ch. 10 problems of the breast

Question 1

benign conditions of the breast

Answer 1

1) anatomic variances:
- micromastia: congenital underdevelopment of breast tissue
- macromastia: large breast
- developmental anomalies

2) pathophysiology of benign breast disorders:
(a) two goals of initial evaluation:
- to distinguish benign from malignant in situ or invasive tumors of the breast
- to assess the risk of subsequent breast cancer associated with the lesion

3) cystic masses

4) fibrocystic changes: most common benign problem
- etiology: changes are due to an exaggerated physiologic response of breast tissue to cyclical changes in ovarian hormones
- clinical manifestations/diagnosis: U/S -> fluid filled vs. solid
- therapeutic mgmt: OC, danazol, tamoxifen, evening primrose oil

5) breast pain (mastalgia)
- character and pattern of breast pain are important: cyclic vs. noncyclic, diffuse vs. focal

6) solid massess:
(a) fibroadenoma:
- the most common solid mass of the breast
- firm, non-tender, solitary masses most often located in the upper outer quadrant

7) reactive inflammatory lesions:
- mammary duct ectasia: characterized by dilated ducts and nipple inversion

8) nipple discharge

9) intraductal papilloma:
- relatively rare, benign condition that develops in the terminal nipple ducts; surfical excision recommended

10) infections of the breast:
- cellulitis

11) care mgmt:
(a) breast self exams (BSE): no longer recommended
(b) client history & physical exmaination
(c) nursing actions might include:
- discuss that intervals for and facets of breast screening (20-39: if at higher risk, 40-54: annual mammogram, 55+: mammogram every other year)
- provide written educational materials
- encourage the verbalization of fears and concerns about treatment and prognosis

Question 2

malignant conditions of the breast

Answer 2

1) incidence: survival rate of 90% at 5 years after diagnosis

2) etiology of breast cancer/risk factors:
- nonmodifiable: heredity, sex, age, family history, and reproductive history
- modifiable: lifestyle behaviors and decisions about childbearing and use of hormones
- other: never have children, first pregnancy after age 30, not breastfeeding

3) genetic considerations:
- approximately 5-10% of breast cancers are d/t inherited genetic mutation
- highest risk: mutation in BRCA 1/BRCA 2
- the breast cancer risk assessment tool (gail model): risk calculator
- chemoprevention: drugs are used for prevention of breast cancer