Introduction to Breast Care: A Handbook for Nurses

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Home For health professionals. When should GPs recommend screening? When should you recommend a patient to book an appointment with BreastScreen Victoria and what happens next? Promote screening with your patients Increase screening participation at your practice or pharmacy with patient recommendations, reminders and free resources. Supporting patients through further tests and diagnosis Sources of information for patients who need further tests or have a breast cancer diagnosis. Translations of key resources Our introduction to breast screening, called 'Put your health first', can be read online in a range of languages.

Education activities for health professionals Education resources about the screening program and care of women diagnosed with breast cancer. Would you like more information? Lumpectomy is usually accompanied by an axillary lymph node dissection or a sentinel lymph node biopsy. In addition, patients who get a lumpectomy usually get radiation therapy as part of their treatment plan.

Breast Cancer - causes, symptoms, diagnosis, treatment, pathology

Patients undergoing radiation therapy are often patients with known residual disease or patients who have undergone a lumpectomy. Contraindications to breast radiation therapy are either characterized as absolute or relative. The only absolute contraindication to radiation therapy is pregnancy due to the teratogenic and severely detrimental effects of radiation on the developing fetus.

Relative contraindications include; prior radiation to the chest wall or breast, inability to lie supine, inability to abduct the arm on the affected side, severe cardiac disease, severe pulmonary disease, systemic scleroderma, active lupus erythematosus and a p53 mutation. Note that a p53 mutation puts a patient at notable risk of developing radiation-induced cancers. Lastly, patients who are on immunosuppressants should be treated cautiously because these medications such as methotrexate can be a radiosensitizer thus putting the patient at even greater risk. Breast cancer is much more frequently diagnosed in women than in men with a ratio of In men, breast cancer often presents as a palpable nodule in the breast.

Often time diagnosis is delayed due to lack of breast self-exams being performed. In addition, men are more likely to delay consultation with a gynecologic specialist. As a result, most patients present with locally advanced disease.

Any unilateral palpable mass in a man over the age of 40 should be worked up for potential biopsy. Men with unilateral breast lesions should be evaluated by a physician. Gynecomastia is defined as palpable enlargement of the male breast which can be unilateral and asymmetric. It can either be glandular gynecomastia which tends to be tender on palpation or fatty gynecomastia which tends to be nontender.


Note that gynecomastia in men can be unilateral and asymmetric. Most bilateral symmetric masses in men are usually gynecomastia. Often gynecomastia will present as an asymmetric mass. Several medications have been linked to gynecomastia including; marijuana, steroid use, use of psychiatric medications such as Haldol, risperidone and tricyclic antidepressants. Over the counter medications have also been associated with gynecomastia such as omeprazole and cimetidine. Cardiovascular medications such as amiodarone and digitoxin have also been linked to gynecomastia.

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Natural supplements are not exempt such as lavender and tea tree oil. During pregnancy, the breast grows directly under the influence of progesterone and estrogen. Lactation is suppressed in the pregnant breast by the pregnancy hormone progesterone which inhibits the effects of prolactin the lactating hormone.

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After delivery, the levels of progesterone in the body drop significantly leaving the actions of prolactin unopposed therefore allowing the new mother to lactate. A growing mass lesion in a pregnant breast cannot and should never be explained by the hormonal changes in pregnancy. These patients must be sent for further evaluation of the palpable mass. Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy or during the month period after delivery. There are several factors which may contribute to a delay in diagnosis of patients with pregnancy-associated breast cancer including clinical provider familiarity with pregnancy-associated breast cancer.

Pregnancy should not exempt patients from getting a biopsy of suspicious masses. As a matter of fact, any masses that do not resolve in 2 or less weeks should receive additional diagnostic attention. Mammography can be safely performed during pregnancy with the use of abdominal shielding for the fetus. The radiation delivered to the fetus is well below the threshold established for fetal malformations. Ultrasound is preferred for imaging in pregnancy given that there is no risk of radiation to the fetus.

Magnetic resonance imaging with the administration of gadolinium contrast has not been studied in pregnant women. Currently, it is not routinely used to diagnose breast cancer in pregnant women because Gadolinium is a class C drug as ranked by the US Food and Drug Administration. Gadolinium has been shown to cross the placenta and effects on the growing fetus are unknown at this time.

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The most common type of breast cancer diagnosed during pregnancy is invasive ductal carcinoma. Treatment of breast cancer during therapy is similar to the treatment that non-pregnant patients receive with a few exceptions. Although the use of anesthesia is not contraindicated during pregnancy, most patients elect to wait until the end of the first trimester before they undergo surgery in order to minimize the risk to the fetus including spontaneous abortion.

Breastfeeding is absolutely contraindicated in patients receiving chemotherapy since most chemotherapeutic agents are excreted in the breast milk.

Information for health professionals

Men with BRCA mutations have a much higher risk of breast cancer compared to the general population. Other risk factors associated with an elevated risk of breast cancer include; Klinefelter's syndrome, increasing age, positive family history including in female relatives, Jewish ancestry, radiation exposure, obesity, gynecomastia and infertility.

Hence, BRCA 1 mutations have a stronger association with breast cancer in women. Patients with breast cancer in one breast are at increased risk of developing another breast cancer in the contralateral breast. Aromatase inhibitors or Tamoxifen a selective estrogen receptor modulator administered in the adjuvant setting have been shown to reduce the risk of contralateral breast cancers developing. Women who have a family history of a BRCA mutation should receive annual breast cancer screening between ages 25 and However, it is not specific.

There are specific criteria which determine when breast MRI should be performed in patients. With the increased use of breast-conserving therapy, radical mastectomies have become essentially obsolete. This allows women to have a more cosmetically acceptable surgical result. Occasionally breast replacements are performed at the time of mastectomy. Patients should be educated about the need for continued monitoring of the contralateral breast in the case of a mastectomy and the need for continued bilateral breast monitoring in the case of a lumpectomy.

After a mastectomy, the patients must be shown how to care for the mastectomy site. In the postoperative setting, the first surgical dressing change is usually performed by the surgical team. If the patient is discharged home in the immediate postoperative setting, the dressing is usually removed by the patient at home with specific instructions from the physician. In the postoperative setting, bleeding from the surgical site is usually a bigger issue in patients who are post-mastectomy.

Occasionally nursing staff may need to use sandbags or compression devices to maintain pressure on the surgical site in the case of an active bleed. If a patient develops a hematoma at the surgical site, the site may become hard on palpation, the patient may experience increased pain and there may be increased discoloration at the surgical site.

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It is important for nurses to evaluate the axillary region since hematomas tend to collect in this area. Hematomas tend to collect in the axilla because this is the most dependent area in the breast especially when the patients are laying down in bed. Once a hematoma is identified, the surgeon should be immediately notified, and vital signs should be trended until the patient becomes hemodynamically stable. Most often, patients with mastectomies will have drains in place; drain output should be closely monitored.

Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses
Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses
Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses
Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses
Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses
Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses
Introduction to Breast Care: A Handbook for Nurses Introduction to Breast Care: A Handbook for Nurses

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