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Breast Cancer
Awareness
Conversation Starters
By the Numbers: Stats
and demographics for
breast cancer.
Genetics:
Predispositions and
available tests
Risk Factors: Drug...
Cell growth involves a system of
checks-and-balances. When an
error occurs in a cell’s
development, it’s usually killed
th...
Tumor is limited
to the areas
within the
breast tissue
and the mass is
small, no more
than 2 cm in
diameter.
Tumor is > 5 ...
99% 2nd Three
Million
Breast Cancer by the Numbers
Number
One
Advanced
age. History of
ovarian
cancer.
Previous
radiation
therapy in the
breast or chest
region.
Nulliparity (no
childre...
GENETIC TESTING
Can Help To
Better Understand
Risks
And Take Action!
CancerTYPE
ID
Oncotype
Dx
MammaPrint
Predispositions
...
Early detection is associated
with higher patient outcomes!
Identifying
women at high
risk and
increasing
surveillancePrognosis is
higher when the
cancer is
detected early,
preferabl...
The Three Tiers of Early Detection
Early Detection = Better Outcomes!
Self-Breast Exam Mammogram Clinical Exam
PointsforTeaching Self-Breast Exam
Mammogram
Clinical Breast Exam
Schedule 1st screening mammogram at the age of
40, and t...
Hormonal fluctuations alter the way
the breasts look and feel. They’re
most consistent 2 days after
menstruation ends.
Self-breast examination involves
both breasts (plus the nipples),
the axillary regions, and the
surrounding tissue (from t...
Teaching Points: Self-Breast Exam
Gently squeeze each
nipples to assess for
drainage.
Examine up to the
clavicles (AKA: co...
Stand in front of a mirror
and examine the
appearance.
Stand in the shower.
Palpate breasts using 3
levels of pressure.
La...
Standing in front of a mirror, view
breasts from a forward position.
Observe the symmetry, shape, color,
and size of each ...
Look and Feel in the Shower
This allows the breasts to be visualized
from a different angle. Standing in the
shower ensure...
Palpation Pattern Technique
With hand still above head, palpate
the breast with the free hand. Using
the Up and Down patte...
Be Thorough and Consistent
Cover All Areas
It helps to get into the habit of starting
on the same side each time.
Remember...
Remember the Nipples!
Nipples Included
Be sure to include the nipples. Inspect
them for changes in size, color, texture,
s...
Lay Down and Pillow Prop
On a Pillow
Lay down and place a pillow under
one shoulder to prop up the breast to
be examined f...
2 versions:
Screening
(standard) and
diagnostic
(when a mass is
detected).Considered to
be the “Gold
Standard” for
early d...
Provides an
extra “check” in
addition to the
self-breast
exam.
The clinician
observes and
feels the breasts.
Involves visu...
Diagnosed… Now What?
Individualized Treatment Plan.
Portrays a
complete
picture of the
case by
providing
information
such as grade,
size, and
margin of the
tumor.Diagnostic
t...
Chemo
Endocrine
Treatment Options
Surgery
Radiation
A regimen of powerful drug
combinations that may be
thought of as ‘cel...
TreatmentModalities Primary Treatment
Adjuvant Treatment
Palliative Treatment
The method used as the main form of curative...
Mastectomies are named based
upon the portion of the breast
removed (if the nipple and
areola are left intact) and
involve...
The minimal amount of radiation
is used to accomplish the desired
therapeutic response. The goal is
to kill cancerous cell...
Cell-cycle specific drugs target a
particular phase of cellular
replication while non-cell-cycle
specific drugs use other
...
Actions: Drugs that inhibit or alter
the effects estrogen. Indications:
adjuvant therapy, prophylactic
treatment, or activ...
Antineoplastic
Agents
Hormones
Alkylating
agents
Antimetabolites
Antitumor
antibiotics
Nitrosoureas
Topoisomerase
I inhibi...
Post-Op Mastectomy
Nursing Care Plan.
1. Risk for infection, related to surgical incision.
2. Ineffective tissue perfusion, related to edema.
3. Acute pain, rel...
Nursing Interventions
 Infection: Monitor incision site. Provide
wound care, as ordered. Educate
patient on symptoms of i...
 The patient doesn’t experience any signs of infection.
 Adequate tissue perfusion is maintained.
 Pain remains at or b...
What about
the 1%?
Consequences of Being Ill-Informed
metastasis
Delayed detection
Myth perpetuation that’s it a
“girl” disease
Unaware of ri...
For any woman reading this, I hope it helps
you to know you have options. I want to
encourage every woman, especially if y...
Many Thanks to these Amazing Sources…
1 Hamilton, R. (2012). Being young, female, & BRCA positive. American Journal of Nur...
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Breastcancerawarenessconversationstartersseriesbyistudentnurse 141103154720-conversion-gate02

  1. 1. Breast Cancer Awareness Conversation Starters
  2. 2. By the Numbers: Stats and demographics for breast cancer. Genetics: Predispositions and available tests Risk Factors: Drugs, hereditary, diet, reproductive, more. The Down-Low: What breast cancer is, how it’s classified. Staging: Criteria for the 4 stages of breast cancer. Self-Breast Exam: Timing, processes, key points for teaching. Clinical Exam: Timing, purpose, who provides the examination. Mammogram: Timing, methods, diagnostic vs. screening. Public Health: The purpose and goals of the nurse. Early Detection: 3 Tiers, overview of each. Take-Away Points Nursing Care Planning: Diagnoses, interventions, outcomes. References: Scholarly journal articles that totally rock! Men: Remembering the 1%, consequences of being ill-informed. Diagnostics: Lab tests, imaging, biopsy, patho report, immunoassay. Treatment: Forms, surgery, chemo, radiation, endocrine.
  3. 3. Cell growth involves a system of checks-and-balances. When an error occurs in a cell’s development, it’s usually killed through apoptosis, or cellular suicide. When this mechanism malfunctions, unhealthy cells are able to continue growing. Breast cancer develops when cells begin to proliferate, or multiply, abnormally… unchecked. A tumor is classified based upon its relationship with the basement membrane. Non-invasive (in-situ) forms are anchored to the membrane. Invasive (infiltrating) masses may to spread to other tissues, such as the lymph nodes. A tumor is staged according to the diameter of the mass and the amount of surrounding tissue that’s invaded. Classifying & StagingWhat is Breast Cancer? The Down-Low on Breast Cancer
  4. 4. Tumor is limited to the areas within the breast tissue and the mass is small, no more than 2 cm in diameter. Tumor is > 5 cm but limited to breast tissue, or < 2 cm in lymph nodes of the arm, or 2-5 cm in lymph nodes of the breast only. Tumor has metastasized beyond the breast and spread to external lymph nodes, tissue groups and organs. Tumor is > 5 cm and has spread beyond the breast tissue, invading the lymph nodes located under the arm. STAGE 1 STAGE 2 STAGE 3 STAGE 4 Staging Breast Cancer One Two FourThree
  5. 5. 99% 2nd Three Million Breast Cancer by the Numbers Number One
  6. 6. Advanced age. History of ovarian cancer. Previous radiation therapy in the breast or chest region. Nulliparity (no children) and having children but not breastfeeding increases lifetime estrogen exposure. Reproductive Age/History Carriers of the BRCA 1 or 2 gene. 1st degree relatives (mother or sister) diagnosed with breast cancer. Genetics Leading theories speculate that high glucose levels act as “fuel” that triggers growth of cancerous cells. Use of certain hormonal contraceptives or hormonal replacement therapy increases estrogen exposure. Hormones Diet/Obesity Risk Factors for Breast Cancer
  7. 7. GENETIC TESTING Can Help To Better Understand Risks And Take Action! CancerTYPE ID Oncotype Dx MammaPrint Predispositions Ashkenazi Jewish heritage 1st degree relatives BRCA-1 or BRCA-2 gene carrier Genetic Tests
  8. 8. Early detection is associated with higher patient outcomes!
  9. 9. Identifying women at high risk and increasing surveillancePrognosis is higher when the cancer is detected early, preferably before it metastasizes. Efforts are focused on educating the public about methods for early detection, such as performing monthly self- breast exams. Nurse’s Role in the Community help women understand benefits public awareness health promotion Early detection surveillance identify high risk improve access
  10. 10. The Three Tiers of Early Detection Early Detection = Better Outcomes! Self-Breast Exam Mammogram Clinical Exam
  11. 11. PointsforTeaching Self-Breast Exam Mammogram Clinical Breast Exam Schedule 1st screening mammogram at the age of 40, and then once again every 5 years. If high risk, schedule 1st imaging between the ages of 25-30 and then once again every year. Schedule 1st clinical breast exam with a clinician beginning at the age of 20 and then once every 2- 3 years until the age of 40. Following 40, increase frequency to once a year. Perform the self-breast exam once a month, 2 days after menstruation. If post-menopausal, perform on the same day, each month. Consistent performance promotes familiarity!
  12. 12. Hormonal fluctuations alter the way the breasts look and feel. They’re most consistent 2 days after menstruation ends.
  13. 13. Self-breast examination involves both breasts (plus the nipples), the axillary regions, and the surrounding tissue (from the sternum, extending to the underarm region, and up to the clavicles). Women are encouraged to exam their breasts on a monthly basis in order to identify early changes.  The breasts are both visualized and palpated.  Size, shape, and texture of the breasts, axillary, and surrounding tissue are examined.  The breasts are palpated using 3 levels of pressure: light, medium, and firm; in order to cover the entire tissue span. How to ExamineWhat, When, & Why About the Self-Breast Exam
  14. 14. Teaching Points: Self-Breast Exam Gently squeeze each nipples to assess for drainage. Examine up to the clavicles (AKA: collar bones). Visualize with arm over head, arms down, and arm propped under a pillow. Common approaches include the checker- board, circle, and square methods. Palpate using 3 levels of pressure: Light, medium, and firm. The axillary, or underarm regions contains lymph nodes. The upper left quadrant is the most common area for breast cancer to originate! Feel and look at both breasts, nipples, axillary, and surrounding tissue, up to the clavicles. Palpate using 3 levels of pressure: light, medium, and firm. Gently squeeze each nipple to assess for drainage. 3 visualizations: arms over head, arms down, and pillow propped under the shoulder. Technique and Pattern: 1) Up and Down, 2) Circle 3) and Wedge. Chose one to use. Examine breasts ↑ to the clavicles (AKA: collar bones). The axillary (AKA: underarms/pits) contain lymph nodes. The upper left quadrant is the most common area for breast cancer to originate! Feel and look at both breasts, nipples, axillary, and include all of the surrounding tissue. Goal: Identify Changes!
  15. 15. Stand in front of a mirror and examine the appearance. Stand in the shower. Palpate breasts using 3 levels of pressure. Lay down, prop up shoulder on a pillow and feel the breasts. 3 Main Steps of the Self-Breast Exam
  16. 16. Standing in front of a mirror, view breasts from a forward position. Observe the symmetry, shape, color, and size of each breast, checking for any new changes. Inspect in Front of a Mirror Next, change the perspective: raise arms over the head, and press palms together. Be sure to also look in the underarm region and visualize the nipples.In the Mirror
  17. 17. Look and Feel in the Shower This allows the breasts to be visualized from a different angle. Standing in the shower ensures that the same position will be used every month. Examine the breasts in the shower. Place the hand on the side of the breast to be examined behind the head. Look down at the breasts to observe the same characteristics as before. In the Shower
  18. 18. Palpation Pattern Technique With hand still above head, palpate the breast with the free hand. Using the Up and Down pattern technique, feel the breast with the finger pads of the first three fingers. Palpate from the outer side to the inner side of the breast; then up and down in order to cover the entire tissue span. Continue by palpating up the axillary regions. Repeat on other side. Up-and-Down
  19. 19. Be Thorough and Consistent Cover All Areas It helps to get into the habit of starting on the same side each time. Remember to raise the arm on the same side to be examined. When palpating, be sure to cover the entire span, including the nipple, breast tissue to the collar bone, the upper chest area, and underarm region.
  20. 20. Remember the Nipples! Nipples Included Be sure to include the nipples. Inspect them for changes in size, color, texture, symmetry, or shape. Feel for lumps, bumps, thickening, or other changes. With the thumb and ring finger, gently squeeze the nipple to access for fluid leakage. Discharge is an abnormal finding and must be reported.
  21. 21. Lay Down and Pillow Prop On a Pillow Lay down and place a pillow under one shoulder to prop up the breast to be examined first. Use the same techniques as before and include all areas. Repeat for the other breast. This position allows the breast tissue to be felt from a different angle. It also enables a deeper level of palpation.
  22. 22. 2 versions: Screening (standard) and diagnostic (when a mass is detected).Considered to be the “Gold Standard” for early detection of breast cancer. Provides an image to visualize the breast tissue by evaluating the density. Epithelial and stromal cells, collagen, and fat tissue all influence the breast density. Screening Mammograms breast imaging screening reduces mortality rates Gold Standard diagnostic version is more detailed
  23. 23. Provides an extra “check” in addition to the self-breast exam. The clinician observes and feels the breasts. Involves visualization (external) and palpation of the breast, surrounding tissue, and the nipple…similar to the self- exam. Clinical Breast Exams once a year starting at 40 exam by clinician remind your provider to examine palpate start at age of 20 extra check Identify palpable masses observe
  24. 24. Diagnosed… Now What? Individualized Treatment Plan.
  25. 25. Portrays a complete picture of the case by providing information such as grade, size, and margin of the tumor.Diagnostic technique used to measures the level of certain molecules such as androgens (sex hormones) and antibodies. Immunoassay PathoReport The diagnostic mammogram, ultrasound tomography (UST), and magnetic resonance imaging (MRI) provide internal visualization. Imaging A tissue sample is obtained and then analyzed. Several types are available. This is the only method for a definitive diagnosis. Blood samples monitor factors such as serum tumor markers, calcium levels, hormones, and alkaline phosphatase. LabWork Biopsy Labs and Diagnostic Procedures
  26. 26. Chemo Endocrine Treatment Options Surgery Radiation A regimen of powerful drug combinations that may be thought of as ‘cell poison.’ Various forms are available. All or part of the breast tissue is removed. May include the nipple, lymph nodes, or only select tissue. A high dose is delivered in fractions to kill cancerous cells while allowing healthy ones time to recover. Drugs that inhibit or alter the effects of hormones. Used for estrogen-receptor positive breast cancer.
  27. 27. TreatmentModalities Primary Treatment Adjuvant Treatment Palliative Treatment The method used as the main form of curative treatment. This usually involves surgery, but may also be another form, such as radiation or chemo. Therapies that complement or enhance the primary treatment. Chemo and endocrine therapy are often used as adjuvants to surgery. Purpose is not curative; rather, it’s to slow tumor growth. It’s used to promote comfort and enhance quality of life by providing relief of symptoms.
  28. 28. Mastectomies are named based upon the portion of the breast removed (if the nipple and areola are left intact) and involvement of surrounding tissues, such as the lymph nodes. Major post-op considerations include incision site infection, fluid balance, and the impact on the woman’s body image.  Lumpectomy: Only the lump is removed (“conservative”).  Partial mastectomy: Only part of the breast is removed.  Simple mastectomy: Breast removed, but the nipple/ areola remains intact.  Radical (Halsted) mastectomy: Breast, nipple/areola, and the lymph nodes are removed. Major Procedure TypesSurgery Down-Low Mastectomies
  29. 29. The minimal amount of radiation is used to accomplish the desired therapeutic response. The goal is to kill cancerous cells while allowing enough time for healthy ones to recover between treatments. Treatment itself is not painful, but rays can irritate the skin, causing a sunburn-like reaction. Fatigue is also common.  As the total radiation dose is fractionated rather than given all at once, each treatment is called a fraction.  Average length/frequency: 2-8 weeks; 4-5 times per week.  Average time: 20 minutes per fraction…up to several hours, including prep and post- treatment monitoring. Radiation ConceptsWhat, How, Why Radiation Therapy
  30. 30. Cell-cycle specific drugs target a particular phase of cellular replication while non-cell-cycle specific drugs use other mechanisms. Many chemo drugs destroy cells that replicate quickly. Alopecia and gastrointestinal disturbances are common as hair and mucosal cells replicate rapidly.  The risk of infection increases as immune system function is compromised.  Maintaining hydration and general nutritional status are priorities.  Nausea and vomiting must be proactively managed through administration of antiemetic drugs and dietary adjustments. Chemo-ConceptsMechanism of Action Chemotherapy
  31. 31. Actions: Drugs that inhibit or alter the effects estrogen. Indications: adjuvant therapy, prophylactic treatment, or active treatment of metastatic cancer of estrogen- receptor positive tumors. Major classes: GnRH agonists, aromatase inhibitors, and selective estrogen receptor modulators (SERMs), and antiestrogen agents. A SERM drug that antagonizes (inhibits) the effects of estrogen while agonizing/mimicking the hormone’s actions in select tissues. May be used for prophylaxis in high-risk cases, as an adjuvant therapy for up to 5 years following primary treatment, or for metastatic tumors. Avoid use with SSRIs as toxicity may occur. Tamoxifen (Nolvadex)What, How, Why Endocrine Therapy
  32. 32. Antineoplastic Agents Hormones Alkylating agents Antimetabolites Antitumor antibiotics Nitrosoureas Topoisomerase I inhibitors Drugs that Fight Cancer Major Drug Classifications
  33. 33. Post-Op Mastectomy Nursing Care Plan.
  34. 34. 1. Risk for infection, related to surgical incision. 2. Ineffective tissue perfusion, related to edema. 3. Acute pain, related to surgery. 4. Disturbed body image, related to loss of breast. 5. Interrupted family processes, related to altered roles, relationships, and functions secondary to illness and treatment. 6. Fear, related to disease process/prognosis. Nursing Diagnoses Nursing Care Planning Mastectomy
  35. 35. Nursing Interventions  Infection: Monitor incision site. Provide wound care, as ordered. Educate patient on symptoms of infection and other signs that warrant action.  Pain: Assess on a 1/10 scale including characteristics. Identify the level that’s tolerable (example: 3/10). Administer medications and reassess response.  Perfusion: Position on non-affected side to promote lymphatic drainage. Monitor for signs of lymphedema, such as arm pain.  Body Image: Establish a therapeutic patient-nurse relationship and supportive environment that promotes expression of response to body changes.  Role: Assess family dynamics and support system. Aid in developing a plan that addresses the need for changed roles and functions throughout recovery.  Fear: Encourage expression of fears about diagnosis, treatment, and mortality. Arrange access to spiritual services as appropriate.
  36. 36.  The patient doesn’t experience any signs of infection.  Adequate tissue perfusion is maintained.  Pain remains at or below tolerable levels throughout recovery.  A positive body image is maintained, independent of decision for reconstructive breast surgery.  New family member roles are acknowledged and effective adjustment methods are identified.  Sources of fear are identified and explored. A plan that addresses effective coping methods is established. Anticipated Outcomes The Goals of Nursing Care
  37. 37. What about the 1%?
  38. 38. Consequences of Being Ill-Informed metastasis Delayed detection Myth perpetuation that’s it a “girl” disease Unaware of risk factors, such as carrying the BRCA-1/2 gene shame Among those diagnosed isolation And higher mortality rates
  39. 39. For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices. Angelina Jolie, in a statement made to the New York Times. Angelina is reported to be a carrier of the BRCA gene. She underwent a prophylactic double mastectomy. Lessons from Pop Culture Image by Michael Cook and MercatorNet.com “
  40. 40. Many Thanks to these Amazing Sources… 1 Hamilton, R. (2012). Being young, female, & BRCA positive. American Journal of Nursing, 112(10), 26-31. Retrieved from http://www.nursingcenter.com/lnc/cearticle?tid=1436197 2 Lieberthal, R. D. (2013). Economics of genomic testing for women with breast cancer. American Journal of Managed Care, 19(12), 1024-1031. Retrieved from http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n12/Economics-of-Genomic-Testing-for- Women-With-Breast-Cancer 3 Mills, S. (2009). Clinical Queries: Performing a clinical breast exam. Nursing, 43(9), 68. Retrieved from http://www.nursingcenter.com/lnc/Static-Pages/CLINICAL-QUERIES-Performing-a-clinical-breast-exam 4 Nichols, M. (2012). The nurse’s role in self-breast examination education. Plastic Surgery Nursing, 32(4), 143-145. Retrieved from http://www.nursingcenter.com/lnc/CEArticle?an=00006527-201210000-00004&Journal_ID=496448&Issue_ID=1470639 5 Opdahl, S., Alsaker, M. D., Janszky, I., Romundstad, P. R., & L J Vatten, L. J. (2009). Joint effects of nulliparity & other breast cancer risk factors. British Journal of Cancer, 105, 731-736. Retrieved from http://www.nature.com/bjc/journal/v105/n5/full/bjc2011286a.html 6 Pelusi, J. (2006). Sexuality & body image: Research on breast cancer survivors documents altered body image & sexuality. American Journal of Nursing, 106(3), 32-38. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=630712 7 Pieszak, S. (2011). Evidence-based interventions for chemotherapy-induced nausea and vomiting. American Nurse Today, 6(10). Retrieved from http://www.americannursetoday.com/article.aspx?id=8310 8 Ruppert, R. (2011). Radiation therapy 101. American Nurse Today, 6(1), 24-29. Retrieved from http://www.americannursetoday.com/radiation-therapy-101/ 9 Thomas, E. (2010). Men’s awareness & knowledge of male breast cancer. American Journal of Nursing, 110(10), 32-40. Retrieved from http://www.nursingcenter.com/lnc/CEArticle?an=00000446-201010000-00027&Journal_ID=54030&Issue_ID=1071532 10 Walden, P. (2010). A chemotherapy primer. Nursing Made Incredibly Easy! 8(3), 18-26. Retrieved from http://www.nursingcenter.com/lnc/static?pageid=1012954 11 Weaver, C. (2009). Caring for a patient after mastectomy. Nursing, 39(5), 44-48. Retrieved from http://www.nursingcenter.com/lnc/static?pageid=869347 Copyright © 2014, iStudentNurseSee more at iStudentNurse.com/breast-cancer-awareness/

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