2. Mammograhy
The primary goal of mammography is to screeen
asymptomatic women to help detect breast cancer at
an early stage.
The goal of screening mammography is to find cancers
before they are clinically palpable, more likely to be
small, and less likely to have nodal involvement.
Few studies factor the effect of the fact that treatment
at earlier stages carries less morbidity and has more
treatment options.
by Yosef A.
3. In general a routine screening mammography consists
of a MedioLateral Oblique (MLO) view
CranioCaudal (CC) view
• With modern low-dose screening, the dose is less than
0.1 rad per study (chest x-ray is 0.025 rad per study)
• The effectiveness of screening also varies depending
on the density of the breast. When the breast density
increase the sensitivity of the mammography
decreases.
• A negative mammography study cannot always
exclude cancer
• It is important to note that the false negative rate is
10%-15%.
by Yosef A.
4. Most studies of mammography use mortality as an end
point. A study in women 40 years or older has reduced
mortality by 20%-30%.
Screening Interval
age ACOG ACS NCI USPDTF
40-49 1-2 years annually 1-2 years Discuss with
MD
50-74 annually annually 1-2 years 2 years
by Yosef A.
5. Screening guidelines for women younger
than age of 40
conditions Timing of annual mammography
Lobular ca in situ/breast ca dx
First degree relative with
premenopausal breast ca
Mantle's irradiation for Hodgkin's ds
BRCA1 or BRCA2 mutation
At time of dx
10 years earlier than relatives age of dx
8 years after completion of theraphy
Age 25-35 years
by Yosef A.
6. Breast imaging Reporting and data system
0 means Needs further evaluation
1 Means NEGATIVE
2 Means Benign findings
3 Means Probably benign findings
4 Means Suspicious abnormality
5 Means Highly suggestive of malignancy
6 Means Proven malignancy
by Yosef A.
7. Abnormalities found on mammography screening may
need further evaluation with additional Mammograhy
views and other imaging modalities.
You can find a mammographic lesions and micro
calcification.
Mammographic lesions are masses shows carcinoma
Micro calcification shows
Digital mammography gives more detailed information
by contrast and
by Yosef A.
8. Nursing care consideration for a women with
mastectomy
A woman undergoing mastectomy will need more
nursing care than one undergoing lumpectomy, as well
as extra emotional support and extensive patient
education about postoperative care. Let's look at what
you'll need to know.
When talking about mastectomy, we need to review
the role of axillary lymph node dissection. In cases of
invasive breast cancer and noninvasive cancer with
aggressive features, the axillary lymph nodes must be
evaluated to see if the cancer has spread locally.
by Yosef A.
9. Help your patient cope with the diagnosis
A cancer diagnosis of any type is likely to create a
whirlwind of emotions for the patient: fear, shock,
anger, anxiety, denial, and depression. Many women
are surprised by the diagnosis because they feel
healthy. Patients with breast cancer, unlike those with
many other cancers, rarely have unpleasant signs and
symptoms at the time of diagnosis.
by Yosef A.
10. Assessing and being sensitive to the patient's
emotional health is essential to nursing care and
effective teaching. Meet with the patient and her
support person in a private area outside the exam
room if possible. To make the best of your limited time
with her, start by asking about her concerns and fears,
and find out if she has questions. Acknowledge that
it's normal to feel overwhelmed and fearful and assure
her that the team will be there to help her.
by Yosef A.
11. Assess her learning needs and readiness to learn before you
begin teaching. Keep in mind that patients (and their
support persons) may have different information-seeking
behaviors.
Tell your patient that after mastectomy, she'll stay in the
hospital overnight. If she has breast reconstruction at the
same time as the mastectomy, her hospital stay will be 2 to
4 nights, depending on the type of reconstruction.
Explain to the patient that she'll be evaluated by her
healthcare provider a few weeks before the surgery. She'll
have blood tests, urinalysis, and an ECG
by Yosef A.
12. Postoperative care and teaching
After the surgery, in addition to monitoring vital signs
and other routine postoperative interventions, assess
your patient for pain, bleeding, hematoma or seroma
formation, and wound infection. Although infection
and wound healing problems are rare, they're most
likely to occur in the first 2 weeks after surgery. Follow
the surgeon's protocol for dressing changes and the
type of dressing used (gauze and transparent sterile
dressings are typical).
by Yosef A.
13. Encourage your patient to look at her incisions so she
can see what's normal; this will help her once she's
home and has to monitor for signs and symptoms of
infection, such as erythema, edema, warmth, and
purulent drainage. Although she may not feel
emotionally ready to look at her incisions, having you
by her side for the first look can be very reassuring and
comforting
Reducing the risk of lymphedema
by Yosef A.
