Chapter 10 - Problems of the Breast

Question 1

Breast

Answer 1

50% of women will have a breast problem at some point in their adult life
BSE-breast self exam
Benign lump or thickened area-fibroadenoma, fibrocystic changes (most common), cysts, atypical hyperplasia

Question 2

Fibrocystic changes ***

Answer 2

Etiology-hormonal changes
Clinical manifestations and diagnosis-lumpiness, can be painful
Therapeutic management-US, aspirate, mammogram
Dietary changes: limit caffeine, chocolate, tobacco
Vit E, decreased salt

Question 3

Fibroadenomas

Answer 3

(second most common) solitary lump, <3 cm, usually do not require surgery

Question 4

Nipple discharge-

Answer 4

Galactorrhea

Spontaneous milky, sticky discharge-elevated prolactin level

Question 5

Mammary duct ectasia-

Answer 5

inflammation of ducts behind nipple-perimenopausel women-thick, sticky, dicharge, white, brown, green, purple-can develop abscess, usually goes away

Question 6

Intraductal papilloma-

Answer 6

rare, benign, bloody discharge

Question 7

Macromastia-

Answer 7

large breasts

should/neck problems

Question 8

micromastia-

Answer 8

small breasts

Question 9

Collaborative care

Answer 9

Assessment of the breasts

Nursing actions - BSE technique, Education

Question 10

Malignant Conditions of the Breast Incidence

Answer 10

US one of the highest rates of breast cancer in the world
Most recent estimates for breast cancer in the U.S. by the American Cancer Society for 2009
192,370 new cases of invasive breast cancer
40,170 female deaths from breast cancer
One in eight American women will develop invasive breast cancer in her lifetime

Question 11

Malignant Conditions of the Breast Etiologic factors

Answer 11

Gender-F
Age-increases with age
Genetic risk factors- 5-10%-BRCA
Family history-maternal or paternal
Personal history of breast cancer
Race-Caucasian
Dense breast tissue
Menstrual periods-before 12 years, menopause after 55
Earlier breast radiation
Treatment with DES-thought to lower chance of miscarriage
Not having children or having them later in life-> 30
Recent use of birth control pills-slightly higher
Postmenopausal hormone therapy (PHT) - Combined PHT, Estrogen replacement therapy
Not breastfeeding
Alcohol-2-5 drinks per day increase risk 1.5%
Being overweight or obese
Lack of exercise
High fat diets

Question 12

Malignant Conditions of the Breast Etiologic factors that are myths

Answer 12

Antiperspirants and bras-no evidence to support
Abortions-myth
Breast implants-myth
Pollution-Currently no clear link
Tobacco-Studies ongoing
Night shift work-Studies looking at

Question 13

Determining a client’s risk of genetically related breast disease

Answer 13

Ethical considerations of genetic testing-insurance
Chemoprevention-tamoxifen
BRCA1 and BRCA2 mutations
Genetic Information Nondiscrimination Act (GINA) if test positive for BRCA

Question 14

Pathophysiology

Answer 14

Metastasis-blood and lymph

Question 15

Clinical manifestations and diagnosis

Answer 15

Can be detected on mammogram before being felt
Lump may be hard, fixed, spongy, soft, well defined or irregular borders
Mammography
MRI
Core needle biopsy
(once turn 40 mammogram once every year)

Question 16

Surgery

Answer 16

Lumpectomy
Partial mastectomy
Total simple mastectomy-no nodes taken
Modified radical mastectomy-includes nodes
Skin- or scar-sparing mastectomy
Nipple- and areola-sparing mastectomy
Preventive/prophylactic mastectomy

Question 17

Breast Reconstruction

Answer 17

Simultaneous reconstruction
“Staged” reconstruction
Delayed reconstruction

Question 18

Radiation

Answer 18

Accelerated breast radiation-6 weeks, 5 days of week

Brachytherapy-implanted

Question 19

Adjuvant therapy

Answer 19

Adjuvant chemotherapy-reduces risk of recurrence and mortality
Hormonal therapy - Tamoxifen-oral antiestrogen, use on cancers that are hormone sensitive
Chemotherapy-most helpful in premenopausal women who have positive nodes

Question 20

Care management

Answer 20

Emotional support after diagnosis
Preoperative care
Immediate postoperative care
Discharge planning and follow-up care
Teaching needs for client/family

Question 21

Key Points

Answer 21

Most common benign breast problem are fibrocystic changes and fibroadenomas
Development of breast neoplasms can have significant physical and emotional effect on the woman and her family
Risk of U.S. women developing breast cancer is 1 in 8

Question 22

Key Points

Answer 22

Estimated 90% of all breast lumps detected by the woman during BSE
Monthly BSE, routine screening mammography, and yearly breast exams are recommended for early detection of breast cancer
Primary therapy for stage I or stage II breast cancer is breast-conserving surgery followed by radiation therapy

Question 23

Key Points

Answer 23

Adjuvant chemotherapy is most helpful to premenopausal women with breast cancer that has spread to the lymph nodes
Tamoxifen may provide first real hope for prevention of breast cancer
Many disruptions caused by breast cancer diagnosis challenge woman’s/family’s ability to cope

Question 24

Key Points

Answer 24

There are more reconstruction options today than ever before
Digital mammography is superior to traditional analog mammography
85% of women diagnosed with breast cancer will be long-term survivors