Initial Discussion Question/Prompt Due Wednesday by 11:59 pm
A 32-year-old female presents for an evaluation of a lump in her right breast that she found on breast self-examination. The lump is found to be 2cm in size, firm, and mobile. No Adenopothy noted.
What are two questions you would ask this patient?
What are two risk factors would you want to assess for?
What are the levels of prevention for this patient?
Discussion Peer/Participation Prompt Due Sunday by 11:59 pm
Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
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Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
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Unit 5 Discussion – Levels of Prevention
What are two questions you would ask this patient?
Just because the patient has a lump in their breast, it does not mean that it is cancerous. Most lumps in the breast actually turn out to be benign so that is why it is important to ask questions and perform examinations and tests that would either rule out or confirm whether or not the lump in the breast is cancerous or benign.
I would ask the patient if the lump in her breast feels different at different times of her cycle. if the lump changes throughout the cycle then the lump could be the cause of fibrocystic changes. Fibrocystic changes benign growths that cause pain and is defined as “changes in hormone balances during the normal, monthly menstrual cycle can create, for some women, symptomatic breast changes” (Benign Breast Disease.2015).
The second question I would ask is if the patient had any recent trauma which could cause traumatic fat necrosis which occurs when there is an injury to the breast and the fat in the breast “form in lumps. The lumps are usually round, firm, hard, single, and painless” (Benign Breast Disease. 2015). If there is a yes to these questions then the diagnosis is most likely benign but either way, tests are needed to confirm that the lumps are not cancerous and then a follow up may be needed to make sure that the size of the lump did not change in 6 months. Risk factors must be assessed also.
What are two risk factors you would assess for?
According to the CDC, the two major risk factors that can lead to breast cancer include genetics and family history. The risk however is “higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer” (Breast Cancer. 2018). I would inquire if the patient has a family history of breast cancer.I would also conduct a genetic test to determine if she has the BRCA 1 and 2 genes. The individuals who have inherited this mutations are at a much higher risk for developing breast cancer.
A risk factor that is important to consider is the risk that if the patient diagnostic tests reveal that she does have cancer, it is essential t determine the risk of the cancer coming back after the treatment process. There is a test called the Oncotype Dx test which will help determine the best treatments for the individual patient and minimize the likelihood of the breast cancer returning.
The “Oncotype Dx test is an option for people with ER-positive and/or PR-positive, HER2-negative breast cancer that has not spread to the lymph nodes as well as in some cases where the cancer has spread to the lymph nodes. This test can help patients and their doctors make decisions about whether chemotherapy should be added to hormonal therapy.” (Cancer.Net Editorial Board. (2020, August 13)
What are the levels of prevention for this patient?
Primary prevention methods for breast cancer include lifestyle changes such as being mindful of an individual’s diet, limiting alcohol consumption, increasing physical exercise which will decrease the rate of morbidity and mortality. The secondary prevention method includes diagnostic tests such as mammography, ultrasonography, magnetic resonance imaging, breast self-examination to aid in the process of early detection of tumors that may or may not be cancerous, so treatment or increased monitoring can start. (Kolak, A., Kamińska, et al. (2017, July 18).This prevention stage is the most important and critical stage. This is the treatment phase. “The most common form of treatment for breast cancer is surgery. This involves removing the tumor and nearby margins. Surgical options may include a lumpectomy, partial mastectomy, radical mastectomy, and reconstruction.” (National Breast Cancer Foundation. (2021).Other treatments include hormone therapy,chemotherapy, and radiotherapy.
References
Benign breast disease. (2015). Cleveland Clinic. Retrieved from
https://my.clevelandclinic.org/health/articles/6270-benign-breast-disease (Links to an external site.)
Breast cancer: What are the risk factors? (2018). Centers for Disease Control and Prevention. Retrieved
from https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm
Cancer.Net Editorial Board. (2020, August 13). Breast Cancer – Diagnosis. Cancer.Net. https://www.cancer.net/cancer-types/breast- (Links to an external site.)
cancer/diagnosis (Links to an external site.).
Kolak, A., Kamińska, M., Sygit, K., Budny, A., Surdyka, D., Kukiełka-Budny, B., & Burdan, F. (2017, July 18). Primary and secondary prevention of
breast cancer. Annals of Agricultural and Environmental Medicine. http://www.aaem.pl/Primary-and-secondary-prevention-of-breast- (Links to an external site.)
cancer,75943,0,2.html (Links to an external site.).
National Breast Cancer Foundation. (2021). Breast Cancer Treatment Options. National Breast Cancer Foundation.
https://www.nationalbreastcancer.org/breast-cancer-treatment/ (Links to an external site.).
ReplyReply to Comment
Collapse SubdiscussionMeghan Heidt-Hoppes
Meghan Heidt-Hoppes
TuesdayJun 8 at 12:07pm
A 32-year-old female presents for an evaluation of a lump in her right breast that she found on breast self-examination. The lump is found to be 2cm in size, firm, and mobile. No Adenopothy noted.
What are two questions you would ask this patient?
What are two risk factors would you want to assess for?
What are the levels of prevention for this patient?
When assessing a female with a complaint of a breast lump, the first question posed should be to determine the exact location of the lump (Bickley, 2016) . The second question asked would be when she first noticed the lump (Bickley, 2016). These inquiries should be paired with change in general breast size or shape, pain or nipple changes or discharge (Bickley, 2016). Additionally, are there any fluctuations in the lump during her menstrual cycle? Finally, she is of childbearing age, is she now or has she recently been breast feeding?
Per the National Cancer Institute, 1:8 women will develop breast cancer in their lifetime (National Cancer Institute, 2020). Bickley (2016) states that the most important risk factor to assess when considering breast lumps is the patients age and goes on to say there is a high degree in variability of breast mass etiologies in younger patients. The second assessment would be for modifiable and non-modifiable risk factors such as family and personal history is cancers, exposures to chemicals or radiation, smoking, breastfeeding (current or within the last year) (Bickley, 2016).
This patient would be a case of secondary prevention. The lump has been detected and as such now needs to be diagnosed and treated or monitored appropriately before progression. If it is determined that the lump is breast cancer, prevention would then be tertiary as the aim is to treat and decrease associated disease sequela (Kisling & Das, 2021). The U.S Preventative Services Task Force (USPSTF) recommends that all women with a personal or family history of breast, ovarian, tubal or peritoneal cancers associated with known or unknown BRCA 1 or 2 gene mutations should be screened using the familial risk assessment tool and subsequently referred for genetic counseling if the screening is positive (Jin, 2019).
Meghan
Bickley, L. S. (2016). Bates’ Guide to Physical Examination and History Taking. [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/9781496354709/ (Links to an external site.)
Jin J. Should I be tested for BRCA mutations? JAMA. 2019;322(7):702. doi:10.1001/jama.2019.11251
Kisling L.,Das J. (2021). Prevention Strategies.In STATPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537222/
National Cancer Institute . (2020, December). Breast Cancer Risk in American Women. In Breast Cancer. Retrieved from https://www.cancer.gov/types/breast/risk-fact-sheet (Links to an external site.)
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