its services (EAMC, 2010).
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       One of the services offered by EAMC that is most pertinent to breast cancer is the Cancer

Center of East Alabama. The staff of this facility includes surgeons, physicians, medical

oncologists, a radiation oncologist, oncology-certified nurses, dieticians, and social workers.

The staff also includes a full-time breast health nurse who devotes all of her time to guiding,

educating, and supporting women through breast cancer screening, diagnosis, and treatment

(EAMC, 2010). The specific breast health services offered by the cancer center include digital

mammography, breast MRI, breast-specific gamma imaging, PET scan, biopsy using breast

MRI, stereotactic breast biopsy, ultrasound-guided biopsy, and sentinel node biopsy (EAMC,

2010). The East Alabama Medical Center Foundation has a Free Mammogram Program that is

available to women with limited or no health care insurance coverage (EAMC, 2010).

       EAMC offers radiology services which include x-rays, CT scans, ultrasounds, digital

mammography, PET scans, and MRI which can all help in the diagnosis of breast cancer

(EAMC, 2010). Auburn Diagnostic Imaging also offers all of these radiology services in an

outpatient setting (EAMC, 2010). These services are very useful for women as the next step

after finding a lump during self-breast examination.

       Some of the rehabilitation facilities in Lee County include inpatient rehabilitation at

EAMC and RehabWorks which are also a part of EAMC (EAMC, 2010). The inpatient

rehabilitation services at EAMC offer physical therapy for oncology patients and also offer

treatment for acute and chronic pain (EAMC, 2010). RehabWorks is an outpatient rehabilitation

service that also offers help for oncology patients (EAMC, 2010). EAMC also has a skilled

nursing facility that offers numerous rehabilitation and restoration services (EAMC, 2010). In

order to qualify for admission to the facility, a patient must have been in a hospital for 72 hours

within the past 30 days and also require skilled daily services of a licensed nurse or therapist
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(EAMC, 2010). The patients must be referred by one of the physicians on EAMC’s list of

credentialed physicians (EAMC, 2010).

       EAMC also has most of the hospice and home health facilities in Lee County. Some of

these include Hospice of EAMC and HomeMed (EAMC, 2010). Bethany House is part of

Hospice of EAMC, and it offers short term care during medical crises and respite care (EAMC,

2010). Hospice of EAMC also offers bereavement services for adults and children to help them

get through the grieving process after losing a loved one (EAMC, 2010). HomeMed offers

people many medical products and services (EAMC, 2010). For women who are post-

mastectomy, it offers post-mastectomy prostheses and mastectomy bras (EAMC, 2010). Lee

County also has numerous long-term care facilities. Some of these are Azalea Place, Camellia

Place, Magnolia Place, Oak Park, and also some assisted living communities (EAMC, 2010).

Azalea Place offers assisted and retirement living (EAMC, 2010). Camellia Place and Magnolia

Place both offer specialty care assisted and retirement living (EAMC, 2010). Oak Park offers

nursing home and independent living (EAMC, 2010).

       The Alabama Department of Public Health has a program called The Alabama Breast and

Cervical Cancer Early Detection Program (ABCCEDP) (Alabama Department of Public Health

[ADPH], 2010). This program offers free breast screenings to women ages 40-64 who have a

family income less than or equal to 200 percent of federal poverty guidelines and who have

limited or no health insurance coverage (ADPH, 2010). The program will also pay for some

follow-up diagnostic care including ultrasound, biopsy, and colonoscopy (ADPH, 2010). The

program will refer women who are diagnosed with breast cancer to Medicaid for its treatment

(ADPH, 2010). The Lee County Department of Public Health is located on Corporate Drive in

Opelika (ADPH, 2010).
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       The Alabama Department of Human Resources offers a number of services including

adult care services, childcare services, family services and family assistance (Alabama

Department of Human Resources [ADHR], 2010). The Lee County Department of Human

Resources is located on Corporate Drive in Opelika and offers family and child services, child

support information, and food assistance information (ADHR, 2010). The social security office

that services Lee County is located on Corporate Drive in Opelika across the street from the Lee

County Health Department (Social Security of America [SSA], 2010). In order to be eligible for

social security benefits, you must be an employee or self-employed worker who is age 62 or

older, and you must have earned the required social security credits during your working years

(SSA, 2010).

       There are many voluntary health-related organizations through the United States, in and

around Lee County, dedicated to helping the community learn about the importance of self-

breast exams and providing information and support for those diagnosed with breast cancer. First

of all, the American Cancer Society is a nation-wide organization dedicated to curing and

preventing cancer by providing education, information, support, research, and funding to victims,

family, and health care professionals. Community based outreach is very important to the

Cancer Society; locally, the closest chapter of the Cancer Society serving Lee County is located

in Montgomery, Alabama at 3054 McGehee Road. To get involved or to obtain information

regarding breast cancer you can contact the Montgomery office at 334-288-5926, or visit their

website at <> (ACS, 2010).

       Though the American Red Cross does not directly help those diagnosed with breast

cancer or provide information regarding breast self-exams, it does provide many services in

support of those patients in need of help and education, even blood transfusions. They oversee
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all disaster relief, military relief efforts, especially providing services for military families,

obtaining and processing blood products for transfusion purposes, and providing education

programs about health and safety. The local Lee County chapter is located at 206 26th St. in

Opelika, AL (American Red Cross, 2010).

        Being diagnosed with any type of cancer, even breast cancer, can be a traumatic time for

any person. If thoughts or signs of depression are becoming apparent, it is important to

recognize and try to fix them. In Lee County, organizations such as the Crisis Center of East

Alabama serve as advocates for suicide prevention, providing a listening ear and caring words to

those suffering from suicidal thoughts. The Crisis Center’s phone number is 334-821-8600; the

volunteers available are eager to help and are available twenty-four hours a day, seven days a

week (Crisis Center, 2010).

        Catholic Charities USA is a Christian, nationwide organization made of a network of

local agencies focused on providing care for those in need by aiming to reduce poverty,

supporting families, and empowering communities. This agency could be helpful for one

diagnosed with breast cancer, providing support and assistance for the patient and family.

Though there is no Catholic Charity agency in Lee County, there is an office in Birmingham,

Alabama. The agency may be contacted through local Catholic churches in Lee County or at

205-776-7125 (Catholic Charities USA).

        The Lee-Russell Aging Foundation, part of the Lee-Russell council of governments, runs

the four local senior centers in the area. These centers provide social activities, nutrition and

health counseling, hot meals, information and referrals if need be. This is a great organization,

and for those who have felt a suspicious lump while performing a self-breast exam can use this
Running head: THE IMPORTANCE OF SELF BREAST EXAMS                                       24

agency to receive a referral for evaluation. For more information about this organization call

(334) 749-5264 (Lee-Russell Council of Governments, 2010).

       Though there is no Healthy Communities Access Program in Lee County, the

Montgomery Area Community Wellness Coalition, located in Montgomery, Alabama, is a

community-based, non-profit organization that provides the uninsured patient with health care

advice and referrals when needed. It was created to enhance chronic disease prevention by

attempting to reduce economic and health problems associated with common diagnoses such as

diabetes, hypertension, COPD for the uninsured. More information can be found at or dial 2-1-1 to find out if one qualifies for Wellness Coalition

services (The Volunteer and Information Center, 2010).

       In conclusion, Auburn, Alabama and the Lee County area are greatly impacted by breast

cancer, and health promotion is key in reducing the mortality associated with this disease. We

provided the some of the Auburn/Opelika community with valuable information regarding breast

cancer and self breast exams by educating how to perform a breast self-exam and identifying the

benefits of the early detection of breast cancer. Our community’s health is important to us, and

we feel privileged to have helped them improve this aspect of their lives.
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