Breast Cancer

Abstract

Breast cancer has the second highest mortality rate of all invasive cancers in women. The 1970's brought awareness for this disease that had been shielded from the public's ear. Although the prevalence of breast cancer continues to increase, a cure has not been found. This paper will discuss a case study involving a thirty-six year old woman, named Anna, who has discovered a small non-dimpled or retracted lump on her right breast. Although Anna has already discovered a lump, there may have been other signs or risk factors she was unaware of. Examining risk factors and sign and symptoms of breast cancer will provide women with the opportunity for early detection. Early detection, advanced diagnostic testing and treatment are essential for the survival of women, like Anna, who develop this life changing disease.

In 1972 breast cancer was the leading cause of death from malignancy for women in the United States, however, in 1897 lung cancer eclipsed breast cancer making it the second leading cause (Davidson, 2008). In addition to the high mortality rate, two influential figures, Betty Ford and Nancy Reagan, went public with their diagnosis and brought breast cancer to the forefront. Physicians began to use epidemiological studies and clinical trials to determine risk factors and patient outcomes. The 1970's also brought about the use of chemotherapy for advanced breast cancer and the introduction of tamoxifen, the first targeted agent for breast cancer (Davidson, 2008). This early research has evolved into the breast cancer treatment seen today and it continues to expand with technological advancement. The knowledge that early detection is essential has lead to screening through routine mammography and testing for genetic predispositions.

Anna has just recently relocated to Miami and is a new patient at the Well Woman clinic. She is 6 months overdue and made the appointment because she noticed a small non-dimpled or retracted lump on her right breast while doing a self-exam. The nurse will need to get a full history from Anna and perform a head to toe assessment so she can relay pertinent information to the doctor in regards to Anna's new findings. Anna explains that she is a mother of four children, who's oldest child is 10 and her youngest is 4. She had breast fed all of her children for more than a year and is using OCP's for contraception. She stays very involved in her children's lives by volunteering for all their school and sport activities. Anna had just been feeling more tired than usual.

The nurse needs to evaluate the risk factors that may place Anna in a high risk category for breast cancer. Anna's gender as a female places her at increased risk. Although breast cancer can occur in men, ninety-nine percent of all breast cancers occur in women (Ignatavicius & Workman, 2006, p. 1796). Age is another factor that shows an increasing rate of incidence as a woman matures. The incidence of breast cancer increases with age and is more common in postmenopausal women. Another risk, although it doesn't apply to Anna, is related to reproductive history. Women who are childless or bear their first child after their thirties have a higher risk for developing breast cancer (Ignatavicius & Workman, 2006, p. 1796). Anna had her first child at age 26 and has had three subsequent births. In addition to having her children earlier in life, Anna breast-fed all of her children for at least a year which may counteract the risk of breast cancer. The most notable finding was that breast-feeding protected against both ERPR-positive and negative breast cancers, regardless of when a women first gave birth. Also the protective effect of additional pregnancies on ERPR-positive cancers was only observed among women who breastfed (Hodges, 2007). If Anna conveys to the nurse a family history of breast cancer, she will be considered at a higher risk. A family history of breast cancer could have previously prompted Anna to get blood testing to check for mutated genes linked to breast cancer. Every person has a fifty percent chance of inheriting a mutated BRCA gene from one of their parents. Women who have a mutated BRCA1 or BRCA2 gene are at an increased risk of breast and ovarian cancers (JAPPA, 2009). The risk for breast cancer increases three times if the mother or a sister has had breast cancer and is further increased if the relative was younger than forty, or if the cancer was bilateral, or if the relative also developed ovarian cancer (Ignatavicius & Workman, 2006, p. 1796). The use or oral contraceptives may also be a risk factor. Anna should be asked about the type and length of time she has used oral contraceptives. There have been debates over whether or not oral contraceptives are a risk for breast cancer. A journal for clinicians, published in 2008, suggested that there was no potential link between oral contraceptives and breast cancer. However, that publication received a harsh review from affiliates at the Mayo Clinic. The affiliates stated, "While we agree that further research is needed to clarify the oral contraceptive and breast cancer link, in the interim, we do not think it is fair to minimize or dismiss the potential risks of premenopausal breast cancer associated with oral contraceptive use." They conclude this with the fact that premenopausal women represent more than twenty percent of newly diagnosed cases of breast cancer in the United States (Kahlenborn, Modugno, Potter, & Server, 2008). Other risk factors include obesity, hormone replacement, diet, and alcohol consumption, along with a previous history of breast cancer.

Along with risk factors for cancer, it is important for the nurse to evaluate her lifestyle. Anna has complaints of feeling more fatigued than usual. The nurse knows from discussions with Anna that she has many responsibilities. The nurse needs to ask Anna, how long have you been having feelings of fatigue; how many hours of sleep she gets each night; what do you typically eat for breakfast, lunch, dinner, and snacks; and are there any major stressor going on in your life? Sleeping less than eight hours a night can interfere with the body's sleep cycle and lead to a more tired feeling throughout the day. Anna may also be experiencing sleep disturbances related to the anxiety of discovering the lump. If Anna is not eating the right foods then her body is not going to be physically capable of keeping up with her busy workload or the potential effects of the cancer and treatment. Any amount of emotional stress can lead to mental and physical effects on the body including increased feelings of fatigue.

The nurse will perform a physical breast exam on Anna to