Fast Facts About Breast Cancer - Case Study Example

Introduction and Overview Breast cancer is one of the leading preventable causes of death among women. Breast cancer is one of the dread diseases but improved techniques which help in early detection had greatly reduced the number of deaths. However, approximately half a million still succumb to this disease, making it the second-leading cause of death among women after lung cancer. But it is the leading cause of cancer-related death among Australian women, with incidence rising 20% in the decade between 1996-2006 (www.breastcanceraustralia.org, n.d., p. 1). In NSW, Australia, about 1 in 10 women will develop breast cancer by age 74 years, with 90% of the 10% having no prior family history (www.bci.org.au, 2009, p. 1). It is the common cause of death from cancer for NSW women, 862 deaths in 2001 (ibid.). In Victoria, figures for 2007 showed an incidence of 3,188 new cases per 100,000 population with 708 deaths (www.cancervic.org.au, 2007, p. 12). Discussion One in eleven women will be diagnosed with breast cancer before the age of 75 (www.cancerscreening.gov.au). It is a leading cause of death among women in 45-55 age bracket (www.imaginis.com, 2010, p. 1). The lifetime chance of ever developing breast cancer is 4.8% in developed Western countries (due to higher hormone use) but only 1.8% in poorer countries. By age groups, those below 20 years old have the lowest prevalence (1 in 1,985). Those in older age groups have higher prevalence rates of 1 in 37 by age 50; 1 in 26 by age 60 and 1 in 24 by age 70. The greatest risk factors for breast cancer are gender (being a woman) and age (by simply growing older) with about 90% of cases due to the ageing process and not due to heredity (www.breastcancer.org, 2010, p. 1). Some 14,000 women will be diagnosed with the disease this year; this makes it the most common cancer among Australian women (BCNA, 2010, p. 1). There is hope, however, as latest statistics indicated a 5-year survival rate of 88%. The average age of a first diagnosis is 60 years old but 75% of new cases develop in women who are 50 years old or older; while women with higher incomes have a higher incidence rate compared to lower-income women (134 vs. 110 but 21.1 overall deaths per 100,000 population). Over 70% of cases diagnosed occur in women aged 50 or older but those women aged 50-69 can reduce chances of dying by 30% if they opt to have a breast screen once every two years (www.bcig.org.au, 2009, p. 1). About 95% of all breast cancer cases occurred in women aged 40 or older but there is an observed decrease in women aged 80 and above (Reed & Audisio, 2009, p. 3). (Note: The yellow highlight (2 paragraphs) already total 299 words). Nursing Assessment and Background The human body’s lymphatic system is vast and complex, composed of the lymphoid tissues and lymphatic vessels that carry the white lymph fluid and is part of the immune and circulatory systems. Lymphoedema (also spelled as lymphedema) is swelling of the arms or legs due to an impairment in the system (Burt & White, 2005, p. 2). Swelling could be due to a number of factors such as surgery, radiotherapy, injury, obesity, paralysis or due to infection (Armer, 2007, p. 25) known as secondary lymphoedema. There are also cases due to genetics called as primary lymphoedema caused by malformation or malfunction of lymphatic system like Milroy’s disease (since birth), or had developed during puberty or after age 35. Arm Assessments The swelling is caused by the build-up of fluid in the tissues in the arm or breast due to removal or damage to the lymph nodes during breast cancer treatment or after surgery or after radiotherapy to the armpit area. It has no known cure but early diagnosis and prompt treatment makes it manageable; not all women whose lymph nodes were removed during the surgery will eventually develop lymphoedema but others develop it even years after surgery. Early symptoms are swelling of the arm, breast or hand, feelings of discomfort or fullness in the arm or breast and finally, an ache, pain or tension in the arm, shoulder, chest or breast. It is emphasized prevention is key, requiring daily attention according to Hunt, Robb, Mendelsohn & Strom (2008, p. 499). The cause is a weakened drainage capacity from disruptions near the arm and the trunk (ipsilateral) from the extirpation of axillary lymph nodes, with or without irradiation, Manchester & Manchester stated (2006, p. 553). Nurses are increasingly in the front line of supporting patients with chronic conditions such as lymphoedema and they need to develop the skills necessary to recognize patients who are at risk, to include taking a detailed history and also conduct a proper physical assessment. Upper extremity lymphoedema can be detected by symptoms like swelling of limbs to twice its normal size, skin that stays indented when pitted (pressed) and also the ensuing thickening, hardening and darkening of the skin known as brawniness (Keeley, 2000, p. 44). According to Yarbo, Frogge & Goodman (2004), the most common method for measuring upper-extremity edema is at points above and below the olecranon process as the reference points (p. 464). Other signs of lymphoedema include dryness, scaling, blisters containing lymph fluid, abnormally warm skin temperature and the presence of nodules. Papillomatosis (cobblestone skin appearance) and lymphorrhea (drains of lymph fluid) may also present to cause cellulitis. Circumferential arm measurements showing 2 cm or greater difference between the affected and non-affected arms at two of the five measurement sites are sufficient signs of the disease (Dow, 2004, p. 216). A thorough assessment requires accurate visual inspection, palpation and volume estimation by water displacement or perometry in comparison to non-affected limb by using infra-red light transmitters to measure the limb’s volume and contours (Zuther, p. 128). According to Malone & Lindsay (2006), heaviness, numbness, redness and tingling are also sure signs of a developing lymphoedema (p. 530). Reinforcing Arm Precautions Arm precautions include no blood draws, IV's, blood pressure or injections taken on the affected extremity which include needle sticks and finger pricks for blood sugar testing (Cole, 2006, p. 971). This is because any foreign object like a needle will cause a reaction or inflammatory response. Anything that constricts collateral circulation should also be avoided such as blood pressure cuffs, tourniquets and tight clothes (Dell & Doll, 2006, p. 50). Other ways to prevent this chronic condition, reinforced on each clinical visit, include keeping skin moist by using a moisturiser, avoid the sun, protect skin with sunscreen, use insect repellents to avoid being bitten and getting itchy, treat tiny cuts and skin breaks with antiseptic and when shaving the armpit areas, use an electric razor instead of a wet razor (Thiadens, 2005, p. 238). It is likewise advisable to avoid circulatory intent, friction, joint movement and excessive focus on the area that can compromise lymph flow (Walton, 2010, p. 251). Deep breathing, exercise and manual lymph drainage can increase lymph flow and essential components of the definitive treatment for lymphoedema (Baranoski & Ayello, 2007, p. 294). A patient needs to elevate the arm frequently, drinking some water and practicing diaphragmatic breathing can help in the prevention of this condition (Burt & White, 2005, p. 39). Better patient education, common sense, healthy habits and lifestyle choices can lower the risk of lymphoedema. Reference List Armer, J. (2007, April). Upper Limb Swelling Following Mastectomy: Lymphedema or Not? Oncology, 21 (4 Supplement), 26-8. Baranoski, S. & Ayello, E. A. (2007). Wound Care Essentials: Practice Principles. Ambler, PA, USA: Lippincott, Williams & Wilkins. Breast Cancer Australia (n.d.). Welcome to Breast Cancer Australia. Retrieved from http://www.breastcanceraustralia.org/home.html Breast Cancer Institute – Westmead (2009). Fast Facts About Breast Cancer. Retrieved from http://www.bci.org.au/index.php/about-breast-cancer/facts-about-breast-cancer Breast Cancer Network Australia (2010). About Breast Cancer. Retrieved from http://www.bcna.org.au/about-breast-cancer Breast Cancer Organization (2010, January 8). Breast Cancer Statistics. Retrieved from http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp Breast Screen Australia Program (2010, September 6). Cancer Screening: About the Program. Retrieved from http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/breastscreen-about Burt, J. & White, G. (2005). Lymphedema: A Breast Cancer Patient’s Guide to Prevention and Healing. Alameda, CA, USA: Hunter House. Cancer Council of Victoria (2007). Victorian Cancer Statistics. Retrieved from http://www.cancervic.org.au/downloads/about_our_research/canstats/more_canstats/canstats-47.pdf Cole, T. (2006). Risks and Benefits of Needle Use in Patients After Axillary Node Surgery. British Journal of Nursing, 15 (18), 969-79. Dell, D. D. & Doll, C. (2006). Caring for a Patient with Lymphedema. Nursing 2006, 36 (6), 49-51. Dow, K. H. (2004). Contemporary Issues in Breast Cancer: A Nursing Perspective. Sudbury, MA, USA: Jones & Bartlett Publishers. Hunt, K. K., Robb, G. L., Mendelsohn, J. & Strom, E. A. (2008). Breast Cancer. New York, NY, USA: Springer-Science. Imaginis Corporation (2010). Breast Cancer: Statistics on Incidence, Survival and Screening. Retrieved from http://www.imaginis.com/breasthealth/statistics.asp Keeley, V. (2000). Lymphoedema. Clinical Features of Lymphoedema. In R. G. Twycross, K. Jenns & J. Todd (Eds.), Lymphoedema (pp. 44-67). Abingdon, Oxon, UK: Radcliffe Medical Press, Limited. Malone, D. J. & Lindsay, K. L. B. (2006). Physical Therapy in Acute Care: A Clinician’s Guide. Thorofare, NJ, USA: Slack Incorporated. Manchester, D. J. & Manchester, D. P. (2006). Breast Cancer. Hamilton, Ontario, Canada: BC Decker, Inc. Reed, M. W. & Audisio, R. A. (2009). Management of Breast Cancer in Older Women. London, UK: Springer. Thiadens, S. R. J. (2005). Lymphedema: An Information Booklet. Oakland, CA, USA: National Lymphedema Network. Walton, T. (2010). Medical Conditions and Massage Therapy: A Decision-Tree Approach. Baltimore, MD, USA: Lippincott, Williams & Wilkins. Yarbro, C. H., Frogge, M. H. & Goodman, M. (2004). Cancer Symptom Management. Sudbury, MA, USA: Jones & Bartlett Learning. Zuther, J. E. (2005). Lymphedema Management: The Comprehensive Guide for Practitioners. New York, NY, USA: Thieme Medical Publishers, Inc. Read More