Research institute for nurse scientists responds to the challenge to expand and strengthen research focused on breast cancer in African American women

Abstract

In an era where scientifically derived ‘evidence’ is used as a basis for nursing practice, it is imperative that nurses have a breadth of knowledge relative to the fundamentals of nursing science; knowledge of the current standards of nursing and medical practice; and knowledge of the characteristics, needs, concerns, and challenges of diverse consumer and patient population groups. Yet, while a significant body of ‘evidence’ that describes the experiences and needs of African American women across the breast care continuum has been generated, research suggests that there is a need to expand and strengthen this body of science. This report presents an overview of a decade of research focused on breast cancer among African American women and describes an initiative funded by the Susan G. Komen Breast Cancer Foundation to expand and strengthen nursing science that aims to reduce and/or eliminate excess breast cancer morbidity and mortality among African American women. Cancer 2007. © 2006 American Cancer Society.

Breast cancer, one of several diseases in which malignant cells arise from tissues in the breast, is the most common form of nonskin cancer experienced by women. Breast cancer accounts for approximately 31% of all the cancers diagnosed among women. It is estimated that about 61,980 new cases of noninvasive breast cancer and about 212,920 new cases of invasive breast cancer will be diagnosed among women in the United States in 2006. 1 Breast cancer, which is exceeded only by lung cancer as the leading cause of cancer death in women, accounts for approximately 15% of all cancer deaths in women. It is estimated that about 40,970 women will die from breast cancer in 2006 in the United States.1

Improvements in breast cancer screening and treatment over the past 3 decades have led to significant increases in the rate of diagnosis of noninvasive early stage breast cancer and significant reductions in breast cancer mortality. According to reports of the National Cancer Institute Surveillance Epidemiology and End Results Program, the rate of noninvasive early stage breast cancer among women of all races and all ages was 19.1 per 100,000 in 1990 and 33.6 per 100,000 in 2002. 2 The rate of invasive breast cancer among women of all races and all ages was 131.6 per 100,000 in 1990 and 132.9 per 100,000 in 2002.2 The overall death rate from breast cancer among women of all races and all ages was reported by the National Cancer Institute Surveillance Epidemiology and End Results Program to be 33.1 per 100,000 in 1990 and 25.5 per 100,000 in 2002. The overall 5-year survival of invasive breast cancer was reported by the NCI SEER Program to be 84.9 in 1989–1991 and 88.2 in 1995–2001.

Breast Cancer Among African American Women

Breast cancer impacts all population groups. When measures of mortality and length of survival are compared by racial/ethnic group, however, African American women are noted to bear a disproportionate burden. The American Cancer Society projected that an estimated 19,240 new cases of breast cancer and an estimated 5640 deaths from breast cancer would occur among African American women in 2005. 3

The overall rate of newly diagnosed breast cancer is significantly lower in African American women when compared with the rate of newly diagnosed breast cancer in white women. According to reports of the National Cancer Institute Surveillance Epidemiology and End Results Program, the rate of noninvasive early stage breast cancer among white women of all ages was 34.0 per 100,000 and 28.3 per 100,000 in African American women in 2002. 2 In 2002, the rate of invasive breast cancer among white women of all ages was 138.2 per 100,000, compared with 120.0 per 100,000 in African American women.

In spite of an overall lower incidence rate of breast cancer, compared with white women diagnosed with breast cancer, African American women diagnosed with breast cancer face a significantly higher rate of dying from their disease. According to reports of the National Cancer Institute Surveillance Epidemiology and End Results Program, the 2002 mortality rate of invasive breast cancer among white women of all ages was 24.9 per 100,000 compared with 34.1 per 100,000 in African American women of all ages; 5.1 per 100,000 among white women compared with 10.0 per 100,000 among African American women <50 years of age; and 77.0 per 100,000 among white women compared with 97.1 per 100,000 among African American women 50+ years of age. Reports from the National Cancer Institute Surveillance Epidemiology and End Results Program also note that while the 5-year relative survival rate from breast cancer in African American women has increased in recent decades, it lags far behind that of white women. Between 1995 and 2001, data indicate a 90.3% 5-year overall survival among white women diagnosed with breast cancer and a 76.7% overall 5-year survival among African American women diagnosed with breast cancer. 2, 4

There is no conclusive evidence to support any single explanation for the excess breast cancer mortality experienced by African American women. The trends are thought to be primarily attributable to variations in the tumor type, the stage of breast cancer at the time of first treatment, the presence of comorbid conditions, sociocultural factors, economic factors, and factors associated with the prescription, delivery and utilization of breast care services. 3, 5–7 Experts have asserted the belief that the excess breast cancer morbidity and mortality experienced by African American women would be reduced if breast cancer screening recommendations were more effectively utilized, and if, when breast cancer is diagnosed, state-of-the-science treatment modalities were prescribed and expeditiously administered. However, although numerous efforts have been undertaken within the private and public sector to improve access to breast cancer screening and state-of-the-science treatment and breast care for all women, research has shown that all too often African American women do not receive state-of-the-science breast cancer screening, diagnostics, treatment, and follow-up care.5, 6, 8

Breast Cancer in African American Women: State of the Nursing Science

Breast cancer has been noted to be the single most common type of cancer studied by nurse researchers. 9 A recent review of reports published over the past decade of outcomes of nursing research that addressed breast cancer among African American women suggested that this body of research has contributed valuable information and insights relative to the attitudes, beliefs, and perceptions of African American women relative to breast cancer, breast cancer screening, and breast cancer control; breast care behaviors; access and utilization of breast care services by African American women; and the lived experiences of African American breast cancer survivors.10 The same is true of insights and information gleaned relative to the design and evaluation of instruments and interventions targeted for use among African American women. The review, however, also revealed several gaps and limitations, including gaps in the conduct of research focused on the needs of African American women across the breast cancer continuum; gaps in the conduct of research focused on the needs of African American women across the breast cancer care continuum; gaps in research focused on the needs and concerns of at-risk groups of African American women; gaps in the conduct of research aimed toward designing and evaluating strategies to increase access, improve utilization of breast care services, and minimize and/or overcome barriers to care experienced by African American women; and limitations in the research relative to the theoretical underpinnings, design/methods, sampling, instrumentation, data analysis that affect the generalizability of the research findings.

The term breast cancer is used to denote several diseases in which malignant cells arise from tissues in the breast. Breast cancers are typed and classified depending on the point of origin; whether the disease is noninvasive and is confined to the ducts, lobules, or nipples or whether the disease is invasive and has invaded the ducts, lobules, or nipples; and, the histological characteristics. Each of these diseases is distinct relative to prevalence, presentation, histology, treatment, follow-up, and prognosis. Yet, review of articles that describe the outcomes of studies aimed to address breast cancer among African American women that were published over the past decade in Oncology Nursing Forum, Cancer Nursing, Journal of the National Black Nurses Association, the Journal of the Association of Black Nursing Faculty, Nursing Research, Image the Journal of Nursing Scholarship, Research in Nursing & Health, the Journal of Chi Eta Phi Sorority, the Journal of Cultural Diversity, the Journal of Transcultural Nursing, and the Journal of Multicultural Nursing and Health suggest that nurse researchers generally do not factor the distinctions into the study design (Table 1).

Table 1. Nursing Research Focused on Breast Cancer Among African-American women, 1994–2004

Citation	Purpose	Sample, characteristics and setting	Methods	Design	Theory/framework
Access to Care
Burnett et al. (1995) 11	Identify perceived barriers to access and use of breast and cervical cancer screening services and to examine the impact of knowledge, attitudes, and influences of others on the use of breast and cervical cancer screening services among medically underserved women.	399 predominantly African-American women recruited from breast and cervical cancer screening sites in DC	Quantitative	Nonexperimental	Theory of reasoned action
Bibb (2001) 12	Identify relationships between access to care and stage of diagnosis of breast cancer in African American and Caucasian women.	Tumor registry records of 62 African American and 573 Caucasian women diagnosed with breast cancer	Quantitative	Nonexperimental	Study of access
Breast Cancer Knowledge, Attitudes and Beliefs
Barroso et al. (2000) 13	Compare the beliefs and attitudes of African-American and white women about health, perceptions of susceptibility to cancer, susceptibility to breast cancer, beliefs about the benefits of early cancer detection, perceptions of the seriousness of breast cancer, and perceived health locus of control.	152 African-American and 197 white women; recruited from multiple health care settings in western Florida.	Quantitative	Nonexperimental	Health belief model; Locus of control framework
Douglass et al. (1995) 14	Identify differences in health beliefs, breast cancer beliefs and breast cancer early detection practices of African-American and white women	117 African-American and 157 white women recruited from a designated school district and from two African- American women's groups	Quantitative	Nonexperimental	Not reported
Lawson (1998) 15	Examined the perceived determinants of risk for breast cancer of African- American women.	One 40-year-old African-American woman diagnosed with a breast cancer.	Qualitative	Nonexperimental
Moore (2001) 16	Examined the images of breast cancer, the perceived risk for developing breast cancer, and the accounts of the breast cancer experience among a sample of African-American survivors.	23 African-American women and 24 white American women survivors of stage I, stage II, stage III and stage IV breast cancer.	Qualitative	Nonexperimental
Graham (2002) 17	Examine relationships between health beliefs and the practice of breast self-examination among African-American women.	179 African-American women; recruited from a major teaching hospital, churches, and health fairs in NY.	Quantitative	Nonexperimental	Health belief model
Breast Cancer Education
Adderley-Kelly & Green (1997) 18	Evaluate the impact of individual instruction, one-on-one practice and feedback on the breast self-examination practices of elderly African-American women	25 African-American women 60 to 84 years of age who resided in a subsidized housing facility for the elderly.	Quantitative	Experimental	Social learning theory
Wood et al. (2002) 19	Test the efficacy of an age and race sensitive, self-monitoring video on breast health in increasing knowledge about breast cancer risk and screening and breast self examination proficiency in older African- American and Caucasian women.	254 African-American and 74 Caucasian women 60+ years of age.	Quantitative	Nonexperimental	Social learning theory
Grindel et al. (2004) 20	Explore the role of affect in the presentation of breast health recommendations.	450 African-American women who had not had a mammogram in the past year; recruited from three Southern rural counties.	Quantitative	Experimental	Persuasive health message framework
Instrumentation
Champion & Scott (1997) 21	Describe the psychometric properties of culturally sensitive scales designed to measure beliefs about mammography and breast self-examination screening in African-American women.	329 African-American women	Quantitative	Nonexperimental	Health belief model
Ford et al. (2002) 22	Evaluate a breast cancer risk factor survey, items in which were a compilation of items from a number of commonly used epidemiologic cancer risk factor surveys, for its appropriateness for use among African-American women.	20 African-American women; recruited from the Henry Ford Health System	Qualitative	Nonexperimental
Breast Cancer Screening and Early Detection
Lauver (1994) 23	Explore the influence of anxiety, utility beliefs, norms and habit on care-seeking behaviors of Caucasian and African-American women seeking care for a self-identified breast cancer symptom	71 African-American women and 64 Caucasian women seeking evaluation for a self-identified breast cancer symptom at a breast surgery clinic in a metropolitan teaching hospital.	Quantitative	Nonexperimental	Theory of health care seeking and behavior; Triandis' theory of behavior
Walcott-McQuigg et al. (1994) 24	Explore the participation of middle-income African-American women in health promotion and disease prevention behaviors.	36 middle-class African-American women; recruited from the membership of four African-American sororities in the Midwest.	Quantitative	Nonexperimental	Not reported
Phillips & Wilbur (1995) 25	Evaluate the health promoting behaviors of African-American nurses.	51 unemployed African-American women, 51 low-income African- American women, and 52 middle-income African-American women; recruited from nursing homes, social service agencies, elementary and high schools from eight communities in a large metropolitan area in the Midwest.	Quantitative	Nonexperimental	Breast cancer screening model of client health behavior
Champion & Menon (1997) 26	Identify variables associated with the mammography utilization and breast self-examination compliance among low-income African-American women.	328 low-income African-American women who were participants in a breast cancer screening intervention trial	Quantitative	Nonexperimental	Behavioral model of health services utilization
Guidry & Wilson (1999) 27	Evaluate the health promoting behaviors of African-American nurses.	49 African-American registered nurses; recruited at a regional conference from the membership of a nursing sorority.	Quantitative	Nonexperimental	Not reported
Phillips et al. (1999) 28	Explore beliefs about breast cancer, breast cancer screening, and possible differences in beliefs and screening behaviors among low-income and middle-income African-American women.	26 African-American women, 8 of which were teachers, 8 of which were service workers and 10 of which were unemployed, with no known history of breast cancer; recruited from a community-based center and a local teachers union in the Midwest.	Qualitative	Nonexperimental
Underwood (1999) 29	Examine the breast cancer screening behaviors of asymptomatic African- American women with risk factors known to contribute to the development of breast cancer and asymptomatic African-American women with no known risk factors.	197 African-American women, 40+ years-of-age; recruited from a community-nursing center in the Midwest.	Quantitative	Nonexperimental	Factors influencing breast cancer screening
Adams et al (2001) 30	Identify barriers to mammography screening.	164 rural and urban African- American women	Quantitative	Nonexperimental	Not reported
Foxall et al. (2001) 31	Examine ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecological cancer screening.	138 white women, 37 African- American women, 29 Hispanic women, and 29 American Indian women; recruited by random sampling from a residential mailing list from a large city in a Midwestern state.	Quantitative	Nonexperimental	Not reported
Phillips et al. (2001) 32	Study the meaning of breast cancer screening among African-American women.	8 low-income and 15 middle-income African-American women without a history of breast cancer; recruited from metropolitan areas in the Northeast.	Qualitative	Nonexperimental
Kinney et al. (2002) 33	Examine the relationship between beliefs about God as a controlling force in health and adherence to breast cancer screening among African-American women.	52 African-American women from SE Louisiana who were participants in a study of a BRCA1 mutation.	Quantitative	Nonexperimental	Transactional model of stress and coping
Thomas (2004) 34	Examine associations between women's memories and their feeling concerning puberty, breast development, breast-feeding, breast cancer screening and their current breast cancer screening behaviors.	12 African-American women; recruited from churches who had at least an associate's degree, health insurance and had not been diagnosed with breast cancer.	Qualitative	Nonexperimental
Breast Cancer Survival and Survivorship
Northouse et al. (1999) 35	Describe the quality of life of African-American women with breast cancer and test a multivariate model of factors that may affect their quality of life.	98 African-American women with a confirmed diagnosis of breast cancer, who were at least one month post-diagnosis; recruited from medical oncology offices in the Southeastern region of Michigan.	Quantitative	Nonexperimental	Cognitive appraisal model of stress and coping
Henderson & Fogel (2003) 36	Determine how African-American women cope with a diagnosis of breast cancer.	43 African American breast cancer survivors from the southeastern US	Quantitative	Nonexperimental	Not reported
			Qualitative
Gates et al. (2001) 37	Identify the caring behaviors of African-American women and the demands of African-American women newly diagnosed with breast cancer.	13 African-American women with a first-time diagnosis of breast cancer; recruited from two oncology clinics in a mid-South metropolitan area.	Qualitative	Nonexperimental	Theory of culture-care diversity and universality
Lackey et al. (2001) 38	Describe the lived experiences of African-American women following the primary diagnosis and while undergoing initial treatment.	13 African-American women undergoing initial treatment for a primary breast cancer; recruited from two cancer clinics in the mid-South.	Qualitative	Nonexperimental
Wilmoth & Sanders (2001) 39	Identify personal issues and relationship concerns of African-American women from a southeastern urban community who had been treated for breast cancer.	16 African-American survivors of breast cancer; recruited from churches serving the African American community and from the Susan G. Komen Breast Cancer. Foundation Race for the Cure	Qualitative	Nonexperimental
Henderson et al. (2003) 40	Identify and study the support networks used by African-American women breast cancer survivors	43 African-American breast cancer survivors from the Southeast who participated in an African-American breast cancer support group.	Qualitative	Nonexperimental
Hamilton & Sandelowski (2004) 41	Assess the types of social support used by African-American women and African-American men with cancer	15 African-American women with breast cancer and 13 African- American men with prostate cancer from the Southeast.	Qualitative	Nonexperimental
Gil et al. (2004) 42	Describe the sources of uncertainty about cancer recurrence and patterns and frequencies of triggers of uncertainty about cancer recurrence and physical symptoms linked to long-term treatment side effects in older African-American and Caucasian breast cancer survivors	73 African-American and 171 Caucasian women, 49 to 87 years of age, who were 5 to 9 years beyond their breast cancer diagnosis.	Quantitative	Nonexperimental	Not reported

The continuum of breast cancer care can be broadly conceptualized as involving the provision of care relative to breast cancer prevention and/or risk management, screening, and early detection; diagnosis; disease management; supportive care, survival, and survivorship (Fig. 1). If the disease cannot be controlled, the spectrum of care would also include palliative care and end-of-life care. Upon review of this same body of literature, it was noted that the overwhelming majority of the reports focused on breast cancer screening of women of average risk. In addition, while there were several reports of studies focused on breast cancer diagnosis, treatment, and coping, very few addressed risk assessment and supportive care, and none addressed breast cancer prevention and/or risk management, palliative care or end of life care. 35–41

Figure 1. Breast cancer continuum.

Scientists remain uncertain as to exactly what causes breast cancer. However, factors known to increase a woman's chance of developing breast cancer include age, race, reproductive and menstrual history, history or hormone use, personal history of breast cancer, family history of breast cancer, genetic alterations, early age at first menstrual period, late age at menopause, late age at the time of birth of her first full-term baby, radiation to the chest at an early age, and certain breast conditions. Obesity after menopause, physical inactivity, and alcohol consumption have also been identified as risk factors for the development of breast cancer in women. 43, 44 Data reported by the National Cancer Institute Surveillance, Epidemiology and End Results System reflective of trends in breast cancer incidence by age and race indicate that, while the prevalence of breast cancer is higher among women of all racial and ethnic groups over the age of 50, African American women under the age of 40 have a significantly higher incidence rate of breast cancer compared with white women.2

The studies included in the review that focused on breast cancer screening and early detection among African American women tended to involve diverse groups of African American women. 23–34 The greater majority of the studies involved conveniently selected groups of women presumed to be at average risk. Several involved women who varied by education, occupation, economic status, and access to care. Few, however, appeared to have been designed to specifically target African American women with clinically defined breast cancer risk factors.

The impact of myths, misperceptions, misinformation, and fear on utilization of breast care services by African American women have been well documented by nurse scientists in the literature. 13–17 The same is true of reports focused on identifying challenges experienced by African American women associated with breast cancer education, outreach, access to breast care, and utilization of breast care services that are associated or due to factors associated with demographics, culture, economics and health care policy11, 12 However, while several reports of studies have been published that well define factors associated with the excess breast cancer morbidity and mortality among African American women, few reports of studies have been published, which describe methods, strategies, or interventions that have been tested to reduce and/or eliminate them.

A variety of designs and methods were used to conduct this body of research. While all of the research studies were subjected to peer-review and deemed to be scientifically sound, constraints observed relative to the design, sampling, instrumentation, data collection, and data analysis reportedly limit the generalizability of the findings. For example, most of the studies conducted by nurses over the past decade that focused on breast cancer among African American women were constructed using nonexperimental designs. The greater majority of the studies used nonprobability, convenience, and purposeful sampling. A variety of standardized and investigator-designed instruments were used to collect date during the course of the studies; however, descriptions of the psychometric properties of the instruments relative to reliability, and/or validity when used among African American populations, in most instances, were not reported. And, the methods and procedures commonly used to analyze the data were most often bivariate descriptive and inferential statistics.

Research Institute for Nurse Scientists: Response to the Challenge to Expand and Strengthen Nursing Science

It is generally believed that nurses could play a dominant role in facilitating efforts aimed toward eliminating the excess breast cancer morbidity and mortality experienced by African American women. Within the United States, nurses number 2.7 million and rank as the nation's largest and most highly regarded health care professional group. 45–47 Nurses engage in practice in virtually all health care settings. Whether functioning as nurse generalists or oncology nurse specialists, there are numerous opportunities for nurses to undertake efforts to promote breast cancer detection and control among racially, ethnically, and culturally diverse groups of women in acute care and community-based settings.

In an era where scientifically derived ‘evidence’ is used as a basis for nursing practice, it is imperative that nurses have a breadth of knowledge relative to the fundamentals of nursing science; knowledge of the current standards of nursing and medical practice; and, knowledge of the characteristics, needs, concerns, and challenges of diverse consumer and patient population groups. 48–51 A significant body of ‘evidence’ that describes the health care experiences of African American women across the breast care continuum has been generated. In order for nurses to more effectively engage in efforts capable of effecting a change in breast cancer morbidity and mortality, however, there is a need to expand and strengthen this body of science.

In an effort to respond to the challenge to expand and strengthen the body of nursing science that aims to address breast cancer among African American women a Research Institute for Nurse Scientists was developed. Funded by a grant from the Susan G. Komen Breast Cancer Foundation, the Institute was designed specifically for nurse scientists engaged in research proposed to reduce and/or eliminate excess breast cancer morbidity and mortality among African American women. The Institute, which aims to address identified gaps and limitations in the body of science, was designed to provide nurse scientists opportunities to enhance their base of knowledge and expertise in 7 core areas: State of the Science and the State of the Practice; Theories, Frameworks, and Models; Research Methods and Methodologies; Instrumentation; Biostatistics; Dissemination and Diffusion; and, Grant Development.

• The State of the Science and the State of the Practice Core was designed to provide nurse scientists opportunities to review current science and practice relative to breast cancer prevention/risk management, detection, breast cancer control, and breast cancer survivorship among African American women.

• The Theories, Frameworks, and Models Core was designed to provide nurse scientists opportunities to review theories, frameworks, and models for relevance and applicability to breast cancer research.

• The Research Methods and Methodologies Core was designed to provide nurse scientists experiences that would foster the utilization of robust methods and methodologies in the conduct of breast cancer research.

• The Instrumentation Core was designed to provide nurse scientists opportunities to evaluate instruments for use in the conduct of research among African American women.

• The Biostatistics Core was designed to provide nurse scientists experiences that would facilitate the use of state of the science biostatistics in the evaluation of outcomes of breast cancer research.

• The Dissemination and Diffusion Core was designed to provide nurse scientists experiences that would facilitate presentation and publication of the outcomes of research in peer-reviewed forums.

• The Grant Development Core was designed to provide nurse scientists experiences that would lead to the development of competitive research proposals.

During the course of the Institute, the nurse scientists are engaged in discussions about breast care concerns and needs of African American women; the availability and accessibility to breast care; and, the standard of breast care received by African American women. In addition, the nurse scientists are afforded opportunities to discuss research methods and designs; the utility of various theories, frameworks, or models for use in the conduct of breast cancer research involving African American women; evaluate the psychometric properties of instruments/tools or procedures for use in the conduct of breast cancer research involving African American women; engage in the review of reports being prepared for publication by peers within the Institute that address breast cancer among African American women for publication, and, the development of proposals for funding.

Institute Accomplishments to Date

Much has been accomplished since the Institute was established. The long-term goals of the Research Institute for Nurse Scientists are 1) to expand and strengthen the body of nursing science that aims to improve/enhance breast detection, breast cancer control, and breast cancer survivorship among African American women, and 2) to increase the number of nurse scientists engaged in programs of research designed to develop interventions to reduce the excess breast cancer morbidity and mortality experienced by African American women. Since the Institute was launched in January 2005, a cohort of 20 nurse scientists from across the country have been recruited to the Institute from nursing organizations chartered and commissioned to work toward improving the health status of African American population groups. Included among them were the National Black Nurses Association; Chi Eta Phi Nursing Sorority; the Association of Black Nursing Faculty; and the Caribbean Nurses Association (Table 2). The recruitment of nurse scientists from these organizations was specifically sought given the organizations' mission to address the health care needs of African American, and other racially, ethnically, and culturally defined population groups, the organizations' support of scientific endeavors that are essential to evidenced-based practice, and the organizations' capacity and commitment to disseminate outcomes of scientific endeavors that address the health care needs of African American population groups in the peer-reviewed literature.

Table 2. Nursing Organizations Represented in the Research Institute for Nurse Scientists

The mission of the National Black Nurses Association is to provide a forum for collective action by African-American nurses to “investigate, define and determine what the health care needs of African Americans are and to implement change to make available to African Americans and other minorities health care commensurate with that of the larger society.”

The Association of Black Nursing Faculty aims to provide mentorship and support for African-American nursing faculty in the areas of teaching, research, service and advocacy.

The Chi Eta Phi Sorority, Inc is a national sorority of registered professional nurses and nursing students whose mission is to elevate the plane of nursing and increase interest in the field members of the sorority, for the nursing community, and other health care professionals.

The Caribbean Nurses Association is an association of nurses from the US Caribbean Islands. The association aims to provide means of support for nurses of all educational and professional backgrounds.

The collaborative effort of the scientists and the Institute leadership has resulted in the publication and dissemination of several reports focused on breast cancer among African American women. Included among them is the report of the current standards of breast cancer screening, diagnostics and treatment in the Journal of the Chi Eta Phi Sorotity; the publication of a series of reports in Advance for Nursing that highlight the efforts of nurse scientists and nurse clinicians to promote breast cancer risk assessment and risk management, early detection, and control among African American women in practice and community settings; the publication of a monograph dedicated to breast cancer among African American women by the Journal of the Association of Black Nursing Faculty; the presentation of a Breast Cancer Institute at the 2005 Annual Conference of the National Black Nurses Association. In addition, several of the nurse scientists are involved in the design and implementation of a clinical research study that aims to improve breast cancer risk assessment, screening, and follow-up among African American women with hereditary risk factors, the design and implementation of a clinical research study that aims to improve symptom management of African American women undergoing treatment for breast cancer; and the design and implementation of a clinical research study that aims to improve breast cancer risk communication between primary care providers and women predisposed to the development of breast cancer.

The Research Institute for Nurse Scientists began as an effort to enhance communication and collaboration among nurse scientists committed to reducing breast cancer morbidity and mortality among African American women. Since the Institute was established in January 2005, it has evolved into an effective model for engaging and supporting the work of nurse scientists. However, while much has been accomplished since the Institute was launched, concerted and sustained efforts are needed to ensure that its long-term goals are achieved.