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Early Stage Breast Cancer

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Early Stage Breast Cancer CHAPTER 47 Joanne Lester, PhD, CNP, AOCN® Early Stage Breast Cancer ➣ Introduction ➣ Prevention, Screening, and Early Detection ➣ Epidemiology Prevention Identification of Individual Risks and ➣ Incidence Geographical Differences Programming Chemoprevention ➣ Etiology and Risk Factors Surgical Interventions Nonmodifiable Risk Factors Screening Gender Mammography Age Ultrasonography Genetic Profile Three-Dimensional Tomosynthesis Family History of Breast or Ovarian Cancer Magnetic Resonance Imaging Race/Ethnicity Early Detection Breast Density ➣ Pathophysiology Abnormal Biopsy Results Breast Anatomy Radiation Therapy to Chest Cellular Characteristics Personal History of Breast Cancer Atypia Endogenous Hormone Status Lobular Carcinoma in Situ Age at Menarche/Menopause Ductal Carcinoma in Situ Age at First Full-Term Pregnancy Invasive Breast Cancer Diethylstilbestrol Exposure Personal History of Other Cancers ➣ Clinical Manifestations Modifiable Risk Factors ➣ Assessment Exogenous Hormonal Level Personal History Pregnancy Family History Lactation Physical Examination Increased Socioeconomic Status Diagnostic Studies Occupational Exposure Mammography Lifestyle Risks Ultrasonography Myths Related to Breast Cancer Risk Three-Dimensional Tomosynthesis Breast Cancer Risk Models Magnetic Resonance Imaging Gail Model/Breast Cancer Risk Assessment Tool Molecular Breast Imaging Claus Model Breast Biopsies Tyrer–Cuzick/IBIS Assessment Fine-Needle Aspiration Ford Model/BRCAPRO Core-Needle Biopsy Limitations of Current Models Stereotactic Biopsy Recommendations for Improved Models Needle-Localization Biopsy Excisional/Incisional Biopsy 1279 © Jones & Bartlett Learning, LLC. An Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION 9781284055979_CH47_1279_1334.indd 1279 DESIGN SERVICES OF 20/08/16 3:30 PM # 158569 Cust: JBL Au: Yarbro Pg. No. 1279 K S4CARLISLE Title: Cancer Nursing: Principles and Practice, 8e Short / Normal Publishing Services 1280 PART VI The Care of Individuals With Specific Cancers ➣ Classification and Staging Nipple-Sparing Mastectomy Types of Breast Cancer Bilateral Mastectomy Ductal Carcinoma in Situ Axillary Surgery Invasive Ductal Carcinoma Breast Restoration Invasive Lobular Carcinoma Future Considerations Inflammatory Breast Cancer Adjuvant Radiation Therapy Prognostic Factors Whole Breast Radiation Biomarkers Partial Breast Radiation Locally Advanced Breast Cancer Prone Positioning Lymph Node Status Skin Care Receptor Status Adjuvant Systemic Treatment Histologic Factors Adjuvant Chemotherapy Comorbid Disease Neoadjuvant Chemotherapy Disparate Conditions Adjuvant Targeted Agents Staging of Breast Cancer Adjuvant Hormonal Agents Tumor Size Molecular Assays Lymph Node Status Tamoxifen Metastatic Disease Aromatase Inhibitors Clinical and Pathological Stage Psychological Impact ➣ Therapeutic Approaches and Nursing Care Distress Local Treatment of Breast Cancer Self-Image Lumpectomy ➣ Conclusion Total Mastectomy ➣ References Total Skin-Sparing Mastectomy INTRODUCTION these changes in patterns of use for hormone replacement therapy, the incidence of breast cancer subsequently began 1,3 Carcinoma of the breast is the most common cancer in to rise. This upward trend continues despite the availabil- women, and the second most common cause of female ity of effective interventions (e.g., selective estrogen recep- cancer deaths (after lung cancer) in the United States.1 tor modulators, aromatase inhibitors) that can significantly 3,5,6 Globally, breast cancer had the highest cancer incidence decrease breast cancer development. rate in women, with an estimated 1.7 million cases in 2012 Outcomes for patients with newly diagnosed breast can- and 522,000 estimated deaths.1,2 The incidence of inva- cers are often better when the person presents for treatment sive breast cancer has demonstrated an upward trend over at an early stage with node-negative disease.7 The recom- the past several decades, despite a brief decline in the early mendations for localized and systemic treatments depend 2000s.3,4 on the type of breast cancer, extent of disease, and indi- During 2002–2003, early data from the Women’s vidual characteristics of the tumor and host.7,8 Attention Health Initiative validated the potential risk of breast can- to the stage of disease, cellular characteristics of the tumor, cer associated with the use of hormone replacement ther- specific markers, and oncogenes enables the multidisci- apy after menopause.5 In response to these findings, most plinary team to provide personalized care for each patient.8 women quit taking hormone replacement therapy and Localized treatment of breast cancer includes surgery with many providers changed their hormone prescribing hab- a lumpectomy or mastectomy, sentinel lymph node biopsy its.5 Hormonal alterations were thought to be responsible or axillary node dissection, and options of immediate or for a downward trend in breast cancer incidence. Despite delayed reconstruction following a mastectomy.7 Radiation © Jones & Bartlett Learning, LLC. An Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION 9781284055979_CH47_1279_1334.indd 1280 DESIGN SERVICES OF 20/08/16 3:30 PM # 158569 Cust: JBL Au: Yarbro Pg. No. 1280 K S4CARLISLE Title: Cancer Nursing: Principles and Practice, 8e Short / Normal Publishing Services CHAPTER 47 Early Stage Breast Cancer 1281 therapy, a treatment component of localized therapy, is rec- women (1 in 8) will develop breast cancer in their lifetime.1 ommended based on stage of disease, extent, and type of Death rates from breast cancer have gradually declined. surgical procedure.8 Systemic treatment of breast cancer Nevertheless, despite the many advances in therapy over includes both oral and intravenous drugs; these effective the past decade approximately 40,290 females die from agents treat micrometastatic disease that is invisible to the breast cancer in the United States each year.10 Early detec- human eye but believed to be present based on the history tion is integral to disease-free outcomes, yet even those per- of this disease. Targeted agents may also be prescribed based sons diagnosed with early-stage node-negative disease can on the oncogenetic characteristics of the tumor.9 Long-term eventually die from their cancer.11,12 This irony highlights rehabilitation and surveillance are necessary to enhance the various interactions between the host and cancer that survivorship, prevent or treat persistent side effects of the may positively or negatively affect outcomes regardless of disease, and screen for recurrence or secondary cancers. type or stage of breast cancer.11,12 EPIDEMIOLOGY GEOGRAPHICAL DIFFERENCES Breast cancers are classified into two categories: noninvasive Geographical conditions may or may not account for the and invasive. Noninvasive tumors do not extend beyond incidence and death rates of breast cancer. Breast cancer their cellular wall (e.g., breast duct) and therefore, do not mortality rates among non-Hispanic white women tend have the potential to develop into metastatic disease.10 to be highest in the West, Midwest, and Mid-Atlantic These tumors occur inside the milk ducts of the breast and regions of the United States.1 In African American women, are termed ductal carcinoma in situ (DCIS). Invasive breast the highest mortality rates are found in the Southern and cancers extend beyond the cellular wall (e.g., ductal, lobu- Midwestern states, which are home to the largest groups lar) into areas rich with lymphatic channels and blood ves- of African American women. In addition, U.S. women of sels.10 Invasive cancers can penetrate these structures, grow, eastern European decent and Jewish faith are at increased and shed cells that travel to other parts of the body. This risk of breast cancer.1 These geographic variations in inci- mechanism enables abnormal growth of cancer in other dence and mortality may be related to patterns of screening organs, termed metastatic disease.9 and treatment of early breast cancers, or they may represent true geographical variations. Men are considered to be at low risk of breast cancer INCIDENCE and high risk of prostate cancer: Both of these diseases are hormonally-dependent cancers.13 More than 2,300 men The incidence of invasive breast cancer continues to dem- are diagnosed with breast cancer every year, with 440 esti- onstrate an upward trend despite known interventions that mated deaths occurring annually from the disease.1 The can decrease its occurrence.4 This increase is in part attrib- treatment of male breast cancer is similar to the interven- utable to improved and advanced imaging that can detect tions recommended for female breast cancer.13 Men who breast cancer in its earliest stages, for example, through are diagnosed with breast cancer should consider genetic mammography, magnetic resonance imaging (MRI), testing due to the cancer’s variance from normalcy.12–14 advanced ultrasonography, three-dimensional imaging, First- and second-degree relatives of men with breast cancer and computerized assessment of images.3 An estimated are at increased risk of cancer development.12 232,000 women are diagnosed with invasive breast cancer Breast cancer can occur at any age, but the median annually,1 and this number continues to grow secondary age at diagnosis is 61 years.4 Seventy-nine percent of new to widespread screening and education. Another 60,000 cases of breast cancer occur in women 50 years of age women are diagnosed with DCIS, a noninvasive cancer.10 and older, with a noted decrease in women
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