Breast Cancer and Nursing Interventions - Essay Example

? Breast Cancer Overview In working with breast cancer, it is important to know the major characteristics and risk factors associated with these types of malignancies. Breast cancer is a potentially life-threatening illness that can develop in both men and women, but occurs most frequently in women. Although several risk factors have been identified, the greatest of these remains gender. The risk of women developing breast cancer is 1000 times greater than the risk of men developing the same. It has been suggested that the primary reason for this is the increased number of mammary glands possessed by women as well as the fact that these glands are activated and used during pregnancy and lactation in ways that are physically impossible in men. Breast cancers can develop in one or both breasts and are typically classified as either invasive or noninvasive. Non-invasive cancers are also known as in situ cancers because they are confined to a specific site in the body. Invasive cancers have the ability to spread throughout the body. Patients with breast cancer will typically come in for treatment complaining of increased breast pain, unusual lumps felt under the skin, and/or nipple discharge when not lactating. Although these symptoms are often caused by benign, or non-cancerous, processes, it is imperative that an accurate evaluation is made of the patient’s condition to rule out the possibility of cancer. “In one study, 16 percent of women between ages 40 and 69 came to the doctor with breast complaints over a 10-year period.” (Barton, 1999) It is for this reason that evaluation of breast complaints and screening for breast cancer account for a large proportion of the primary physician’s case load and will remain a significant part of the primary care practice. Although there are an estimated 190,000 women in the United States diagnosed with breast cancer every year, the number of women receiving screening mammography as recommended continues to vary between only 72 and 81 percent. These numbers reflect the number of insured women who receive the recommended care of receiving mammography screening between the ages of 50 and 64 at least every two years, more frequently when additional risk factors have been identified. It goes without saying that uninsured women receive less preventative care. Despite this, breast cancer mortality has declined gradually over the past decade to about 40,000 per year. (Bloom, et. al, 2000) ‘Screening’ is performed when there are no signs or symptoms of illness as a precautionary measure in women with high risk factors or women within the recommended age group. When symptoms are present, such as breast pain, lumps and nipple discharge, evaluation procedures may require going a bit beyond the simple screening procedures. Even after a history of risk factors has been established and an examination focused on the specific complaint have been completed, ruling at most benign disorders as being the cause of complaint, treatment may still need to take place to remove the issues caused by the benignity. If cancer is suggested following these tests, discussions with the patient regarding diagnostic modalities – imaging, aspiration or biopsy – should be discussed during the office visit. Because breast cancer manifests itself in a variety of ways, differing in histologic, biologic and immunologic characteristics from patient to patient, this clinical evaluation may lead to referral of the patient to more advanced studies. As discussed in the previous section, breast masses can be placed into different categories, many of which are benign. Overall, cancerous lumps differ in many ways from benign lumps. They are much harder than benign masses; they are also fixed and stationary while benign lumps are more movable. Identifying of five risks through nursing assessment Although women with genetic dispositions for breast cancer are typically aware of the risks involved and strive to keep up to date with screening and regular medical care, there are also a number of factors that are known to increase the possibility for women without genetic history of breast cancer to develop malignant tumors. Chief among these factors is age. While breast cancer remains extremely uncommon in women who are younger than 30 years old, this incidence rate gradually begins increasing between the ages of 35 and 39, not reaching its plateau until approximately 80 years of age. (SEER, 2003). Another strong risk factor remains race. “In the United States, breast cancer risk is slightly higher in whites than in African Americans, although the incidence of early-onset cancers is higher in African Americans. Incidence rates are markedly lower in other racial and ethnic groups.” (SEER, 2003). History A history of breast cancer should include not only the characteristics of symptoms in relation to the illness, but also their timing in relation to menstrual cycles as this can provide important clues as to the type and severity of the patient’s possible condition. The most common causes of breast pain are fibrocystic changes and mastitis. Mastitis usually occurs in conjunction with sudden onset of pain and some inflammation. Larger, pendulous breasts may also cause more pain. In conducting the screening, the caregiver should first determine whether or not there are any lumps present and whether they grow or shrink with the changing phases of the menstrual cycle. Changes occurring in conjunction with the menstrual cycle can indicate fibrocystic changes, assisting with diagnosis. If symptoms are associated with menstrual cycles, or if they are sustained over long periods of time, an endocrine workup for prolactin excess can be conducted to help diagnosis. (Gail, M.H. et al, 1989). The risk of cancer decreases further when the discharge does not contain any bloody matter. Other causes of discharge, especially discharge described as pussy, can include mastitis or abscess. Childbirth and some medications will cause a milky discharge, even when the patient is not breastfeeding. Regardless of whether the visit is for screening only or for specific concerns, the history should include information regarding previous biopsies, treatments or usage of hormones and any known risk factors. Important information includes current age with mammography recommended every two years for patients older than 55, whether the patient experienced menarche onset prior to age 12 as earlier development has been identified as a risk, onset of menopause after age 55 as later menopause also indicates a higher risk and whether the patient had her first live birth when older than 30. As might be expected, where there are abnormal cells, there is an increased risk of cancer. (Gail, M.H. et al, 1989). Lifestyle and environmental factors Some of the few controllable risk factors for breast cancer can be found in lifestyle choices. “Obesity has been extensively studied and in general has been found to increase the risk of breast cancer by up to two and a half times in postmenopausal women.” (McTiernan A. 2003). Strangely enough, the opposite seems to hold true for premenopausal women, with obesity seeming to provide a protection against cancerous growth. Studies indicate this might be because of increased anovulatory cycles, which reduces the level of circulating estrogens in younger obese women. Encouraging patients to reduce their amount of alcohol consumption can also serve to reduce a patient’s risk of breast cancer. Nursing Interventions A great deal of the interventions available to nurses for their patients can be justifiably classified as patient education. This begins by providing a diagnostic and treatment center setting as friendly and welcoming to the patient as possible. This includes explaining procedures and policies in terms that are easy for the patient to understand with sensitivity to experience and education level. This encourages full disclosure from the patient regarding symptoms and history, making proper diagnosis, treatment and patient involvement more successful and accurate. With this open and friendly communication established, nurses are then able to more accurately assess the patient’s level of understanding and encourage further interaction. An example of this would be when a nurse is able to pick up on a patient’s fear of screening because she has been told too much screening can lead to the development of cancer, allowing the nurse to intervene with more accurate information and encourage more positive involvement in health care. In addition, this enables the nurse to more accurately assess the patient’s emotional state regarding their illness, including making the referral to the appropriate support group if the patient seems to be sinking into a dangerous or depressive mental state. Although it doesn’t fall strictly within the bounds of medicine, nurses can also serve as an objective sounding board for the many other stressors that women face in their daily lives, helping them to find solutions or to delegate some of these responsibilities while they need to conserve their energy and strength for the treatment of their cancer. (Hanser, 2004) Clinical Signs and Symptoms Best Nursing Practices When discussing breast cancer diagnosis, there is a significant difference between a symptom and a sign. A symptom is described as an indication of illness that usually takes the form of a fever, chills, shortness of breath or a cough. These types of conditions are usually noticed by the individual, but are not necessarily noticed by anyone else. A sign, on the other hand, is an observation that is made by a health care practitioner. An example of this might be a rapid breathing rate or abnormal sounds heard through a stethoscope. As in childhood diseases, a combination of a few signs or symptoms on their own is not sufficient to provide an accurate diagnosis of cancer. For most patients, it is necessary to obtain more information through additional medical tests and perhaps biopsies before launching into cancer treatment options. As in other types of cancer, breast cancer treatment is most successful when it is detected early in its development. This allows medical professionals to treat the cancer while it is still small and relatively isolated from the rest of the body. However, there remains a large percentage of the population that tends to ignore symptoms either through fear of treatment or lack of recognition for what it is. “General symptoms, such as fatigue, are more likely to have a cause other than cancer and can seem unimportant, especially if they have an obvious cause or are only temporary. In a similar way, a person may reason that a more specific symptom like a breast mass is probably a cyst that will go away by itself. But neither of these symptoms should be discounted or overlooked, especially if they have been present for a long period of time or are getting worse.” (“Cancer, Signs and Symptoms,” 2006) Less common symptoms of breast cancer can include dimpling of the breast, a lump in the underarm area, nipple discharge, pain, inversion (turning inward), skin irritation of the breast or nipple and swelling. The average patient should be encouraged to perform breast self-examination approximately one week after the end of their menstrual period every month in the method that is described to them by their health care professional. Clinical examination involves examining each breast for retractions, skin changes and discharge while the breasts and underarms are felt for lumps. References American Cancer Society. (February 28, 2006). Detailed Guide: Cancer ‘Signs and Symptoms.’ Available April 18, 2011 at http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_What_are_the_signs_and_symptoms_of_cancer.asp?sitearea. Barton, M.B.; Elmore, J.G. & Fletcher, S.W. (1999). “Breast Symptoms Among Women Enrolled in a Health Maintenance Organization: Frequency, Evaluation and Outcome.” Annual of Internal Medicine. Vol. 130, pp. 651-57. Bloom, S.A.; Harris, J.R.; Thompson, B.L.; Ahmed, F.; & Thompson, J. (2000). “Tracking Clinical Preventive Service Use: A Comparison of the Health Plan Employer Data and Information Set with the Behavioral Risk Factor Surveillance System.” Medical Care. Vol. 38, pp. 187-94. Gail, M.H.; Brinton, L.A.; Byar, D.P.; Corle, D.K.; Green, S.B.; Schairer, C. & Mulvihill, J.J. (December 20, 1989). “Projecting Individualized Probabilities of Developing Breast Cancer for White Females who are Being Examined Annually.” Journal of the Cancer Institute. Vol. 81, N. 24, pp. 1879-86. Hanser, Marilyn. (2006). “Breast Cancer in the 21st Century: Hope on the Horizon.” National Center of Continuing Education. Available April 18, 2011 at http://www.nursece.com/online_course.php?id=9005. Korde, L.A.; Calzone, K.A. & Zujewski, J. (October 2004). “Assessing Breast Cancer Risk: Genetic Factors are not the Whole Story.” Postgraduate Medicine. Vol. 116, N. 4. McTiernan A. (2003). “Behavioral Risk Factors in Breast Cancer: Can Risk be Modified?” Oncologist. Vol. 8, N. 4, pp. 326-34. Page, D.L.; Jensen, R.A.; Simpson, J.F.; et al. (2000). “Historical and Epidemiologic Background of Human Premalignant Breast Disease.” Journal of Mammary Gland Biologic Neoplasia. Vol. 5, N. 4, pp. 341-9. Surveillance, Epidemiology, and End Results (SEER) Program. (November 2003). “SEER*Stat Databases: Incidence – SEER 11 regs + Alaska public-use, Nov 2003 Sub for Expanded Races (1992-2001).” National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch. Available April 18, 2011 at http://www.seer.cancer.gov. Read More

 

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