By Yosef A.

by Yosef A.

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.

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.

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.

Screening guidelines for women younger than age of 40conditions Timing of annual mammography

Lobular ca in situ/breast ca dxFirst degree relative with premenopausal breast caMantle's irradiation for Hodgkin's dsBRCA1 or BRCA2 mutation

At time of dx10 years earlier than relatives age of dx

8 years after completion of theraphyAge 25-35 years

by Yosef A.

Breast imaging Reporting and data system0 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.

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.

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.

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.

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.

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.

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 seromaformation, 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.

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.