Breast Cancer isn't pink or pretty.
For women, the most frequent site of a newly diagnosed cancer is the breast, followed by lung and colon. Breast cancer is not as common in men, occurring in roughly 3000 men each year, per the American Cancer Society (ACS).
There are many types of breast cancer: ductal carcinoma in situ, invasive ductal carcinoma, tubular carcinoma, medullary carcinoma, mucinous carcinoma, inflammatory breast cancer ... that can be classified according to certain characteristics: HER2 positive, triple negative ...
Breast cancer facts:
- Breast cancer has a high survival rate overall.
- Breast cancer is frequently found in the upper, outer breast quadrant in the axilla.
- Signs include lumps, dimpling, discharge, rash, burning sensation.
Modify the risk!
- Get moving!
- Obtain a health weight.
- Reduce alcohol use to one drink daily or fewer.
- Have a child, or a few children, and breastfeed.
- Choose non-hormone-based birth control.
- Use alternate therapies for menopause symptoms, avoiding hormones and soy.
Non-modifiable risk factors
- Getting older.
- Women are at higher risk than men.
- Menstruating earlier or later in life than is average.
- Inheriting certain gene defects is not common, but having the identified genetic defects increases risk significantly.
- African-American women are at risk for development of breast cancer while younger than 45 years.
(per the ACS)
Many of these risks, including obesity, are directly tied to prolonged or excess exposure to estrogen.
Screening is performed before there are signs of a condition.
To screen or not to screen?
- Mammograms have become so sensitive that they often pick up non-cancerous areas or cancers that do not require intervention, costing money, time, and worry.
- Mammograms are not very specific to breast cancer for people younger than 50 years due to tissue density.
- Ultrasounds, MRI scans, biopsy, and experimental imaging techniques are also available, but are not considered under typical screening circumstances.
- The US Preventive Services Task Force recommends screening via mammography every two years for women aged 50-74 years for individuals with no factors such as family or personal history.
- The American Cancer Society women aged 45-54 years be screened annually, and women older than 55 years screened every two years.
- The ACS and CDC reiterate that clinical and self-breast exams do not demonstrate good evidence for reducing the risk of dying from cancer.
What do nurses tell their clients, then?
- Self-breast exams are not as useful as being familiar with the look and feel of your breasts. If something looks or feels abnormal, talk to your health care provider. Even the smallest new dimple is important!
- If you think you'd like to begin screening sooner than recommended, talk to your health care provider. This can often be done for peace of mind, if for no other reason. Screening guidelines are not hard and fast rules.
- If you have risk factors that increase your risk of breast cancer, talk to your health care provider. Risk factors include obesity, stress, genetic mutations, birth control use, and alcohol use.
Options for treatment depend on the type of breast cancer, characteristics, and the stage of the breast cancer (TiS/0, 1A/1B, 2A/2B, 3A/3B/3C, 4). Treatments are usually combined to produce the best outcome.
- Surgery - breast conserving or mastectomy:
- encourage patient to use continued gentle movement of affected side while healing!
- Chemotherapy - many available systemic medications, used in any of these ways:
- before surgery to shrink tumor
- after surgery to kill remaining cells
- as the primary treatment
- Targeted therapies - monoclonal antibody or kinase inhibitor
- Radiation therapy - localized treatment of the cancer:
- External: beamed down from a machine
- Internal: radioactive implant
- Hormone therapy - used in one of two ways:
- to reduce recurrence risk
- to treat hormone-positive cancers
Immediate issues include lost income, medical bills, fatigue, fear, feeling alone, image perception, and lack of family support. Counseling and groups are widely available to assist clients in this journey. A breast cancer navigator is invaluable to assisting the client in gathering and using resources of every kind.
Survival issues vary, but include sexuality difficulties, memory changes, concentration difficulties, lymphedema, and the prevention of recurrence. After the 5 year mark, when clients with breast cancer have a reduced risk of recurrence, many clients feel abandoned, even as fears and symptoms persist. Continued support from health care providers is essential.
Nursing care clearly depends on the client's place in the process of their care, but here is a start.
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