Breast Cancer Awareness

Conversation Starters

By the Numbers: Stats

and demographics for

breast cancer.

Genetics:

Predispositions and

available tests

Risk Factors: Drugs,

hereditary, diet,

reproductive, more.

The Down-Low: What breast cancer is, how

it’s classified.

Staging: Criteria for the

4 stages of breast

cancer.

Self-Breast Exam:

Timing, processes, key

points for teaching.

Clinical Exam: Timing,

purpose, who provides

the examination.

Mammogram: Timing,

methods, diagnostic vs. screening.

Public Health: The purpose and goals of

the nurse.

Early Detection:

3 Tiers, overview of

each.

Take-Away Points

Nursing Care Planning: Diagnoses, interventions,

outcomes.

References: Scholarly

journal articles that

totally rock!

Men: Remembering the

1%, consequences of

being ill-informed.

Diagnostics: Lab tests,

imaging, biopsy, patho

report, immunoassay.

Treatment: Forms, surgery, chemo,

radiation, endocrine.

Cell growth involves a system of

checks-and-balances. When an

error occurs in a cell’s

development, it’s usually killed

through apoptosis, or cellular

suicide. When this mechanism

malfunctions, unhealthy cells are

able to continue growing. Breast

cancer develops when cells

begin to proliferate, or multiply,

abnormally… unchecked.

A tumor is classified based upon

its relationship with the basement

membrane. Non-invasive (in-situ)

forms are anchored to the

membrane. Invasive (infiltrating)

masses may to spread to other

tissues, such as the lymph nodes.

A tumor is staged according to

the diameter of the mass and the

amount of surrounding tissue

that’s invaded.

Classifying & StagingWhat is Breast Cancer?

The Down-Low on Breast Cancer

Tumor is limited

to the areas

within the

breast tissue and the mass is

small, no more

than 2 cm in

diameter.

Tumor is > 5 cm

but limited to

breast tissue, or

< 2 cm in lymph nodes of the

arm, or 2-5 cm

in lymph nodes

of the breast

only.

Tumor has

metastasized

beyond the

breast and spread to

external lymph

nodes, tissue

groups and

organs.

Tumor is > 5 cm

and has spread

beyond the

breast tissue, invading the

lymph nodes

located under

the arm.

STAGE 1 STAGE 2 STAGE 3 STAGE 4

Staging Breast Cancer

One Two FourThree

99% 2nd Three

Million

Breast Cancer by the Numbers

Number

One

Advanced

age. History of

ovarian

cancer.

Previous

radiation

therapy in the

breast or chest

region.

Nulliparity (no

children) and

having children

but not

breastfeeding

increases

lifetime

estrogen

exposure.

Re

pro

du

ctiv

e

Ag

e/H

isto

ry

Carriers of the

BRCA 1 or 2

gene. 1st

degree

relatives

(mother or

sister)

diagnosed with

breast cancer.

Ge

ne

tic

s

Leading

theories

speculate that

high glucose

levels act as

“fuel” that

triggers growth

of cancerous

cells.

Use of certain

hormonal

contraceptives

or hormonal

replacement

therapy

increases

estrogen

exposure.

Ho

rmo

ne

s

Die

t/O

be

sity

Risk Factors for Breast Cancer

GENETIC TESTINGCan Help To

Better Understand

RisksAnd Take Action!

CancerTYPE

ID

Oncotype

Dx

MammaPrint

Predispositions

Ashkenazi

Jewish

heritage

1st degree

relatives

BRCA-1 or

BRCA-2 gene

carrier Genetic Tests

Early detection is associated

with higher patient outcomes!

Identifying

women at high

risk and

increasing

surveillance Prognosis is

higher when the

cancer is

detected early,

preferably before it

metastasizes.

Efforts are focused on

educating the public about

methods for early

detection, such as

performing monthly self-

breast exams.

Nurse’s Role in the Community

help women understand benefitspublic

awareness

health

promotion

Early detection

surveillance

identify

high risk

improve

access

The Three Tiers of Early Detection

Early Detection = Better Outcomes!

Self-Breast Exam Mammogram Clinical Exam

Po

ints

fo

r Te

ac

hin

g Self-Breast Exam

Mammogram

Clinical Breast Exam

Schedule 1st screening mammogram at the age of

40, and then once again every 5 years. If high risk,

schedule 1st imaging between the ages of 25-30

and then once again every year.

Schedule 1st clinical breast exam with a clinician

beginning at the age of 20 and then once every 2-

3 years until the age of 40. Following 40, increase

frequency to once a year.

Perform the self-breast exam once a month, 2 days

after menstruation. If post-menopausal, perform on

the same day, each month. Consistent

performance promotes familiarity!

Hormonal fluctuations alter the way the breasts look and feel. They’re

most consistent 2 days after

menstruation ends.

Self-breast examination involves

both breasts (plus the nipples),

the axillary regions, and the

surrounding tissue (from the

sternum, extending to the

underarm region, and up to the

clavicles). Women are

encouraged to exam their

breasts on a monthly basis in

order to identify early changes.

The breasts are both visualized

and palpated.

Size, shape, and texture of the

breasts, axillary, and

surrounding tissue are

examined.

The breasts are palpated using

3 levels of pressure: light,

medium, and firm; in order to

cover the entire tissue span.

How to ExamineWhat, When, & Why

About the Self-Breast Exam

Teaching Points: Self-Breast Exam Gently squeeze each

nipples to assess for

drainage.

Examine up to the

clavicles (AKA: collar

bones).

Visualize with arm over head, arms down, and

arm propped under a

pillow.

Common approaches

include the checker-

board, circle, and

square methods.

Palpate using 3 levels

of pressure: Light,

medium, and firm.

The axillary, or

underarm regions

contains lymph nodes.

The upper left quadrant is the most common

area for breast cancer

to originate!

Feel and look at both

breasts, nipples, axillary,

and surrounding tissue,

up to the clavicles.

Palpate using 3 levels

of pressure: light,

medium, and firm.

Gently squeeze each

nipple to assess for

drainage.

3 visualizations: arms over head, arms down,

and pillow propped

under the shoulder.

Technique and Pattern:

1) Up and Down, 2)

Circle 3) and Wedge.

Chose one to use.

Examine breasts ↑ to

the clavicles (AKA:

collar bones).

The axillary (AKA:

underarms/pits)

contain lymph nodes.

The upper left quadrant is the most common

area for breast cancer

to originate!

Feel and look at both

breasts, nipples, axillary,

and include all of the

surrounding tissue.

Goal: Identify Changes!

Stand in front of a mirror and examine the

appearance.

Stand in the shower. Palpate breasts using 3

levels of pressure.

Lay down, prop up shoulder on a pillow

and feel the breasts.

3 Main Steps of the Self-Breast Exam

Standing in front of a mirror, view

breasts from a forward position.

Observe the symmetry, shape, color,

and size of each breast, checking for

any new changes.

Inspect in Front of a Mirror

Next, change the perspective: raise

arms over the head, and press palms

together. Be sure to also look in the

underarm region and visualize the

nipples.In the Mirror

Look and Feel in the Shower

This allows the breasts to be visualized

from a different angle. Standing in the

shower ensures that the same position

will be used every month.

Examine the breasts in the shower.

Place the hand on the side of the

breast to be examined behind the

head. Look down at the breasts to

observe the same characteristics as

before.

In the Shower

Palpation Pattern Technique

With hand still above head, palpate

the breast with the free hand. Using

the Up and Down pattern technique,

feel the breast with the finger pads of

the first three fingers.

Palpate from the outer side to the

inner side of the breast; then up and

down in order to cover the entire tissue

span. Continue by palpating up the

axillary regions. Repeat on other side. Up-and-Down

Be Thorough and Consistent

Cover All Areas

It helps to get into the habit of starting

on the same side each time.

Remember to raise the arm on the

same side to be examined.

When palpating, be sure to cover the

entire span, including the nipple,

breast tissue to the collar bone, the

upper chest area, and underarm

region.

Remember the Nipples!

Nipples Included

Be sure to include the nipples. Inspect

them for changes in size, color, texture,

symmetry, or shape. Feel for lumps,

bumps, thickening, or other changes.

With the thumb and ring finger, gently

squeeze the nipple to access for fluid

leakage. Discharge is an abnormal

finding and must be reported.

Lay Down and Pillow Prop

On a Pillow

Lay down and place a pillow under

one shoulder to prop up the breast to

be examined first. Use the same

techniques as before and include all

areas. Repeat for the other breast.

This position allows the breast tissue to

be felt from a different angle. It also

enables a deeper level of palpation.

2 versions:

Screening

(standard) and

diagnostic

(when a mass is

detected). Considered to

be the “Gold

Standard” for

early detection

of breast cancer.

Provides an image to

visualize the breast tissue

by evaluating the

density. Epithelial and

stromal cells, collagen,

and fat tissue all

influence the breast

density.

Screening Mammograms

breast imaging

screening reduces mortality rates

Gold

Standard

diagnostic

version is

more

detailed

Provides an

extra “check” in

addition to the

self-breast

exam.

The clinician

observes and

feels the breasts.

Involves visualization

(external) and palpation of

the breast, surrounding

tissue, and the

nipple…similar to the self-

exam.

Clinical Breast Exams

once a year starting at 40exam by

clinician

remind

your

provider to

examine

palpate

start at

age of 20

extra

check

Identify palpable masses

observe

Diagnosed… Now What?

Individualized Treatment Plan.

Portrays a

complete

picture of the

case by

providing

information

such as grade,

size, and

margin of the

tumor.Diagnostic

technique used

to measures

the level of

certain

molecules such

as androgens

(sex hormones)

and antibodies.

Imm

un

oa

ssa

y

Pa

tho

Re

po

rt

The diagnostic

mammogram,

ultrasound

tomography

(UST), and

magnetic

resonance

imaging (MRI)

provide internal

visualization.

Ima

gin

g

A tissue sample

is obtained and

then analyzed.

Several types

are available.

This is the only

method for a

definitive

diagnosis.

Blood samples

monitor factors

such as serum

tumor markers,

calcium levels,

hormones, and

alkaline

phosphatase.

Lab

Wo

rk

Bio

psy

Labs and Diagnostic Procedures

Chemo

Endocrine

Treatment Options Surgery

Radiation

A regimen of powerful drug combinations that may be

thought of as ‘cell poison.’

Various forms are available.

All or part of the breast tissue is removed. May

include the nipple, lymph

nodes, or only select tissue.

A high dose is delivered in

fractions to kill cancerous cells while allowing healthy

ones time to recover.

Drugs that inhibit or alter

the effects of hormones.

Used for estrogen-receptor positive breast cancer.

Tre

atm

en

t M

od

alit

ies Primary Treatment

Adjuvant Treatment

Palliative Treatment

The method used as the main form of curative

treatment. This usually involves surgery, but may also

be another form, such as radiation or chemo.

Therapies that complement or enhance the primary

treatment. Chemo and endocrine therapy are

often used as adjuvants to surgery.

Purpose is not curative; rather, it’s to slow tumor

growth. It’s used to promote comfort and enhance

quality of life by providing relief of symptoms.

Mastectomies are named based

upon the portion of the breast

removed (if the nipple and

areola are left intact) and

involvement of surrounding

tissues, such as the lymph nodes.

Major post-op considerations

include incision site infection, fluid

balance, and the impact on the

woman’s body image.

Lumpectomy: Only the lump is

removed (“conservative”).

Partial mastectomy: Only part

of the breast is removed.

Simple mastectomy: Breast

removed, but the nipple/

areola remains intact.

Radical (Halsted) mastectomy:

Breast, nipple/areola, and the

lymph nodes are removed.

Major Procedure TypesSurgery Down-Low

Mastectomies

The minimal amount of radiation

is used to accomplish the desired

therapeutic response. The goal is

to kill cancerous cells while

allowing enough time for healthy

ones to recover between

treatments. Treatment itself is not

painful, but rays can irritate the

skin, causing a sunburn-like

reaction. Fatigue is also common.

As the total radiation dose is

fractionated rather than given

all at once, each treatment is

called a fraction.

Average length/frequency: 2-8

weeks; 4-5 times per week.

Average time: 20 minutes per

fraction…up to several hours,

including prep and post-

treatment monitoring.

Radiation ConceptsWhat, How, Why

Radiation Therapy

Cell-cycle specific drugs target a

particular phase of cellular

replication while non-cell-cycle

specific drugs use other

mechanisms. Many chemo drugs

destroy cells that replicate

quickly. Alopecia and

gastrointestinal disturbances are

common as hair and mucosal

cells replicate rapidly.

The risk of infection increases

as immune system function is

compromised.

Maintaining hydration and

general nutritional status are

priorities.

Nausea and vomiting must be

proactively managed through

administration of antiemetic

drugs and dietary adjustments.

Chemo-ConceptsMechanism of Action

Chemotherapy

Actions: Drugs that inhibit or alter

the effects estrogen. Indications:

adjuvant therapy, prophylactic

treatment, or active treatment of

metastatic cancer of estrogen-

receptor positive tumors. Major

classes: GnRH agonists,

aromatase inhibitors, and

selective estrogen receptor

modulators (SERMs), and

antiestrogen agents.

A SERM drug that antagonizes

(inhibits) the effects of estrogen

while agonizing/mimicking the

hormone’s actions in select

tissues. May be used for

prophylaxis in high-risk cases, as

an adjuvant therapy for up to 5

years following primary

treatment, or for metastatic

tumors. Avoid use with SSRIs as

toxicity may occur.

Tamoxifen (Nolvadex) What, How, Why

Endocrine Therapy

AntineoplasticAgents

Hormones

Alkylating

agents

Antimetabolites

Antitumor

antibiotics

Nitrosoureas

Topoisomerase

I inhibitors

Drugs that Fight Cancer

Major Drug Classifications

Post-Op Mastectomy

Nursing Care Plan.

1. Risk for infection, related to surgical incision.

2. Ineffective tissue perfusion, related to edema.

3. Acute pain, related to surgery.

4. Disturbed body image, related to loss of breast.

5. Interrupted family processes, related to altered roles,

relationships, and functions secondary to illness and treatment.

6. Fear, related to disease process/prognosis.

Nursing Diagnoses

Nursing Care Planning

Mastectomy

Nursing Interventions

Infection: Monitor incision site. Provide

wound care, as ordered. Educate

patient on symptoms of infection and

other signs that warrant action.

Pain: Assess on a 1/10 scale including

characteristics. Identify the level that’s

tolerable (example: 3/10). Administer

medications and reassess response.

Perfusion: Position on non-affected side

to promote lymphatic drainage. Monitor

for signs of lymphedema, such as arm

pain.

Body Image: Establish a therapeutic

patient-nurse relationship and supportive

environment that promotes expression of

response to body changes.

Role: Assess family dynamics and support

system. Aid in developing a plan that

addresses the need for changed roles

and functions throughout recovery.

Fear: Encourage expression of fears

about diagnosis, treatment, and

mortality. Arrange access to spiritual

services as appropriate.

The patient doesn’t experience any signs of infection.

Adequate tissue perfusion is maintained.

Pain remains at or below tolerable levels throughout recovery.

A positive body image is maintained, independent of decision for

reconstructive breast surgery.

New family member roles are acknowledged and effective

adjustment methods are identified.

Sources of fear are identified and explored. A plan that addresses

effective coping methods is established.

Anticipated Outcomes

The Goals of Nursing Care

What about

the 1%?

Consequences of Being Ill-Informed

metastasis

Delayed detection

Myth perpetuation that’s it a

“girl” disease

Unaware of risk factors, such as carrying

the BRCA-1/2 gene

shame Among those diagnosed

isolation

And higher mortality rates

For any woman reading this, I hope it helps

you to know you have options. I want to

encourage every woman, especially if you

have a family history of breast or ovarian

cancer, to seek out the information and

medical experts who can help you through

this aspect of your life, and to make your

own informed choices.

Angelina Jolie, in a statement made to the

New York Times.Angelina is reported to be a carrier of

the BRCA gene. She underwent a

prophylactic double mastectomy.

Lessons from Pop Culture

Image by Michael Cook and MercatorNet.com

“

“

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1024-1031. Retrieved from http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n12/Economics-of-Genomic-Testing-for-

Women-With-Breast-Cancer

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http://www.nursingcenter.com/lnc/CEArticle?an=00006527-201210000-00004&Journal_ID=496448&Issue_ID=1470639

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Journal of Nursing, 106(3), 32-38. Retrieved from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=630712

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Retrieved from http://www.americannursetoday.com/article.aspx?id=8310

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http://www.americannursetoday.com/radiation-therapy-101/

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http://www.nursingcenter.com/lnc/CEArticle?an=00000446-201010000-00027&Journal_ID=54030&Issue_ID=1071532

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