Breast Disorders

Breast Abscess

  • Definition: A localized collection of pus in the breast.

  • Causes:

    • Non-lactational breast abscesses are often related to:

    • Diabetes

    • Clogged sweat glands

    • Acne

    • Trauma

  • Risk Factors:

    • Smoking

    • Obesity

    • Nipple piercings

  • Treatment Options:

    • Broad-spectrum antibiotics

    • Ultrasound-guided aspiration

    • Incision and drainage

Mastitis

  • Definition: Inflammation of breast tissue which may or may not involve infection.

  • Symptoms:

    • Pain

    • Redness and swelling

    • Sometimes associated with lactation, but can occur in non-lactating women as well.

  • Risk Factors:

    • More common in women who smoke or have nipple piercings

  • Treatment Options:

    • Antibiotic therapy

    • Steroid therapy

    • Watchful waiting (observation)

Noninvasive (In Situ) Breast Cancers

  • Types:

    • Ductal Carcinoma In Situ (DCIS): A non-invasive cancer that begins in the milk ducts.

    • Lobular Carcinoma In Situ (LCIS): A condition in which abnormal cells are found in the lobules of the breast.

Invasive Breast Cancers

  • Types:

    • Invasive Ductal Carcinoma: The most common type of breast cancer; originates in mammary ducts and invades surrounding tissue.

    • Characterized by:

      • Fibrosis developing around the cancer.

    • Peau d’orange: A symptom associated with advanced breast cancer characterized by an orange-peel appearance of the skin.

    • Inflammatory Breast Cancer (IBC):

    • Symptoms include:

      • Diffuse erythema (redness)

      • Edema (swelling)

      • Breast pain

      • Rapidly growing breast lump

Paget’s Disease

  • Description: A rare form of breast cancer affecting the nipple and areola.

  • Characteristics:

    • Scaly, red, irritated appearance resembling eczema.

    • May indicate the presence of other types of breast cancer:

    • Ductal Carcinoma In Situ

    • Invasive Breast Cancer

Incidence and Prevalence

  • Statistic: One in every eight women in the U.S. will develop breast cancer in her lifetime.

  • Rank: Second leading cause of cancer death among women.

Etiology and Genetic Risk Factors

  • Increased Risk Includes:

    • Increasing age

    • Family and genetic history (especially mutations in BRCA1 and BRCA2)

    • Early menarche and late menopause

    • Overweight and obesity

    • Physical inactivity

    • Use of combination postmenopausal hormone replacement therapy (HRT)

    • Alcohol consumption

Health Promotion and Disease Prevention

  • Guidelines: Establishment of evidence-based guidelines for screening by:

    • American Cancer Society (ACS)

    • Canadian Cancer Society (CCS)

  • Recommendations:

    • Encourage men with family history or genetic mutations to consult with primary health care provider.

    • Teach multiple methods for early detection, including:

    • Mammography

    • Clinical breast examination

    • Breast self-awareness

    • Options for high-risk women

Recognize Cues: Assessment

  • History to Consider:

    • Risk factors

    • Breast mass

    • Health maintenance practices

    • Obstetrics and gynecology (OBGYN) history

    • Alcohol use

    • Medication review (including supplements and birth control use)

Recognize Cues: Assessment - Examination

  • Examination Focus:

    • Location, shape, size, consistency, mobility of mass

    • Skin changes (e.g., rash, swelling)

    • Enlargement of axillary lymph nodes

    • Pain or tenderness

    • Psychological states: fear, shock, disbelief

  • Additional Considerations:

    • Previous mental illness history

    • Age and life circumstances may increase distress

    • Encourage emotional expression and referral to counseling when needed

    • Assess concerns regarding sexuality

Diagnostic Assessment

  • Laboratory Assessments:

    • Pathologic study of breast mass tissue and lymph nodes

  • Imaging Assessments:

    • Mammography

    • Digital breast tomosynthesis

    • Ultrasonography

    • MRI

    • PET scan

    • Brain MRI

    • CT of chest/abdomen/pelvis

  • Breast Biopsy:

    • Various biopsy methods may be utilized

  • Genomic Tests:

    • Evaluation of genetic risk

Breast Self-Examination (BSE)

  • Instructions:

    • Check your breasts once a month, ideally 7-10 days after your period starts (if menstruating); otherwise, choose a date.

    • Examine with arms raised, hands on hips, and arms relaxed.

    • Look for:

    • Lumps or swelling

    • Redness or rash

    • Changes in shape or position of the nipples

    • Gently squeeze each nipple for pain or discharge.

  • Methodology:

    • Use 3-4 fingers on the other hand, examine armpits and cover small sections of the breast moving towards the nipple in various motions (up and down, in circular motions).

    • Repeat steps while lying on your back. Use a pillow under shoulder if desired.

  • Follow-Up:

    • Consult a doctor with any concerns.

    • Annual mammograms are advised starting at age 40.

Analyze Cues and Prioritize Hypothesis: Analysis

  • Potential Issues:

    • Potential cancer metastasis due to inadequate treatment.

    • Potential impaired coping due to the diagnosis and its treatment.

Generate Solutions and Take Action: Planning and Implementation

  • Goals Include:

    • Decreasing the risk for metastasis.

  • Management Options:

    • Nonsurgical management (includes complementary and integrative health).

    • Surgical management (e.g., breast reconstruction).

    • Preoperative care and operative procedures.

    • Postoperative care and adjuvant therapy (systemic chemotherapy, radiation, combined therapies).

Care Coordination and Transition Management

  • Home Care Management:

    • May require assistance with drains, dressings, and activities of daily living (ADLs).

    • Self-management education on caring for surgical sites and preventing complications like lymphedema.

    • Focus on improving body image, coping mechanisms, and relationships with healthcare resources.

  • Resources:

    • Information from national breast cancer organizations.

Case Study - Risk Factor Analysis

  • Patient Details: 66-year-old female with a mother diagnosed with breast cancer, a history of:

    • Never been pregnant

    • Smoking 1 pack daily

    • Drinking two glasses of wine each night.

  • Risk Factors Identified:

    • Family history of breast cancer

    • Nulliparity (never been pregnant)

    • Smoking

    • Alcohol consumption

Case Study - Educational Information

  • Teaching Points:

    • Annual MRI of breasts is recommended, contrary to the incorrect statement about mammograms.

    • Clinicians can perform clinical breast examinations (CBE) during visits.

    • Notify providers about any noticeable breast changes.

    • Emphasize that breast self-examination (BSE) is a critical tool for early detection.

Case Study - Surgical Procedure Explanation

  • Scenario: Patient with a confirmed left breast mass scheduled for surgical excisional biopsy.

  • Procedure Description:

    • The nurse should explain the surgical excisional biopsy as a procedure to remove the mass for diagnostic evaluation.

Question and Appropriate Nursing Response

  • Scenario: Client post-bilateral mastectomy expressing concern about body image.

  • Responses Evaluated:

    • Appropriate response:

    • “It sounds like you are concerned about how your body looks after surgery.” (This acknowledges the patient’s feelings and opens dialogue).

    • Other options downplayed patient concerns or avoided engaging with the patient’s feelings.