In the attached assignments, I need the 4 discussion questions in 200 words each.

There are 3 projects, I need them in 3 pages each.

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SMART Goals for Breast Cancer Comment by Carolyn Brown: Please see APA 7th edition on how to format the title page.

NR514: Epidemiology and Population Health

Norwich University

April 11, 2022.








SMART Goals for Breast Cancer Comment by Carolyn Brown: This should be bolded.

Goal 1: Advocate for 20 Percent Increase in Screening Breast Cancer Among African American Women in the next 5 years.

Major US medical organizations recommend frequent and early screening mammography for women aged above 40 years. It is recommended that screening mammography reduce cancer mortality by about 35% in the vulnerable group. African American (AA) women experiences and perceptions with medical providers contribute to adverse outcomes after mammogram result. Inadequate communication between provider and patient about mammography results is common among women of color. Anticipated discrimination and distrust in medical settings are some of the barriers to follow-up in AA women. These undesired experienced lower the possibility of getting subsequent mammograms. Therefore, there is need to advocate and promote positive medical experiences to create an environment where patients are satisfied with mammograms. Comment by Carolyn Brown: Almost every sentence in the paragraph need a citation. When you make these statements without citing them, it can be considered plagiarism.

Medical advocacy will help African American women overcome distrust and discrimination. This is a culturally appropriate strategy to improve satisfaction and adherence with care. The intervention will include examining reasons why the vulnerable population shy from breast cancer screening. Some of the intervention which can ensure access to mammogram include ensure equal access to affordable cancer screening for the vulnerable population and fight against discrimination in insurance benefits. Supporting people at risk and raising awareness about breast cancer will increase the numbers of people screened (De Moor, Mariotto, & Parry, 2017). Cancer advocacy is empowering and positive experience. The success of the advocacy can be evaluated after 5 years. This goal will be measure based on the number of people who visit cancer screening centers and reduced mortality related to breast cancer.

Goal 2: BY 2025, Reduce the Number of African American Women Aged above 40 Years in Vermont who are at Risk of Breast Cancer from 20%.

Breast cancer is higher among African American women aged above 40 years in the US. The mortality rate from breast cancer has decreased in the recent past due to emphasis on early detection. Although the mortality rates have reduced, in some ethnic populations the numbers is still high and continues to grow (McCarthy & Armstrong, 2020). Among the Vermont, breast cancer is mostly diagnosed among Blacks. There are more than 40,000 adult Vermonters diagnosed of breast cancer. Moreover, Vermont females have higher rates of breast cancer compared to the country rate. Mammography and early detection can reduce risk of breast cancer. Screening reduce later stage diagnosis and mortality. If African American when can access health care, detection of breast cancer at early stage has better prognosis compared to late detection when the cancer has spread. Comment by Carolyn Brown: Needs a citation. Comment by Carolyn Brown: Citation Comment by Carolyn Brown: Again, many of these statements need citations. If they are from the same source, the first sentence should be cited, then the following sentences should be clear that they are from the same source. One way of doing this is by using transition words or phrases such as “Furthermore …” or “In addition to …”

Increasing age is a risk factor for breast cancer. A study by American Cancer Society(2019) shows that 75% of breast cancers diagnosed occur in women aged above 45 years. For Vermont women dying from this cancer, 80% of deaths occurred to women aged above 50 years. Lifetime exposure to hormones play a role to breast cancer, late age of menopause and having no children. The intervention to reduce risk of breast cancer include getting and maintaining healthy weight and being physically active. Vermont women should engage in physical activities to reduce risk of breast cancer. Increased weight is linked with higher risk of breast cancer more so after menopause. Women past menopause should avoid weight gain by balancing physical activity with food intake.

Goal 3: Reduce by 10% the Burden of Cancer (Disability) among the African American Women Living in Vermont in the next 6 years.

The national costs for cancer care is estimated to be $320.8 billion in 2021. This is an increase of 10% in 2015 due to growth and aging population in the US. These medical costs include costs for medical services and drugs. The cost is largest for breast cancer. Cancer is expensive medical condition to manage, and spending has been higher in the recent past due to advanced imaging, long treatment period, support care, and therapies. Cancer survivors face high costs for their care, and this include copayments and coinsurance (Jiemin & Jemal, 2017). Without charity care, survivors from racial minority in Vermont may be forced to foot the entire cost of care. Financial hardship is common, with many African American women report challenges in paying medical bills and increased financial distress. Moreover, cancer survivors spend considerable amount of time travelling to get care and this represent time outside work and leisure. Patient time costs is substantial and cause financial burdens. EPIDEMIOLOGY & POPULATION HEALTH

Some ways of reducing out-of-pocket costs include early diagnosis and availability of information on cancer. Interventions to reduce cancer burden include knowing the risk factors. Research shows some risk factors include use of tobacco, alcohol use, overweight, and lack of physical activity (Centers for Disease Control and Prevention, 2017). Cancer burden will be reduced by cancer prevention, early detection, and affordable treatment. Many organizations are engaged in breast cancer control including state governments, volunteer agencies, and health communities. Much of the financial burden due to breast cancer are therefore preventable by expanding use of cancer screening. State of Vermont can also promote media campaigns about the need for screening. Providing information will raise awareness of cancer and help unscreened people to subscribe to the intervention measures.




American Cancer Society. (2019). Can I Lower My Risk of Breast Cancer? Retrieved from American Cancer Society, Inc: https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/can-i-lower-my-risk.html

Centers for Disease Control and Prevention. (2017). Cancer, smoking and tobacco use: Highlights:. National Center for Chronic Disease Prevention and Health Promotion. Retrieved from https://www.cdc.gov/tobacco/data_statistics/sgr/2004/highlights/cancer/index.htm

DE MOOR, J. S., MARIOTTO, A. B., PARRY, C., ALFANO, C. M., PADGETT, L., KENT, E. E., FORSYTHE, L., SCOPPA, S., HACHEY, M., & ROWLAND, J. H. (2013). Cancer survivors in the united states: Prevalence across the survivorship trajectory and implications for care. Cancer Epidemiology, Biomarkers & Prevention, 22(4), 561-570.  https://doi.org/ 10.1158/1055-9965.EPI-12-1356 Comment by Carolyn Brown: These should not be all bolded.

Ma, J., Jemal, A., Fedewa, S. A., Islami, F., Lichtenfeld, J. L., Wender, R. C., Cullen, K. J., & Brawley, O. W. (2019). The American cancer society 2035 challenge goal on cancer mortality reduction. CA: A Cancer Journal for Clinicians, 69(5), 351-362.  https://doi.org/ 10.3322/caac.21564

McCarthy, A. M., & Armstrong, K. (2020). Genetic testing may help reduce breast cancer disparities for African American women. JNCI : Journal of the National Cancer Institute, 112(12), 1179-1180.  https://doi.org/ 10.1093/jnci/djaa042


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