breast cancer

Prevalence and Survival of Breast Cancer

Breast cancer is a significant health crisis, with 1 in 8 women expected to be diagnosed throughout their lifetime. It is recognized as the leading cause of cancer among women, as well as the leading cause of cancer-related death in Black and Hispanic women. Additionally, it ranks as the second leading cause of cancer-related death among Asian, Pacific Islander, American Indian, Alaskan native, and white women. Worldwide, breast cancer is the predominant cause of cancer-related mortality in women. The incidence rates of breast cancer show that approximately 0.7 cases per 100 women over the age of 50 are diagnosed, while the rate increases to 1.4 cases per 100 women younger than 50. Since 2012, the prevalence of breast cancer continues to escalate.

Factors such as excess body weight, older age at first childbirth, and the number of births profoundly influence survival rates, which vary significantly based on the stage of cancer at diagnosis: 99% survival for local disease, 87% for regional disease, and only 32% for distant disease. Importantly, there is a growing number of individuals, assigned male at birth, living with metastatic breast cancer. In the United States, breast cancer comprises about 1% of all cases, reflecting approximately 2,800 new annual cases and leading to 510 deaths each year.

Psychosocial Implications and Health Disparities

Breast cancer outcomes reveal significant inequities, particularly among Hispanic and Latina women, who are more likely to be diagnosed at later stages compared to their white counterparts. Additionally, uninsured women typically exhibit lower rates of screening than those with health insurance benefits. The lesbian and bisexual female populace experiences limited screenings due to fears of discrimination, negative encounters with healthcare providers (HCPs), or inadequate health coverage.

The mortality rates from breast cancer among Black women reach as high as 40%, attributable to higher incidences of aggressive cancer forms diagnosed at later stages. These outcomes are mainly underpinned by systemic barriers to high-quality healthcare, which are driven by long-standing systemic racism and socio-economic disadvantages associated with geographic and resource disparity. Factors such as inequitable access to high-quality imaging, delayed referral processes, underrepresentation in awareness campaigns, and historical abuse in clinical trials and research continue to fuel systemic issues in breast cancer healthcare.

Modifiable and Non-Modifiable Risk Factors

Breast cancer risk factors are classified into modifiable and non-modifiable categories:

Modifiable Risk Factors

  • History of hormonal birth control and hormone replacement therapy

  • Excess body weight or significant weight gain during adulthood

  • Alcohol consumption

  • Physical inactivity

Non-Modifiable Risk Factors

  • Age

  • Gender at birth

  • Family history and genetic predisposition

  • Medical predispositions, such as dense breast tissue or past benign breast exams

  • Radiation exposure

  • Type II diabetes

  • Long menstrual histories

  • Number of childbirths

  • Later age at first childbirth

Genetic risk factors play a crucial role in assessing breast cancer vulnerability. For example, women with a BRCA gene mutation—especially those carrying BRCA1 or BRCA2 mutations—face about a 72% chance of developing breast cancer by age 80. Women with these mutations may opt for more aggressive treatments, including prophylactic mastectomy for positive relatives, as they also signify an increased risk for ovarian cancer.

Types of Breast Cancer

The most prevalent type of breast cancer is invasive ductal carcinoma. Another form, inflammatory carcinoma, is rare but aggressive, characterized by a 'peau d'orange' appearance, and can often be mistaken for an infection due to its invasiveness and skin changes. Other notable types include infiltrating lobular, medullary, mucinous, tubular, and cribriform carcinoma.

Signs and Symptoms of Breast Cancer

Awareness of the signs and symptoms of breast cancer is vital for early detection:

  • Hard, immovable, painless lumps with irregular borders

  • Retraction or dimpling of the breast

  • Retraction of the nipple

  • Enlarged supraclavicular, infraclavicular, and axillary lymph nodes

  • Signs of metastasis, which may include headache, neurological issues, back pain, and liver enzyme abnormalities.

Screening and Diagnostics

Early detection strategies include clinical breast examinations and mammograms. Women at high risk should consider annual breast MRI alongside mammography starting at age 30. Masses that do not change with menstruation should be referred for mammographic or ultrasound evaluations. Biopsy or excisional biopsy is necessary for diagnosis. Support for patients during biopsies involves emotional care, communicating effectively when patients express fears or overwhelm, and managing anxiety through techniques such as providing information about post-procedure expectations. During formal assessments, care for patients undergoing Fine Needle Aspiration (FNA) or core biopsies may require holding NSAIDs and non-cardiac blood thinners pre-emptively, advising on the use of Steristrips, and suggesting pre-emptive pain relief like Tylenol.

Comprehensive Breast Cancer Programs

Ensuring insurance coverage for referrals, tests, and treatments is essential for patient advocacy. Comprehensive breast cancer programs should address financial, spiritual, physical, nutritional, and educational needs through detailed assessment strategies.

Node Testing Options

  • Sentinel Node Biopsy: This procedure targets the first lymph node draining the tumor; if it’s negative, axillary nodes may be spared. If positive, axillary node dissection becomes necessary, which entails complete extraction of all lymph nodes from the axilla, with the number varying per patient. The management of lymphedema is vital since it arises when lymphatics are compromised.

Risk Factors and Complications

  

  • The risk of lymphedema due to sentinel node biopsy is approximately 7%, while complete lymphectomy raises the risk to about 15-57%. The consequences include nerve compression, cellulitis, baselines swelling exacerbation, and enduring complications associated with lymphedema management.

  • Preventive approaches include lymphatic massage, compression sleeves during strenuous activities or long travel, gradual introduction of weight-bearing exercises on the extremity, guided water therapy, and yoga as suitable rehabilitation exercises. Weight management and injury avoidance to the affected extremity are pivotal, including recommendations against hot tubs and using electric razors instead of blades.

Individualized Treatment Plans

Breast cancer treatment demands a personalized approach, recognizing that each patient’s experience varies based on age, preferences, genetic factors, node involvement, tumor size, stage, grade, hormone, and HER2-neu status. Treatment modalities include:

  • Surgery: Can range from lumpectomy to mastectomy, unilateral or bilateral, often involving the option for reconstruction that may start immediately or occur later.

  • Chemotherapy: Recommended for patients with node involvement and tumors, categorized as either adjuvant (post-surgery) or neoadjuvant (pre-surgery). Common medications include cyclophosphamide, methotrexate, fluorouracil, and adriamycin. The duration of chemotherapy typically spans 3-6 months. The treatment’s side effects can include severe nausea, vomiting, myelosuppression, potential amenorrhea, neuropathy, and weight gain exceeding 10 lbs. Additionally, skin and nail changes are common.

Nursing Interventions and Support

Nursing interventions focus on anticipatory education, supporting patients through crisis moments, implementing prevention strategies, and advising on chemoprecautions at home. Essential nursing responsibilities encompass:

  • Port Care: Patients require diligent monitoring and management of medical ports for chemotherapy.

  • Sexual Health: Open communication is crucial regarding sexual health concerns related to treatment impacts.

  • Alopecia: Management of hair loss involves patient education on coping strategies and skin care, particularly with sensitivity to soaps and perfumes, and recommendations against tight clothing or under-wire bras.

  • Emotional Support: This is critical during the breast cancer journey since patients are at higher risk for lymphedema, pneumonia, heart issues, rib fractures, fibrosis, or secondary cancers.

  • Assessments regarding the use of herbal supplements and vitamins should be conducted, alongside nutritional recommendations focused on high-protein diets to assist in recovery.

  • Long-term Care: Survivor advocacy includes navigating unique issues related to ongoing management of treatment consequences, rehabilitation, and palliative/end-of-life care. Coordination, education, and advocacy are essential throughout the continuum of care for patients.