1.

Summarize the guidelines for the early detection of breast cancer by developing
a teaching plan for breast self-examination for patients.

 Cancer is a leading cause of death and disability in the Eastern Mediterranean Region. Member
States are becoming increasingly aware of the importance of cancer control programmes within
their national health plans. A well managed national cancer control programme can lower cancer
incidence and improve the lives of people living with cancer. The guidelines were prepared by
the WHO Regional Office for the Eastern Mediterranean. The participation of regional experts in
the process was recognized as critical to their effective implementation. These evidence-based
guidelines are designed to support Ministries of Health in their policy-setting for early detection
and screening of breast cancer.

 Hormonal factors
Hormone regulation is important in the development of breast cancer. Long
duration of reproductive life, multi parity and late age imply increased exposure to
estrogen during menstrual cycles. Use of oral contraceptives at an older age has
also been linked to an increase in breast cancer cases diagnosed.

 Environmental factors
Irradiation during infancy for thymus enlargement has a linear dose-response risk
for breast cancer development at a later stage in life. Radiation exposure after
the age of 40 results in a minimal increase in risk, while radiation in adolescence
is associated with the greatest risk.

 Sociobiological factors
Breast cancer is one of the most common cancers in women, with 75% of new
cases and 84% of deaths occurring in women aged 50 and older. Age and
gender are risk factors for developing breast cancer, as well as hormonal and
nutritional intake and imbalances.

 Physiological factors
Moderate physical activity is associated with a lower risk of developing breast
cancer compared to no exercise at all. Studies have shown a 30% reduction in
the risk level associated with vigorous exercise compared to a few hours per
week of low-intensity exercise, according to the American Journal of Sports
Medicine.

Pathology of the breast

Breast disease
Clinically, among 100 female patients aged 40–65 years presenting with breast complaints, the
following is likely: 30% have no breast lesion, 40% have fibrocystic changes, 7% have a benign tumour
diagnosis and 10% have carcinoma. Breast disease can therefore be divided into the following group.

 Inflammatory lesions
These are rare breast lesions that can be acute or chronic and include acute mastitis, duct ectasia,
post-traumatic lesions and granulomatous mastitis. Benign fibrocystic lesions Fibrocystic changes
represent the single most common disorder of the breast and account for more than 40% of all
surgical operations on the female breast. It is diagnosed frequently between the ages of 20 and 40
years, and rarely develops after menopause. It is frequently influenced by hormonal imbalance.

 Benign breast diseases

These are rare tumours, which include fibro adenomas, phyllodes tumours and large duct papilloma.

 Proliferative breast disorder

Epidemiological studies have identified changes in the breast resulting in an increased risk of
developing carcinoma. This risk is due to hyperplasia with or without atypia. These lesions are often
accompanied by fibrocystic changes as well. They can be associated with mammographic
abnormalities.

 Carcinoma of the breast

Breast cancer can be divided into two main groups: non-invasive or carcinoma in situ, and invasive
carcinoma. Table 1 presents the incidence of various breast pathologies.

Prevention
Although breast cancer cannot be prevented, the risks of developing breast cancer can be minimized
through specific preventive activities. These include achieving changes in lifestyle, diet, overall
physical characteristics and obesity, and interventions for women at high risk of developing breast
cancer using tamoxifen and other anti-estrogen compounds.

Early detection
The most important and beneficial area of protection activities is the early detection of breast cancer
(screening). Diagnosis during the early stages of disease has been positively linked to a decrease in the
mortality and morbidity of the illness. Clinical breast examination is one of the primary modes of
screening for breast cancer, but its effectiveness is dependent upon the skills of the health worker
and the facilities.

Care/disease intervention
Cancer control programme must ensure the diagnosis of the disease at the earliest possible stage
when treatment is most effective and cure is most likely. Treatment of breast cancer should be
expanded to include interventions such as drug therapy and radiation procedures. Increasing the
psychosocial support and the palliative care available can\increase the quality of life for women with
breast cancer and their families.

 Screening for breast cancer

Breast cancer is most easily and effectively treated in its early stages. Survival rates are dramatically
reduced when women present with advanced cases regardless of the setting. A primary strategy for
reducing breast cancer mortality is increasing the proportion of cases that are detected during the
early stages of the disease. The goals of screening guidelines are to provide guidance regarding
the appropriate use of screening tools for breast cancer detection.Breast self-examination

Overview
Breast self-examination should be used in combination with mammography and clinical breast
examination, and not as a substitute for either method. Breast self examination- consists of two basic
steps: tactile and visual examination of the breast. A working group of the International Agency for
Research on Cancer has concluded that there is inadequate evidence that breast self-examining alone
canreduce mortality from breast cancer.

Tactile examination
An effective breast self-examination is one that is conducted at the same time each month and covers
the whole area of each breast. In all three methods, the woman should use two or three fingers,
thumb extended and using the sensitive palmar pads on the flat, inner surfaces of the fingers. Each
area of examination should be covered three times, using light, medium and firm pressure.

Vertical strip
With the vertical strip method the woman should start in the underarm area of thebreast, moving the
fingers downward slowly until she reaches the area below the breast. The fingers are then moved
slightly towards the middle and the process begins again, this time moving the hand upwards over the
breast. This process continues up and down until the whole surface of the breast and underarms is
examined. Both breasts should be examined.

Wedge section
The wedge section technique was developed as some women find the circular movement of the hand
easier to use during the breast self-examination. In this method, the breast is divided into wedges
moving the palmar pads of the fingers towards the centre of the breast or the nipple. Both breasts are
examined wedge by wedge in this manner until completely covered.

Concentric circle
In this method, the woman uses a circular motion starting with a small circle around the nipple area
to feel the breast. The circle is widened as the woman moves over the surface of the breast. The
breast, upper chest and underarm area are fully examined through this circular motion. As with other
methods, both breasts should be fully examined.’

2. A 48-year-old man is married with two young children and has been newly
diagnosed with ametastatic spinal cord tumor. Identify appropriate nursing
interventions to alleviate the patient’s and family’s physiologic and emotional
stressors.

INTERVENTION
 Note components of family, presence of extended family and others (friends and neighbors).
 Identify patterns of communication in family and patterns of interactionbetween family
members.
 Assess role expectations of family members and encourage discussion about them.
 Note cultural and religious beliefs.
 Listen for expressions of helplessness
 Assess role expectations of family members and encourage discussion about them.
 Each person may view the issue in their own unique way, and identifying and communicating
these expectations helps people understand each other.
 Note cultural and religious beliefs. Affects patient and SO reaction andadjustment to diagnosis,
treatment, and outcome of cancer.
 Listen for expressions of helplessness.
 Feelings of helplessness may make it difficult to react to a cancer diagnosis and comply with a
treatment program.
 Deal with family members in a warm, caring, respectful way.
 Acknowledge difficulties of the situation (diagnosis and treatment of cancer, possibility of
death).
 Identify and encourage use of previous successful coping behaviors.
 Stress importance of continuous open dialogue between family members
 Refer to support groups, clergy, family therapy as indicated.

RATIONALE
 Assists the patient and caregiver in determining who is available to help with care or provide
respite and support
 Provides information on communication efficacy and highlights issues that may impede a
family's capacity to support the patient and adjust positively to the cancer diagnosis and
treatment
 Each person may view the issue in their own unique way, and identifying and communicating
these expectations helps people understand each other.
 Affects patient and SO reaction and adjustment to diagnosis, treatment, and outcome of cancer.
 Feelings of helplessness may make it difficult to react to a cancer diagnosis and comply with a
treatment program
 Empathy is elicited, and the individual's sense of worth and skill in dealing with the current
circumstance is enhanced.
 Communicates acceptance of the reality the patient and family are facing.
 The vast majority of people have learned good coping skills that maybe used to their current
situation.
 Promotes understanding and aids family members in maintaining open lines of communication
and efficiently resolving conflicts.
 May require further support to manage disorganization issues thatmay arise as a result of a
possibly fatal disease diagnosis (cancer).