Breast cancer is a major problem in the United States. Its overall incidence rose by 54% between 1950 and 1990. In the 1990s, the incidence leveled off and stabilized (American Cancer Society [ACS], 2002). At present, there is no cure for breast cancer. Between 1990 and 1994, the mortality for breast cancer decreased by 5. 6%, the largest short-term decline in more than 40 years, suggesting that the combination of early detection and better systematic treatment option is having an effect on overall survival.
Current statistics indicate that a woman’s lifetime risk for developing breast cancer is 1 in 8, but this risk is not the same for all age groups. For example, the risk for developing breast cancer by age 35 years is 1 in 622; the risk for developing breast cancer by age 60 years is 1 in 23. Approximately 80% of breast cancers are diagnosed after the age of 50. According to the American Cancer Society, more than 193,000 cases of breast cancer are diagnosed each year, with estimated 40,000 deaths. About 1% of these cancers occur in men.
Women who are diagnosed with early-stage localized breast cancer have a 5-year survival rate of 98% (ACS, 2002). This paper discusses the importance of exposing facts about Breast Cancer since most women nowadays are being victimized of this deadly disease. Women should be made aware of the causes, the precipitating factors that could lead to the development of this disease that could then eventually affect them all through out their lives. There is no single, specific cause of breast cancer; rather, a combination of hormonal, genetic, and possibly environmental events may contribute to its development.
Hormones produced by the ovaries have an important role in breast cancer. Two key ovarian hormones, estradiol and progesterone, are altered in the cellular environment by a variety of factors, and these may affect growth factors for breast cancer. The role of hormones and their relationship to breast cancer remain controversial. Research suggests that a relationship exists between estrogen exposure and the development of breast cancer. In laboratory studies, tumor grows much faster when exposed to estrogen, and epidemiologic research suggests that women who have longer exposure to estrogen have a higher risk for breast cancer.
Early menarche, nulliparity, childbirth after 30 years of age, and late menopause are known but minor risk factors. The assumption is that these factors are all associated with prolonged exposure to estrogen because of menstruation. The theory is that each cycle (which has high levels of endogenous estrogen) provides the cells of the breast another chance to mutate, increasing the chance for cancer to develop. Estrogen itself does not cause breast cancer, but it is associated with its development. Growing evidence indicates that genetic alterations are associated with the development of breast cancer.
These genetic alterations include changes or mutations in normal genes and the influence of proteins that either promote or suppress the development of breast cancer. Genetic alterations may be somatic (acquired) or germline (inherited). To date, two gene mutations have been identified that may play a role in the development of breast cancer. A mutation in the BRCA-1 gene has been linked to the development of breast and ovarian cancer, whereas a mutation in the BRCA-2 gene identifies risk factors for breast cancer, but less so for ovarian cancer (Houshmand, 2000).
These gene mutations may also play a role in the development of colon, prostate, and pancreatic cancer, but this is far from clear at present. It has been estimated that 1 of 600 women in the general population has either mutation; the risk foe developing breast cancer can range 50% to 90% (Kauff & Satagopan, 2002). At present, only 5% to 10% of all breast cancers are estimated to be associated with the BRCA-1 or BRCA-2 gene mutations. It is thought, however, that breast cancer is genetic and that up to 80% of women diagnosed with breast cancer before age 50 years have a genetic component to their disease (Boyd, 2005).
This is believed to be linked to either unidentified BRCA-1 or BRCA-2 carriers or less penetrating genes that have yet to be identified through genetics research. A woman’s risk for either BRCA-1 or BRCA-2 should be interpreted with caution and with an exhaustive look at all her other risk factors; this is usually carried out by a genetics counselor. Abnormalities in either of the two genes can be identified by a blood test; however, women should be counseled about the risks and benefits before actually undergoing genetic testing. The risks and benefits of a positive or negative result should be explored.
Treatment options for a positive result are long-term surveillance, bilateral prophylactic mastectomy, or chemoprevention with tamoxifen as discussed previously. A positive result can cause tremendous anxiety and fear, can unleash potential discrimination in employment and insurability, and can cause a woman to search for answers that may not be available. A negative result can produce survivor guilt in a person with a strong family history of cancer. For these women, the risk for breast cancer is similar to that of the general population, and routine screening guidelines should be followed.
The decision to pursue genetic testing must be made carefully, and women should be asked what they will do differently after they know the results. Furthermore, because testing is relatively new and health care providers have yet to determine a true benefit from a positive or negative result, genetic testing should be done under the auspices of clinical research protocols to protect the patient (because these data are kept separate from the patient’s medical record). Nurses play a role in educating patients and their family members about the implications of genetic testing.
Ethical issues related to genetic testing include possible employment discrimination, bias in insurability and possibly with insurance rates, and family members’ concerns (e. g. , effect on siblings, children). Some women who are at high risk for breast cancer may elect to undergo prophylactic mastectomy. This procedure can reduce the risk for cancer by 90% (Hartmann et al. , 2000), so as more appropriate term for this surgery is “risk-reducing” mastectomy. The procedure, performed by a breast surgeon, consists of a total mastectomy (removal of breast tissue only).
Possible candidates are women with a strong family history of breast cancer, a diagnosis of LCIS or atypical hyperplasia, a diagnosis of BRCA-1 or BRCA-2 gene mutation, an extreme fear of cancer (“cancer phobia”), or previous cancer in one breast. Many women opt for immediate reconstruction with the mastectomy (Brunner,1993). The woman needs to understand that this surgery is elective and not emergent. To be sure that she understands the implications of surgery, the woman should be offered a consultation with a plastic surgeon, a genetic counseling session, and a psychological evaluation.
Women who make an informed decision tend to demonstrate more satisfaction with the cosmetic results (Rowland, 2003). Nursing interventions for the woman considering a risk-reducing mastectomy include ensuring that the patient has information about reconstructive options and providing referrals to the plastic surgeon, genetic counselor, and psychological counselor. Many women need time to think over the procedure, and the nurse can be helpful in answering questions about the procedure and its implications and in assisting the patient to decide whether the surgery is an appropriate option.
The woman considering this option may wish to talk with a woman who ahs had the procedure (Wagman, 1985). Certain factors may be protective in relation to the development of breast cancer. Regular, vigorous exercise has been shown to decrease risk, perhaps because it can delay menarche, suppress menstruation, and, like pregnancy, reduce the number of ovulatory menstrual cycles. Also, exercise decreases body fat, where estrogens are stored and produced from other steroid hormones. Thus, decreased body fat can decrease extended exposure to estrogen.
Breastfeeding is also thought to decrease risk because it prevents the return of menstruation, again decreasing exposure to endogenous estrogen. Having had a full-term pregnancy before the age of 30 years is also thought to be protective. Protective hormones are released after delivery of the fetus, with the purpose of reverting to normal the proliferation of cells in the breast that occur with pregnancy. D. Clinical Manifestations Breast cancers occur in the breast, but most are found in the upper outer quadrant, where most breast tissue is located.
Generally, the lesions are nontender rather than painful, fixed rather than mobile, and hard with irregular borders rather than encapsulated and smooth. Complaints of diffuse breast pain and tenderness with menstruation are usually associated with benign breast cancer. Marked pain at presentation, however, may be associated with breast cancer in the later stages. With the increased use of mammography, more women are seeking treatment at an earlier stage of disease (Brunner, 1993). These women may have no symptoms and no palpable lump, but abnormal lesions are detected on mammography.
Unfortunately, many women with advanced disease seek initial treatment only after ignoring symptoms. For example, they may seek attention for dimpling or for a peau d’orange (orange-peel) appearance of the skin (a condition caused by swelling that result from obstructed lymphatic circulation in the dermal layer). Nipple retractions and lesions fixed to the chest wall may also be evident. Involvement of the skin is manifested by ulcerating and fungating lesions. These classic signs and symptoms characterize breast cancer in the late stages.
A high index of suspicion should be maintained with any breast abnormality, and abnormalities should be promptly evaluated (Walker, 1999). There are still lots of studies to be conducted to prevent this disease from killing innocent women. Health care professionals should further do researches that would not just eradicate Breast Cancer temporarily but if it possible should be diminished for a lifetime. Several features of breast tumors contribute to the prognosis. Generally, the smaller the tumor, the better the prognosis.
Carcinoma of the breast is not a pathologic entity that develops overnight. It starts with a genetic alteration in a single cell. It can take about 16 doubling times for a carcinoma to become 1 cm or larger, at which point it becomes clinically apparent. The prognosis also depends on whether the cancer has spread. In addition to tumor size, nodal involvement, evidence of metastasis, and histologic type, other measures in determining prognosis. The presence of estrogen and progesterone receptor proteins indicates retention of regulatory controls of the mammary epithelium (Vogel, 2000).
The presence of both receptor proteins associated with improved prognosis; their absence is associated with a poorer prognosis. Similarly, a tumor with a high degree of differentiation is associated with a better prognosis than a poorly differentiated anaplastic tumor. The assessment of a tumor’s proliferative rate and DNA content by laboratory assay may help to determine prognosis because these two factors are strongly correlated with other prognostic factors. I would like to recommend further studies about Breast Cancer and how it can be prevented from developing.
The things to avoid, medications to administer that could help alleviate the pain and maybe also to help cure the disease without any fatal side effect towards women’s health. Reference: 1. Allender, J. A. , & Spradley, B. W. (2000). Community health nursing: Concepts and practice (5th Ed. ). Philadelphia: Lippincott Williams and Wilkins. 2. American Cancer Society [ACS], 2002. Cancer facts and figures. Atlanta: American Cancer Society. 3. Boyd, J. (2005). BRCA2 as a low penetrance cancer gene.
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