 Among all cancers, breast cancer has been the 2 nd leading cause of death in women (right behind lung cancer)  Causes about 40,000 deaths annually  About 5-10% of women who develop this cancer have a genetic predisposition with the BRCA1 gene.  Breast cancer also affects glands and the lymphatic system

 About 80% of breast cancers arise in the ductal tissue, while the other remaining % occurs in the lobular tissue  As with many cancers, breast cancer is highly influenced by hormones- our female sex hormones such as FSH, Estrogen, Progesterone can stimulate the growth of a tumor  How does it become cancer? Cells of the breast may undergo growth changes during tissue renewal and differentiation that can ultimately give rise to cancer.

 Those who study breast cancer and how it arises understand that the developmental pathways of the breast tissues (ducal and lobular) and its responses to the hormones and growth factors that regulate tissue development  The cellular abnormalities of why tumors occur is not yet known, however researchers do know that tumors originate in the breast tissue and begin to proliferate abnormally as a direct result of genetic changes within the breast and hormones.  Symptoms= tumor that may or may not be palpable

 DCIS- Ductal carcinoma in situ= Abnormal cells arise in the ductal tissue, where is can progress through the lining of the milk ducts and invade the fatty tissue of the breast. In the normal process of tissue development during puberty, ductal tissue develops in response to estrogen.  LCIS=lobular carcinoma in stiu= begins in the lobules that produce milk and may progress to infiltrating invasive lobular carcinoma.

 What is BRAC? › Breast and Ovarian Cancer gene › BRAC 1 was the first gene identified; carries with this mutation have a higher risk of developing breast or ovarian cancer during their lifetime › BRAC2 an inherited gene also significantly increases risks › Both BRCA1 and 2 have been shown to promote the development of breast cancer as a result of their growth-promoting effects on breast tissue.

 A vast majority of cases are in the ABSENCE of genetic predisposition  Age- increases over 50  First menstruation before the age of 12  First childbirth after the age of 35  Menopause after the age of 50

 Self breast examination  Mammogram  To determine malignancy: › Biopsy- removal of small amonut of tissue from the breast › Ultrasonography- uses sound waves to explore tissue structure › Mammogram-radiography of the soft tissue of the breast

 Primary treatment= surgical removal of tumor  Mastectomy  Radiation  Chemotherapy  Hormone therapy  Protein  Medications: Tamoxifen, Evista, a newer class of antiestrogens called aromatase inhibitors (AI)

 Prognosis is all dependent on tumor size, appearance, local invasiveness, and lymph node involvement for possible metastasis  Individualized ;age, menopause etc. are also taken into account for prognosis

 Medical › Alternative treatments › Consent › Prescriptions › Surgical interventions  Nursing › Patient education › Empathy › Symptom management › Support › Coordination of care › Medication administration › Consult › Multidisciplinary care

 Ineffective coping  Risk for disturbed body image  Pain  Impaired self-esteem  Risk for infection  Depression  Anxiety  Social isolation

 Scenario  HPI  Signs and symptoms  Gaps between clinical experience and new research

 A nurse is caring for a patient who has just found out she has stage 2 breast cancer. She asks the nurse what could have caused this. The nurse would reply  A. “You might have had trauma in the past that lead to tissue damage”  B. “There is nothing you could have done to prevent it, try not to worry”  C. Breast cancer can be caused by a number of factors including hormones, age, childbirth, onset of menses and menopause and even genetics”  D. “ You just have bad genes”

 A nurse is explaining the process of an ultrasonography to a patient. The nurse knows the patient understands what the procedure is when she says which of the following?  A. “There will be a needle inserted into my breast tissue”  B. “The use of sound waves will explore my breast structure”  C.” My breast will be placed between a table and compressed”  D. “I will need to be prepared for surgery”

 A nurse is treating a 55 year old women who had of a left mastectomy 6 months ago. The patient states she feels pressure under her arm. Upon assessment the nurse notes +4 edema on the left arm. What conclusion can the nurse make based upon these assessment findings?  A. The patient is having a reaction to anesthesia.  She is showing signs of sepsis  Her cancer has now spread to her lymph nodes  The patient is now suffering from lymphedema due to her mastectomy

 Crawford, Sarah, PH.D., Alder, Richard, Ph.D., (2013). Breast Cancer. Magill’s Medical Guide (Online Edition). Retrieved from b.usf.edu/eds/detail?sid=3e78d67e-132e-48d6-abfc- ee94a2e3a562%40sessionmgr4005&vid =4&hid=4203&bdata=JnNpdGU9ZWRz LWxpdmU%3d#db=ers&AN= http://eds.a.ebscohost.com.ezproxy.li  Korber, Susan F., Padula, Cynthia., Gray, Julie., Powell, Margot., (2011). A Breast Navigator Program: Barriers, Enhancers, and Nursing Interventions. Oncology Nursing Forum. 38(1), Retrieved from ?sid=2a6b876d-566c-49f1-a96e- 891eb8a23870%40sessionmgr4004&vid=8&hid= 