Breast Cancer Awareness and Risk Factors
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Questions and Answers

What is true about hormone receptor-positive breast cancers?

  • They can be treated with hormone therapy drugs. (correct)
  • They have no estrogen or progesterone receptors.
  • They are more likely to grow rapidly.
  • They tend to have a poorer prognosis.
  • What distinguishes triple negative breast cancer from other types?

  • It has a better short-term outlook.
  • Hormone therapy is ineffective. (correct)
  • It has both estrogen and progesterone receptors.
  • It is more common in women over 40.
  • Which receptor status is associated with a poor short-term prognosis for breast cancer?

  • Triple negative
  • Hormone receptor-positive
  • Hormone receptor-negative (correct)
  • Triple positive
  • What is a characteristic of hormone receptor-negative breast cancers?

    <p>They often return within the first few years after treatment. (B)</p> Signup and view all the answers

    What does it mean for breast cancer to be triple positive?

    <p>It is positive for estrogen, progesterone, and HER2. (C)</p> Signup and view all the answers

    Which group is more likely to develop triple negative breast cancer?

    <p>Women under 40 years of age. (D)</p> Signup and view all the answers

    Which option correctly describes the growth rate of hormone receptor-positive cancers compared to hormone receptor-negative cancers?

    <p>Hormone receptor-negative cancers tend to grow faster. (C)</p> Signup and view all the answers

    What is the significance of HER2 status in triple positive breast cancers?

    <p>It helps identify suitable treatments targeting HER2. (C)</p> Signup and view all the answers

    What characterizes hormone receptor-positive breast cancer?

    <p>Presence of one or both estrogen or progesterone receptors (C)</p> Signup and view all the answers

    What is the primary aim of keeping estrogen and progesterone from attaching to receptors in breast cancer treatment?

    <p>To prevent cancer from growing and spreading (C)</p> Signup and view all the answers

    Which type of radiation therapy is administered after local excision of the breast mass?

    <p>Primary Radiation Therapy (C)</p> Signup and view all the answers

    What defines hormone receptor-negative breast cancer?

    <p>Absence of estrogen and progesterone receptors (B)</p> Signup and view all the answers

    What system is used in high-dose brachytherapy to focus radiation on the tumor site?

    <p>Balloon Catheter System (A)</p> Signup and view all the answers

    What is a common adverse effect of external beam radiation therapy?

    <p>Fatigue and skin changes (B)</p> Signup and view all the answers

    Which type of therapy aims to destroy tumor cells that may have spread to distant sites?

    <p>Systemic Therapy (C)</p> Signup and view all the answers

    What describes the use of chemotherapy in breast cancer treatment?

    <p>Use of cytotoxic drugs to destroy cancer cells (C)</p> Signup and view all the answers

    What is an overall goal for clients with breast cancer during their treatment process?

    <p>Verbalize acceptance of physical changes and engage in self-care activities (A)</p> Signup and view all the answers

    Which of the following is NOT a nursing intervention when caring for clients undergoing breast cancer treatment?

    <p>Encourage clients to ignore their pain during recovery (C)</p> Signup and view all the answers

    What should nurses emphasize when preparing clients for surgery?

    <p>What to expect during the surgery and post-operative care (D)</p> Signup and view all the answers

    How should nurses approach the client's need for information regarding their treatment?

    <p>Be sensitive to the individual's need for and type of information (D)</p> Signup and view all the answers

    What is a critical aspect of the therapeutic plan for clients with breast cancer?

    <p>To ensure adherence and management of therapy side effects (D)</p> Signup and view all the answers

    What is the primary purpose of preoperative (neoadjuvant) chemotherapy in breast cancer treatment?

    <p>To decrease the size of the primary tumor (B)</p> Signup and view all the answers

    Which of the following is NOT a common adverse effect of hormonal therapy with tamoxifen?

    <p>Increased hair growth (B)</p> Signup and view all the answers

    Which patient history factor is considered a significant risk for breast cancer?

    <p>Menstrual history of early menarche (D)</p> Signup and view all the answers

    What is a possible symptom indicative of metastasis in breast cancer patients?

    <p>Cognitive disorientation (C)</p> Signup and view all the answers

    What psychological impact may be experienced by breast cancer patients due to their condition?

    <p>Disturbed body image (B)</p> Signup and view all the answers

    Tamoxifen is primarily effective against which type of breast cancer cells?

    <p>Estrogen receptor-positive cells (A)</p> Signup and view all the answers

    Which lifestyle factor can increase the risk for breast cancer?

    <p>Nulliparity or late first full-term pregnancy (D)</p> Signup and view all the answers

    What nursing diagnosis may be associated with a breast cancer patient's treatment decisions?

    <p>Decisional conflict related to insufficient information (D)</p> Signup and view all the answers

    Which of the following is a common side effect of chemotherapy impacting the gastrointestinal tract?

    <p>Nausea (C)</p> Signup and view all the answers

    Which factor is associated with an increased risk of breast cancer based on past medical history?

    <p>History of benign breast disorders with atypical changes (B)</p> Signup and view all the answers

    What is the role of acetaldehyde in cancer development?

    <p>It damages DNA and hinders the repair process. (A)</p> Signup and view all the answers

    Which hereditary factor increases the risk of developing breast cancer the most?

    <p>Having a first-degree relative with breast cancer. (B)</p> Signup and view all the answers

    What characteristic is often associated with inflammatory breast cancer?

    <p>Orange-peel skin (Peau d’orange). (B)</p> Signup and view all the answers

    What does a mammography primarily help to detect?

    <p>Lumps less than 1 cm in diameter. (C)</p> Signup and view all the answers

    What is one primary purpose of a fine-needle aspiration biopsy?

    <p>To confirm the diagnosis of a lesion. (D)</p> Signup and view all the answers

    What should clients avoid before undergoing a biopsy?

    <p>Blood-thinning agents. (C)</p> Signup and view all the answers

    Which screening method is recommended for high-risk patients aged 30-69 in Ontario?

    <p>Regular mammograms and breast MRIs. (D)</p> Signup and view all the answers

    What is a significant risk factor for men regarding breast cancer?

    <p>Hyperestrogenism. (A)</p> Signup and view all the answers

    Which surgical procedure often preserves the breast, including the nipple?

    <p>Lumpectomy. (D)</p> Signup and view all the answers

    How often should eligible women in Ontario schedule a mammogram after 40 years of age?

    <p>Every 2 years. (C)</p> Signup and view all the answers

    What indicates the need for a chest radiograph in diagnostic studies?

    <p>Investigation of potential metastasis. (D)</p> Signup and view all the answers

    Which statement about breast cancer surgery is correct?

    <p>Radiation therapy is often used in conjunction with surgery. (B)</p> Signup and view all the answers

    What is the primary goal of using local anesthesia during biopsy procedures?

    <p>To ensure the patient feels no pain during the procedure. (C)</p> Signup and view all the answers

    What should be monitored after a lumpectomy procedure regarding the incision site?

    <p>Skin color and presence of any unusual swelling. (B)</p> Signup and view all the answers

    What primary need does the ABC program address for cancer survivors?

    <p>Psychological, physical, and cosmetic needs (B)</p> Signup and view all the answers

    Who founded the after BREAST CANCER organization?

    <p>Alicia Vianga (B)</p> Signup and view all the answers

    Which type of support does the ABC Care KITS! not include?

    <p>Financial counseling services (C)</p> Signup and view all the answers

    What significant issue did Alicia identify while reviewing the Bra and Breast Prosthesis Guide?

    <p>Absence of a program providing breast prostheses in Toronto (A)</p> Signup and view all the answers

    What item is included in the ABC Care KITS! to offer comfort during recovery?

    <p>Handmade knitted blanket (B)</p> Signup and view all the answers

    Which organization can assist healthcare professionals in addressing the needs of breast cancer patients?

    <p>Canadian Cancer Society (D)</p> Signup and view all the answers

    What does ABC provide to clients at no cost?

    <p>Breast prostheses and bras (A)</p> Signup and view all the answers

    Which item in the ABC Care KITS! assists with post-surgery recovery?

    <p>Front Closure Mastectomy Bra (D)</p> Signup and view all the answers

    What lifestyle factor is associated with a higher risk of breast cancer following menopause?

    <p>Increased alcohol intake (D)</p> Signup and view all the answers

    Which risk factor significantly increases the likelihood of developing breast cancer if a person has a family history of the disease?

    <p>Smoking before age 17 (C)</p> Signup and view all the answers

    What is a potential effect of smoking on breast cancer development besides directly increasing risk?

    <p>Raises the incidence of hormone receptor-positive breast cancer (D)</p> Signup and view all the answers

    Which of the following is a common characteristic of individuals who are at higher risk of breast cancer?

    <p>Having a high body mass index (BMI) after menopause (C)</p> Signup and view all the answers

    When considering the modifiable risk factors for breast cancer, which of the following has a significant impact?

    <p>Reducing alcohol consumption (B)</p> Signup and view all the answers

    What is the role of BRCA1 and BRCA2 genes in breast cancer prevention?

    <p>They are involved in inhibiting tumor development. (B)</p> Signup and view all the answers

    Which of the following clinical manifestations is most commonly associated with Paget's Breast Cancer?

    <p>Abnormal nipple discharge (A)</p> Signup and view all the answers

    What is the most accurate statement regarding mammography for breast cancer screening?

    <p>It can show lumps less than 1 cm in diameter. (D)</p> Signup and view all the answers

    Which factor distinguishes individuals who should consider genetic testing for BRCA mutations?

    <p>Family history of ovarian cancer in first-degree relatives. (B)</p> Signup and view all the answers

    What is a significant nursing intervention post-lumpectomy?

    <p>Inspecting the incision site for signs of infection. (B)</p> Signup and view all the answers

    What is the primary therapeutic approach of hormone receptor-positive breast cancer?

    <p>Keeping hormones from attaching to the receptors (C)</p> Signup and view all the answers

    Which statement accurately describes high-dose brachytherapy?

    <p>Balloon catheter insertion with radioactive seeds is a common technique. (C)</p> Signup and view all the answers

    What defines palliative radiation therapy in the context of breast cancer?

    <p>It stabilizes symptomatic metastatic lesions. (A)</p> Signup and view all the answers

    What is the purpose of adjuvant therapy in breast cancer treatment?

    <p>To prevent the spread of cancer after primary treatment. (C)</p> Signup and view all the answers

    What distinguishes systemic therapy from other types of treatments for breast cancer?

    <p>It destroys tumor cells that may have metastasized. (B)</p> Signup and view all the answers

    Which of the following adverse effects is NOT commonly associated with external beam radiation therapy?

    <p>Severe hair loss on the scalp (C)</p> Signup and view all the answers

    Which aspect is NOT a characteristic of chemotherapy in breast cancer treatment?

    <p>It focuses solely on hormone receptor-negative tumors. (A)</p> Signup and view all the answers

    What is a primary benefit of skin-sparing mastectomy compared to traditional mastectomy?

    <p>Less scar tissue and a more natural appearance (A)</p> Signup and view all the answers

    Which procedure involves using a woman's own tissue to reconstruct the breast mound?

    <p>Tissue flap procedures (A)</p> Signup and view all the answers

    During nipple–areolar reconstruction, which of the following materials can be used to create an areola?

    <p>Tattooing with pigmented dye (C)</p> Signup and view all the answers

    Sentinel lymph node biopsy is primarily performed to assess what aspect of breast cancer?

    <p>If cancer has spread to nearby lymph nodes (D)</p> Signup and view all the answers

    What is one purpose of using a tissue expander in breast reconstruction?

    <p>To stretch the skin and muscle for future implant placement (D)</p> Signup and view all the answers

    In what way does hormone receptor status affect breast cancer treatment planning?

    <p>It indicates the need for hormone therapy (C)</p> Signup and view all the answers

    Which type of surgical procedure typically includes the use of a tissue expander?

    <p>Breast reconstruction post-mastectomy (B)</p> Signup and view all the answers

    What is a significant advantage of reconstructing the nipple–areolar complex after breast reconstruction?

    <p>It helps restore a natural appearance to the breast (D)</p> Signup and view all the answers

    Which risk factor is NOT commonly associated with an increased likelihood of developing breast cancer?

    <p>Having a family history of diabetes (B)</p> Signup and view all the answers

    Which lifestyle factor is most associated with an increased risk of hormone receptor-positive breast cancer?

    <p>Daily alcohol consumption (A)</p> Signup and view all the answers

    What significant impact does starting to smoke before age 17 have on breast cancer risk?

    <p>It raises the risk for at least twenty years after quitting (B)</p> Signup and view all the answers

    Which factor related to reproductive history is considered a significant risk in developing breast cancer?

    <p>Delayed first pregnancy after age 30 (D)</p> Signup and view all the answers

    Which non-reproductive factor has been correlated with an increased incidence of breast cancer in individuals working night shifts?

    <p>Disruption of circadian rhythms (A)</p> Signup and view all the answers

    What is the role of BRCA1 and BRCA2 genes in relation to cancer development?

    <p>They inhibit tumor development when functioning normally. (B)</p> Signup and view all the answers

    Which symptom is often characteristic of Paget’s breast cancer?

    <p>Blood-stained nipple discharge (A)</p> Signup and view all the answers

    What effect does acetaldehyde have on DNA?

    <p>It damages DNA and hinders repair processes. (B)</p> Signup and view all the answers

    How is mammography effective for early cancer detection?

    <p>It can show lumps smaller than 1cm in diameter. (C)</p> Signup and view all the answers

    What is the purpose of performing an axillary node dissection during breast cancer surgery?

    <p>To assess and remove potentially cancerous lymph nodes. (B)</p> Signup and view all the answers

    Flashcards

    Hormone Receptor-Positive Breast Cancer

    Breast cancer cells that have estrogen (ER) and/or progesterone (PR) receptors.

    Hormone Receptor-Negative Breast Cancer

    Breast cancer cells lacking estrogen and progesterone receptors.

    Triple-Negative Breast Cancer

    Breast cancer cells lacking estrogen, progesterone, and HER2 receptors.

    Estrogen Receptor (ER)

    A protein in breast cancer cells that estrogen attaches to to stimulate growth.

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    Progesterone Receptor (PR)

    A protein in breast cancer cells that progesterone attaches to to stimulate growth.

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    HER2 Receptor

    A protein in some breast cancer cells that contributes to rapid growth.

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    Hormone Therapy

    Treatment for breast cancers with estrogen or progesterone receptors, lowering hormone levels or blocking receptors.

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    Triple-Positive Breast Cancer

    Breast cancer cells that are positive for estrogen, progesterone, and HER2 receptors.

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    Alcohol's impact on DNA

    Alcohol breaks down into acetaldehyde, damaging DNA and hindering its repair, which can lead to uncontrolled cell growth.

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    BRCA genes

    Tumor suppressor genes (BRCA1 and BRCA2) located on chromosomes 17 and 11 that prevent tumor development.

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    Hyperestrogenism

    Excessive estrogen levels, a risk factor for breast cancer in men and AMAB individuals.

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    Breast cancer risk factors (family)

    Having a first-degree relative with breast cancer increases the risk by 1.5-3 times, depending on the age.

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    Mammography screening

    X-ray procedure for breast cancer detection, recommended every 2 years for women aged 50-69 in Canada.

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    Fine-needle aspiration (FNA)

    A procedure to remove breast tissue/fluid for examination, often used for biopsy confirmation.

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    Breast-conserving surgery

    A surgical procedure that tries to preserve the breast while removing cancerous tissue (lumpectomy).

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    Modified radical mastectomy

    Breast cancer surgery that removes the breast and surrounding axillary lymph nodes.

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    Total/Simple Mastectomy

    Removal of the entire breast and nipple, but not the lymph nodes, sometimes used for high-risk individuals.

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    Lymphedema

    Accumulation of lymph in soft tissues, potentially caused by breast cancer surgery or radiation.

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    Ultrasonography

    Non-invasive imaging technique used to determine breast mass consistency (solid or fluid).

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    Biopsy

    A tissue sample taken for examination to determine if cancerous.

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    Breast Cancer Manifestations

    Possible symptoms include nontender lumps, skin changes, nipple discharge, and pain.

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    Diagnostic Studies (Breast Cancer)

    Evaluating methods include physical exams, mammograms, biopsies, and imaging to diagnose breast cancer.

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    Post-Biopsy Nursing Interventions

    Monitoring for complications, pain management, and education about activities post-biopsy are important.

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    Breast Cancer Treatment Goals

    The overall aims for clients with breast cancer are: accepting physical changes, improving body image, promoting self-confidence and self-care, actively participating in treatment decisions, adhering to the therapeutic plan, managing therapy's side effects, and utilizing support from loved ones & healthcare providers.

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    Preparing for Breast Surgery

    Nursing interventions include reviewing treatment options, explaining the surgical process, educating about drains, arm/shoulder mobility, and exercises. Consent, NPO, pre-op pain management, turning, deep breathing, and coughing techniques are also important.

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    Maintaining Communication

    Open and honest communication is crucial for breast cancer clients. It involves providing realistic expectations, supporting their coping mechanisms, and connecting them with resources.

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    Individualized Information Needs

    It's essential to be sensitive to the patient's specific information requirements and how they prefer to receive it.

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    Coping with Uncertain Future

    Nurses provide support to clients struggling with the emotional challenges of cancer, including the uncertainty about the future.

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    ER-positive breast cancer

    Breast cancer where the cancer cells have estrogen receptors.

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    PR-positive breast cancer

    Breast cancer where the cancer cells have progesterone receptors.

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    Hormone receptor-positive cancer

    Breast cancer where the cancer cells have either estrogen or progesterone receptors, or both.

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    Hormone receptor-negative cancer

    Breast cancer where the cancer cells do not have estrogen or progesterone receptors.

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    Adjuvant therapy

    Treatments given after the primary treatment for breast cancer to reduce the risk of recurrence.

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    Primary radiation therapy

    Radiation therapy given as the initial treatment for breast cancer.

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    Chemotherapy

    Use of drugs to kill cancer cells, often used in breast cancer treatment.

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    Palliative radiation therapy

    Radiation therapy to ease symptoms from advanced breast cancer.

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    after BREAST CANCER (ABC)

    A registered charity founded in 2013 by Alicia Vianga, providing support and resources to breast cancer survivors.

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    ABC Care KITs

    Kits provided by after BREAST CANCER (ABC) containing items like temporary breast prostheses, mastectomy bras, and other essentials for breast cancer survivors.

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    What was the gap Alicia identified in healthcare?

    A lack of access to breast prostheses and bras for cancer survivors without insurance or financial means.

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    What is the purpose of after BREAST CANCER (ABC)?

    To provide breast prostheses and bras at no cost to financially challenged breast cancer survivors in Toronto.

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    What kind of support do ABC Care KITs provide?

    They provide physical, psychological, and cosmetic support by offering practical items for post-surgery recovery and comfort.

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    What is the unique value proposition of after BREAST CANCER (ABC)?

    They offer new and gently used bras and prostheses at no cost, specifically targeting individuals who are financially challenged.

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    Who are the volunteers at after BREAST CANCER (ABC)?

    Breast cancer survivors who can share their experiences and answer questions about expectations, surgery, and recovery.

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    What is the website address for after BREAST CANCER (ABC) for more information?

    https://www.afterbreastcancer.ca/

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    Neoadjuvant Chemotherapy

    Chemotherapy given before surgery to shrink the tumor, potentially allowing for less invasive surgery.

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    Adverse Effects of Chemotherapy

    Side effects of chemotherapy, often affecting the gastrointestinal tract, bone marrow, and hair follicles. Examples include nausea, fatigue, and hair loss.

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    Hormonal Therapy for Breast Cancer

    Treatment that targets estrogen or progesterone receptors on breast cancer cells, aiming to slow down or stop tumor growth.

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    Estrogen Receptor Blockers

    Drugs that prevent estrogen from attaching to cancer cells, inhibiting their growth. Tamoxifen is a common example.

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    Tamoxifen

    A common antiestrogen drug used to treat early and advanced breast cancer, as well as preventing breast cancer in high-risk individuals.

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    Adverse Effects of Tamoxifen

    Side effects of Tamoxifen can include hot flashes, mood swings, vaginal changes, and increased risk of blood clots, cataracts, stroke, and endometrial cancer.

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    Family History of Breast Cancer

    Having a mother, sister, or other close relative diagnosed with breast cancer, especially at a young age, increases the risk of developing the disease.

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    Abnormal Mammogram Findings

    Results from a breast screening mammogram that show potential abnormalities, raising concern for breast cancer.

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    Benign Breast Disorders with Atypical Changes

    Non-cancerous breast conditions that show some unusual features, increasing the risk for future breast cancer development.

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    Psychological Stress and Breast Cancer

    High levels of stress can potentially increase the risk of developing breast cancer.

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    Breast Cancer Risk: Age

    The risk of breast cancer increases significantly after age 50.

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    Breast Cancer Risk: Early Menstrual Period

    Starting periods before age 12 raises the risk of breast cancer.

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    Breast Cancer Risk: Late or No Pregnancy

    Having your first pregnancy after age 30 or not having children at all increases breast cancer risk.

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    Breast Cancer Risk: Menopause

    Starting menopause after age 55 is associated with a higher risk of breast cancer.

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    Breast Cancer Risk: Dense Breasts

    Having dense breast tissue makes it harder to detect breast cancer through mammograms.

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    Alcohol and Cancer

    Alcohol breaks down into acetaldehyde, a chemical that damages DNA and hinders its repair, increasing the risk of uncontrolled cell growth, which can lead to cancer.

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    Sentinel Lymph Node Biopsy

    A procedure where a lymph node that is most likely to receive cancer cells is removed and examined to check for cancer spread.

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    Tissue Expander

    A device used to stretch skin and muscle before implants are inserted after mastectomy.

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    Tissue Flap Procedures

    Reconstruction using tissue from other parts of the body, like the abdomen or back, to recreate the breast mound.

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    Nipple–Areolar Reconstruction

    A procedure to restore the natural appearance of the reconstructed breast by creating a nipple and areola.

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    Hormone Receptor Status

    Testing breast cancer cells to see if they have estrogen or progesterone receptors, which can affect treatment.

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    Breast Implants

    Artificial replacements for the breast, placed under the pectoralis muscle to protect and cover them.

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    Skin-sparing Mastectomy

    Breast removal surgery that preserves some of the breast skin for potential reconstruction.

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    Autologous Tissue

    Tissue taken from the patient's own body for reconstruction.

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    What is Adjuvant Therapy?

    Treatments given after the primary breast cancer treatment (surgery, radiation) to reduce the risk of cancer returning.

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    What is Primary Radiation Therapy?

    Radiation given as the main initial treatment for breast cancer, often after surgery to kill remaining cancer cells.

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    What is Palliative Radiation Therapy?

    Radiation therapy used for metastatic breast cancer to ease symptoms like bone pain or tumor pressure.

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    What is Breast Cancer?

    A disease where abnormal cells grow uncontrollably in breast tissue, forming a tumor that can spread to other parts of the body.

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    Breast Cancer Risk Factor: Age

    The risk of breast cancer increases significantly after age 50.

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    Breast Cancer Risk: Late Pregnancy

    Having your first pregnancy after age 30 increases breast cancer risk.

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    Breast Cancer Screening: Mammography

    Mammograms are X-rays of the breast that can detect small lumps or abnormalities. They are recommended every 2 years for women aged 50 to 69 in Canada.

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    Study Notes

    Female Reproductive Cancers: Breast Cancer

    • Breast cancer refers to individuals assigned female at birth (AFAB), even if the term "female" is used.
    • Symptoms may include nipple changes (turning inward, discharge), lumps in the underarm area, swelling of part or all of the breast, skin dimpling, and breast or nipple pain/irritation.

    Risk Factors

    • Female and AFAB: Account for 99% of cases.
    • Increasing age: (over 50)
    • Early menstrual period: (before age 12)
    • Late or no pregnancy: (first pregnancy after age 30)
    • Starting menopause after age 55:
    • Dense breasts:
    • Combination hormone therapy:
    • Oral contraceptives:
    • Personal history of breast cancer: Breast cancer is more common in those with a prior diagnosis.
    • Personal history of certain non-cancerous breast diseases:
    • Higher income:
    • Working night shifts:
    • Overweight or obese after menopause: (BMI >31.1)
    • Lack of physical activity:
    • Alcohol intake:

    Simple Modifiable Risk Factors and Cancer Connection

    • Smoking: Higher risk if started before age 17, and risk remains elevated for at least 20 years after quitting. A 35% increased risk with a family history of breast cancer. Associated with hormone receptor-positive breast cancer.
    • Physical activity: Related to lower sex hormone levels and growth factors (e.g., breast, colon).
    • Alcohol: Alcohol breaks down into acetaldehyde, damaging DNA and preventing repair. Damaged DNA can lead to uncontrolled cell growth that forms a tumor.

    Genetic Factors

    • Family history: A first-degree relative (mother, sister, daughter) with ovarian cancer and/or bilateral breast cancer significantly increases risk. BRCA1 and BRCA2 gene mutations have a high risk (~85% lifetime chance) of breast and ovarian cancer.
    • BRCA genes: Located on chromosomes 17 (BRCA1) and 11 (BRCA2), these are tumor suppressor genes.

    Clinical Manifestations

    • Nontender lump: Frequently located in the upper outer quadrant of the breast.
    • Firm (fixed), hard mass: Embedded in surrounding tissue.
    • Dimpling of skin:
    • Asymmetrical shape:
    • Irregular shape (not round):
    • Inflammatory breast cancer: Orange-peel skin, nipple discharge, rash, nipple retraction, flaking or eruption near nipple, burning, stinging, or prickly sensation.
    • Paget's breast cancer: Abnormal nipple discharge (blood), rash around nipple area.

    Diagnostic Studies

    • Health history: Including family history.
    • Biopsy:
    • Fine-needle aspiration:
    • Surgical biopsy:
    • Breast MRI: (if indicated)
    • Mammography:
    • Physical examination: Including breast and lymph nodes.
    • Ultrasonography:
    • Metastasis assessment (if suspected): Bone scan, chest radiograph, complete blood count, platelet count, liver function tests, CT scan of chest, abdomen, and pelvis.

    Fine-Needle Aspiration

    • A needle used to collect fluid or tissue for examination.
    • Best for confirming a diagnosis.
    • A few minutes procedure, often as an outpatient.
    • Collected tissue sent for histological examination.
    • Clients should avoid NSAIDs, Vitamin E supplements, herbal supplements (e.g., ginkgo biloba, garlic), and warfarin (Coumadin) before the procedure.

    Screening

    • Mammography: Canadian Cancer Society recommends every 2 years for women aged 50-69.
    • X-ray with compression: 2 views to detect lumps (<1cm). Low radiation (equivalent to 1 hour in the sun). High accuracy for detection (~90.05%).
    • Stages: Stage I (<2cm, no nodes), Stage II (2–5cm, 1–3 nodes), Stage III (>5cm, 4–9 nodes), Stage IV (any size, any nodal involvement).
    • Ultrasonography: Helpful to differentiate between solid and fluid-filled masses.

    Breast Cancer Update for Ontario (2023)

    • Eligible women, non-binary, trans, and two-spirit people ages 40–74 can self-refer for mammograms every two years.
    • Eligible people may get regular mammograms and breast MRIs between the ages of 30 and 69.

    Collaborative Care

    • Surgery: Breast-conserving (lumpectomy) with or without sentinel lymph node dissection (SNLD), axillary lymph node dissection (ALND). Modified radical mastectomy (may include reconstruction).
    • Radiation Therapy: Primary (after local excision), adjuvant (following surgery), high-dose brachytherapy, palliative.
    • Chemotherapy:

    Breast-Conserving Surgery

    • Lumpectomy: Breast tissue and nipple preserved. Radiation therapy often part of this treatment.
    • Axillary Node Dissection: Removal of lymph nodes on the same side. Complications may include lymphedema.

    Post-Mastectomy Surgical Therapy

    • Breast Reconstruction:
      • Breast implants and tissue expansion.
      • Tissue flaps: autologous tissue to re-create a breast mound.
      • Nipple-areolar reconstruction: gives a more natural appearance.

    Hormone Receptor Status

    • Breast cancer cells are tested for estrogen (ER) and progesterone (PR) receptor status and HER2 status.
      • ER+: Treatment with hormone therapy
      • PR+: Treatment with hormone therapy
      • Negative: Treatment with chemotherapy
      • Triple-negative cancers: tend to be more aggressive and respond to chemotherapy.
    • Receptors are proteins on cells that attach to blood substances. If the receptors for hormones are present, the hormones stimulate cancer growth.

    Other Therapies

    • Adjuvant Therapy: Includes local radiation and systemic treatments like chemotherapy or hormone therapy.
    • Primary Radiation Therapy: After local excision of a mass.
    • High-Dose Brachytherapy: Radioactive seeds placed in the breast after tumor removal.
    • Palliative Radiation Therapy: Addresses symptomatic metastatic disease in bone, soft tissues, or the brain.
    • Systemic Therapy: For cancers that have spread to distant sites.

    Assessment

    • Past Health History: Family history of breast cancer (especially mother or sister), age at diagnosis, history of abnormal mammograms/biopsies, any benign breast disorders, menstrual/pregnancy history, previous cancers, dietary habits, alcohol usage, level of physical activity, and medications (hormones, oral contraceptives).
    • Symptoms: Palpable breast changes, obesity/weight loss, cognitive changes, neurological symptoms, headache, bone pain, unilateral nipple discharge (bloody or milky), change in breast size/contour or symmetry, psychological stress, and anxiety.

    Nursing Diagnoses

    • Decisional conflict related to treatment options or their effects.
    • Anxiety related to cancer diagnosis and treatment.
    • Disturbed body image from breast surgery or scars.

    Planning

    • Client will verbalize acceptance of physical changes, improve body image, engage in self-care, and active participation in decision-making process.
    • Adherence to therapeutic plans, management of treatment side effects, access to support systems.

    Nursing Interventions

    • Review treatment options, arm/shoulder mobility, range-of-motion exercises, pain/medication management, turning and positioning, good communication with client, realistic expectations, support for coping with pain and uncertainty, providing supportive resources, informing clients about postoperative sensations/pain relief, maintaining privacy, providing bras or breast forms, monitoring for potential complications (infection, hematoma, drainage), assessing the drainage, and assessing affected arm for tingling or numbness.
    • Hand/arm care: restoring arm function, prevention, no blood pressure/injections/draws, elevated arm positioning, gentle exercises; avoidance of pressure/heavy items and restrictive actions.

    Follow-Up and Survivorship Care

    • Continued monitoring for recurrence, regular professional examinations, monthly self-breast examinations, close monitoring of the surgical site after surgery, appropriate breast imaging, and encouragement of clients to process their feelings.

    References

    • (All references listed in the uploaded document should be included in a formal study guide)

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    This quiz explores essential information about breast cancer, specifically focusing on symptoms and various risk factors associated with the disease. Learn how age, reproductive history, and lifestyle choices can influence the likelihood of developing breast cancer. Empower yourself with knowledge to promote awareness and early detection.

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