1. HEALTH PSYCHOLOGY Psychological Aspects of Breast Cancer

2. Established and Probable Risk Factors for Breast Cancer Age Geography Age at menarche Age at menopause Age at 1st term pregnancy Family history Previous. benign disease Cancer in other breast Socio-economic group Diet Body weight High alcohol intake Exposure to ionising radiation Combined OCP Hormone Replacement Diethylstilboestrol

3. SCREENING Simple to apply cheap easy to perform easy and unambiguous to interpret able to identify those with disease able to exclude those without

4. Clinical Service Family History Clinics (geneticists) National Breast Screening Programme asymptomatic One Stop Symptomatic Service

5. PERSONNEL General Practitioner/Practice Nurse Hospital Administration (two week wait) Clinic Receptionist Out-Patient Nurse Clinician Cytologist Radiographer/Radiologist Breast Care Nurse Ward Staff/Theatre Staff Oncology Macmillan Nurse/District Nurse General Practitioner Palliative Care

6. CASE SCENARIOS 1 25 yr....... old women engaged nodular area L breast GP reassure referral requested multi-focal BrCA family history 86 yr....... old woman partially sighted care home supportive family don’t want her to know

7. CASE SCENARIOS 11 43 yr....... old woman married, 3 children husband - America on HRT asked about screening -no lump - BrCA 52 yr....... old woman single, full-time career went for screening with friend Ca++ DCIS large area mastectomy

8. CASE SCENARIOS 111 64 yr....... old married, grown up children 3rd screen normal breast lump BrCA 58 yr....... old man lump BrCA