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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