Breast cancer is a dangerous disease that can significantly worsen one’s quality of life or lead to lethal outcomes if not diagnosed promptly. Therefore, the topic of breast cancer awareness is important and is promoted worldwide. Promoting regular scanning to enhance breast cancer identification is one of the agendas of a breast awareness campaign that results in higher survivorship. Therefore, as a nurse practitioner, it is vital to be familiar with the disease to contribute to its timely diagnosis and treatment.
Background and Significance
Understanding breast cancer means understanding the anatomy of the area and organs that are affected by it. It is important to note that lobules are key structures of the breast tissue, which are essentially chambers of milk production, and they are submerged in adipose cells. When it comes to the secretory process of milk extraction, the ducts are utilized as channels of milk excretion from the nipple area. From the immunological standpoint, one should be aware that lymph vessels and nodes in breast tissue are tightly interconnected with armpit structures.
Breast cancer appears when healthy breast cells become aberrant, grow out of control, and form tumors. Sometimes the disease can spread to other parts of the body. Statistically, nearly one in eight women is at risk of breast cancer. The disease can damage not only women, as one in a thousand men is likely to be diagnosed with it. As estimated by Sung et al. (2021), in 2021, the number of new cases in both sexes reached 284,200 (281,550 women), and the estimated number of deaths was 44,130 (43,600 among women). Hence, breast cancer is a concerning disease that needs to be properly addressed to minimize new cases and deaths.
Carcinoma in situ, abbreviated as DCIS, is a form of breast cancer that primarily affects the duct channels of the breast. One subcategory of DCIS is called IDCIS, which refers to invasive ductal carcinoma. It tends to spread from the original site of cancerous growth to other areas in the nearby tissues. Another subcategory is named LCIS, which stands for lobular carcinoma in situ. This form is not categorized as cancer, but it is a form of abnormal cell growth in the labial area of the breast tissue. Similar to DCIS, the abnormal cells of the LCIS can spread into the surrounding tissue resulting in cancer called invasive lobular carcinoma in situ (ILCIS).
There are several signs of breast cancer, which can be identified through visual observation or palpation. One of the most visible methods revolves around skin alterations, which can range from dimpling and inflammation to redness. In addition, other signs involve nipple discharges, changes in the nipple structure, and shifts in size and shape of the breast tissue as well as the armpit. Since the scanning is easy to perform, breast cancer awareness campaigns emphasize the importance of paying attention to the signs associated with the disease.
Women are the main victims of breast cancer, with a constantly growing number of novel cases regardless of the region. In 2008, the overall estimated number of new cases reached 1,380,000 new cases in women, which makes it the most frequent cancer in the female population (Youlden et al., 2012). Although it is not the deadliest of cancers, it is the fifth, with 458.000 deaths worldwide. One should be aware that the cancer of the breast tissue is the most frequent cause of lethal outcomes (Youlden et al., 2012). In developing countries, it results in 269,000 deaths and 189,000 deaths in developed regions (Youlden et al., 2012). The determinants of such difference are the availability of healthcare, awareness of the disease, and early identification of it.
Breast cancer is an oncological condition associated with the risk factors common for other cancers. Among the most significant risk factors are family history, such as having a parent or sibling with breast cancer, personal history, such as having breast cancer before, and aging. Genetics has a vital relevance in increasing the likelihood of this form of cancer. For example, BRCA1 and BRCA2, alongside other risk factors, can be considered contributors to increasing the chance of cancerous breast growth since they are hereditary (Youlden et al., 2012). In addition, having Ashkenazi or Jewish ancestry increases the chances of getting the disease. Additional risk factors include excessive alcohol consumption or drinking, increased levels of obesity, and being menopausal. Cancer treatment is associated with high costs for patients, often preventing patients from choosing the best treatment options. In addition, the disease is associated with adverse social effects, as women who lost their breasts due to cancer face psychological problems associated with self-worth and self-esteem. Removal of breasts diminishes women’s ability to become mothers.
Surveillance and Reporting
Regular screening is one of the most effective ways of finding breast cancer in its early stages, and it can be done in various ways. Firstly, a person might consider a screening mammogram, which is essentially an x-ray of the breast tissue. Secondly, one might request her healthcare professional to assess and examine the breasts. Thirdly, an individual is able to conduct her own breast analysis by looking for observable signs. It is recommended to have a self-examination monthly within the equivalent time frames. This can be conducted by palpating both the armpit and breast while being on the outlook for any of the signs mentioned above, such as lumps or nipples, skin, or form changes.
Other ways of diagnosing breast cancer are ultrasound of the breast. The given method is mainly utilized to identify and see if the identified lump is liquid or solid in its composition. A lump predominantly filled with fluid substance is not as dangerous as, in most cases, it is a cyst. However, solid lumps have a higher chance of being cancerous, which makes breast ultrasound an important tool for diagnosis and disease prevention. A breast MRI is the most detailed and precise way of diagnosis. However, it is best suited for diagnosing the aspects of breast abnormality unobservable by a regular mammogram, such as minor accumulation of mass elements or alterations.
Unlike the previously mentioned methods of breast cancer surveillance and reporting, breast biopsy is more invasive and physical. It is conducted by collecting cell samples from the area of suspicion or interest, which usually involves small collections of tissue or cells. A doctor responsible for the analysis of the breast biopsy tissue is called the pathologist. The tissue analysis is conducted by observing a sample under a microscope and performing specific tests. The biopsy report results provide doctors with information on whether there is cancer and the reasons for its growth. For example, the emergence of cancer can be caused by human epidermal growth factor receptor 2 (HER2) protein, progesterone receptors, or estrogen receptors (Youlden et al., 2012). By using the biopsy test and its findings, the doctors are able to decide on the most appropriate treatment for the case.
One of the important factors in deciding the treatment of cancer is the behavior of the tumor. Hence, it is crucial for doctors to understand the dynamics and changes of this form of cancer and classify its behavior. The types of oncological occurrences can be non-invasive, which refers to cancer that did not expand to the outside of the tissue where it began. Metastatic cancers are problematic due to their ability to spread to different parts of the body since a tumorous cell is capable of migrating and relocating to other tissues causing multiple tumors throughout the body.
Some types of breast cancer are more common than others. Invasive lobular cancer and invasive ductal carcinoma are the most common types. However, metaplastic breast cancers, colloid breast cancers, tubular breast cancers, and inflammatory breast cancers are far less likely to occur compared to carcinoma of the duct channels. In the case of triple-negative cancerous cells of the breast, the cell surfaces are devoid of HER2 protein receptors or progesterone and estrogen receptors. It is considered one of the most severe and deadly types of disease, which requires more intense treatment. Breast cancer is a disease that progresses in one’s body and therefore has four stages. Each stage is differentiated on the basis of its parameters, which include spreading capability, location, and size of the growth. The grading of every corresponding stage is done in accordance with values of one to three. The first grade is given if the cells resemble and are comparable to non-cancerous cells, but the third grade identifies the most distinct cellular abnormalities and aggressive tumor growth patterns.
The main treatment includes the use of individual or combination treatments, which usually comprise targeted therapy, hormone therapy, chemotherapy, radiation, or surgery. Women should be aware that breast cancer public health can be drastically improved by increasing access and rate of examinations with the use of mammography. The latter enables a greater outcome for women since it is able to detect cancerous development in the early stages of progression. The core data points of interest include family history, address, health insurance, the rate of regular health checkups, household income, education, race or ethnicity, and age (Spring, Marshall, & Warner, 2017). Collecting these vital data points provides oncologists with a clearer and more accurate picture of the risk factors as well as treatment procedures. In other words, the more informed the professionals are about a patient, the more likely they will be able to determine the best course of action.
Despite the fact that it is highly advised for women to seek to undergo the screening process, they additionally need to be aware of the health implications of the procedures. For example, female patients must be capable of making an informed decision on the appropriateness of mammography. Such a framework of decision-making based on an informed approach is heavily reliant on decision support systems rooted in evidence and science (Elkin et al., 2017). Since healthcare professionals are not always available to provide accurate information to the patients directly, websites and similar methods proved to be more effective at making patients more knowledgeable and educated about their health.
Moreover, patients themselves have the ability and opportunity to contribute to breast cancer research. It can be primarily done by sharing their mammography results with the relevant databases, centers, and health professionals to create a more accurate statistical understanding of the patterns and common risk factors. For instance, some organizations assess and analyze mammogram information collected from the patients with their permission to provide women with reliable and evidence-based knowledge about the disease globally (Lee et al., 2016). These enterprises have methods of data collection that are safe and secure, so the patients need not worry or be concerned about personal patient information leaks. However, it should be noted that each patient needs to follow a set of specific guidelines when sharing their data with such organizations.
The types of surgical interventions involve lumpectomy, forms of mastectomy, and lymph node biopsies. The former is a direct tumor removal, whereas the latter is surgically treating lymph nodes, such as the ones in the armpit area. When the whole breast is removed, it is called simple mastectomy, and the procedure can be done in a preventative fashion if the risks are serious to justify the process. Reconstruction of the breast is an option, where the entire tissue is replaced surgically.
Chemotherapy can be delivered either intravenously or orally, and it is designed to target cancerous cells with the use of specific chemical agents. Radiation therapy exposes a patient to radiation to attack the tumorous cells. Some cancers can be sensitive to certain hormones, which is why they can be targeted with the use of hormone therapy. For example, progesterone or estrogen can be used to directly kill oncogenic cells. In most cases, these approaches are used in combination to comprehensively treat a patient.
In conclusion, breast cancer is among the most common cancerous diseases in the female population. The frequency and estimated death make breast cancer awareness an important initiative as early diagnosis of cancer can improve later treatment and healthcare outcomes. Healthcare providers of different areas should be familiar with disease epidemiology as well. Therefore, as a future nurse practitioner, I have identified key risk factors and determinants, as well as classification of the disease and types of treatment.
Elkin, E. B., Pocus, V. H., Mushlin, A. I., Cigler, T., Atoria, C. L., & Polaneczky, M. M. (2017). Facilitating informed decisions about breast cancer screening: development and evaluation of a web-based decision aid for women in their 40s. BMC medical informatics and decision making, 17(1), 29.
Lee, C. S., Bhargavan-Chatfield, M., Burnside, E. S., Nagy, P., & Sickles, E. A. (2016). The national mammography database: Preliminary data. American Journal of Roentgenology, 206(4), 883-890.
Spring, L. M., Marshall, M. R., & Warner, E. T. (2017). Mammography decision making: Trends and predictors of provider communication in the Health Information National Trends Survey, 2011 to 2014. Cancer, 123(3), 401-409.
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
Youlden, D. R., Cramb, S. M., Dunn, N. A., Muller, J. M., Pyke, C. M., & Baade, P. D. (2012). The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer epidemiology, 36(3), 237-248.