Breast cancer

Overview of Breast Cancer

Most common cancer among women in the US, men can also develop breast cancer.
Can occur in different breast parts:
- Lobules: where milk is produced.
- Ducts: canals connecting lobes to nipples.
- Paget's Disease: affected nipples.
- Angiosarcoma: can occur in fat and connective tissue.

Mammograms: key for early detection.
- Table 12-3 (p. 309 in Med-Surg book), recommends:
  - Women aged 45-55: Annual screenings.
  - Women aged 40-44: Can begin annual screenings earlier.
  - Women aged >55: Can opt for biennial screenings or continue annual checks if health is good.
Insurance Coverage: Most agencies cover annual mammograms.
Radiation Risks: Minimal compared to benefits of early detection. Average daily radiation exposure compared to mammography explained in the textbook.

Mammograms: X-ray pictures of breast tissue while compressed.
- Gold standard for screening, can detect lesions as small as 0.5 cm.
- Self-exams may only detect tumors of around 2.5 cm.
Pre-mammogram patient care guidelines in maternity-peds book (p. 218).
Detection Methods: Change or lump often detected during normal activities.

Breast cancer risk factors include:
- Sporadic cases: >80% with no family history.
- Familial cases: 20% with family history without genetic link.
- Risk associated with obesity, alcohol use, smoking, sedentary lifestyle, and night shift work.
Non-risk factors: No evidence linking silicone implants or anti-perspirants to increased risk.

Genetic Mutations: 5-10% are linked to specific mutations such as BRCA1 & BRCA2, associated with a higher risk (up to 70%) of breast cancer.
- Screening recommended by age 25 for genetically high-risk individuals, earlier than 45 years if family history suggests.
- Genetic testing and counseling may be pursued.
Elective Procedures: Some women with high risk may opt for preventive mastectomies.

Protective lifestyle factors against breast cancer include:
- Prolonged breastfeeding (>1 year).
- Regular physical activity and healthy weight maintenance.

Common symptoms to monitor:
- Changes in breast tissue (lumps, swelling, dimpling).
- Nipple retraction, discharge (especially bloody).
- Asymmetry and skin irritation in breasts.
- Emotional support considerations: anxiety and body image concerns prevalent.

Invasive Ductal Carcinoma (IDC): Most common (80% of cases).
Invasive Lobular Carcinoma (ILC): Can affect both breasts more significantly.
Inflammatory Breast Cancer: Rare, characterized by blockage of lymph vessels. Presents symptoms like redness, swelling, and an orange peel appearance.
Triple Negative Breast Cancer: Does not have three key receptors; aggressive and harder to treat.

Matching treatment to cancer stage and type:
- Chemotherapy: Toxic to all rapidly dividing cells, targeted for breast cancer treatment, with various agents used.
- Hormone Therapy: To manage receptor-positive cancers. Includes SERMs, SERDs, and Aromatase inhibitors.
- Surgery: Options include mastectomy or breast-conserving surgery with considerations for reconstruction.
Radiation Therapy: Often used before and after surgery to destroy residual cancer cells, can lead to side effects such as skin irritation and risk of long-term damage.

Sentinel vs. Axillary Lymph Node Biopsy:
- Sentinel is less invasive, with reduced risk of lymphedema.
- Axillary dissection removes multiple nodes but increases lymphedema risk.
Reconstructive surgery may be planned individually based on patient preference.

Educational Focus: On treatment options, side effects, and lifestyle changes to minimize risks.
Emotional Support: Address body image concerns, fears of recurrence, and knowledge gaps about treatment.
Follow-up Care: Regular assessments for signs of recurrence, potential side effects, and overall health management.