Discussion: Breast Cancer Assignment

Discussion: Breast Cancer Assignment

Discussion: Breast Cancer Assignment

Week 2 discussion Discussion Part One Shelby is a 32-year-old mother of two, who has smoked 1 pack-per-day for the last 15 years, and who comes to see you today for her yearly well-woman exam in your family practice clinic. She has a family history, in a single paternal grandmother of breast cancer at age 52. She also has a history of an abnormal cervical cancer screening three years ago requiring colposcopy. Given her history please consider the following: Choose one screening test that might be considered either now or in the next few years of Shelby’s care. Define the test, its positive predictive value, reliability and validity. Discussion Part Two Upon the course of your history you find out that Shelby has a great aunt on her mother’s side who died of ‘some woman cancer in her stomach’ and an uncle on her father’s side who died of pancreatic cancer. Her mother and older sisters are all in good health. Does this information change your recommendations for screening? Why or why not? Discussion Part Three Please provide a summary of the case or information you have discussed this week.

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Breast cancer is cancer that develops from breast tissue.[7] Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, a newly-inverted nipple, or a red or scaly patch of skin.[1] In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.[8]

Risk factors for developing breast cancer include being female, obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, older age, prior history of breast cancer, and family history.[1][2] About 5–10% of cases are due to genes inherited from a person’s parents,[1] including BRCA1 and BRCA2 among others.[1] Breast cancer most commonly develops in cells from the lining of milk ducts and the lobules that supply the ducts with milk.[1] Cancers developing from the ducts are known as ductal carcinomas, while those developing from lobules are known as lobular carcinomas.[1] In addition, there are more than 18 other sub-types of breast cancer.[2] Some cancers, such as ductal carcinoma in situ, develop from pre-invasive lesions.[2] The diagnosis of breast cancer is confirmed by taking a biopsy of the concerning lump.[1] Once the diagnosis is made, further tests are done to determine if the cancer has spread beyond the breast and which treatments are most likely to be effective.[1]

The balance of benefits versus harms of breast cancer screening is controversial. A 2013 Cochrane review stated that it is unclear if mammographic screening does more good or harm.[9] A 2009 review for the US Preventive Services Task Force found evidence of benefit in those 40 to 70 years of age,[10] and the organization recommends screening every two years in women 50 to 74 years of age.[11] The medications tamoxifen or raloxifene may be used in an effort to prevent breast cancer in those who are at high risk of developing it.[2] Surgical removal of both breasts is another preventative measure in some high risk women.[2]In those who have been diagnosed with cancer, a number of treatments may be used, including surgery, radiation therapy, chemotherapy, hormonal therapy, and targeted therapy.[1] Types of surgery vary from breast-conserving surgery to mastectomy.[12][13] Breast reconstruction may take place at the time of surgery or at a later date.[13] In those in whom the cancer has spread to other parts of the body, treatments are mostly aimed at improving quality of life and comfort.[13]

Outcomes for breast cancer vary depending on the cancer type, the extent of disease, and the person’s age.[13] Survival rates in the developed world are high,[14] with between 80 and 90% of those in England and the United States alive for at least 5 years.[4][5] In developing countries, survival rates are poorer.[2] Worldwide, breast cancer is the leading type of cancer in women, accounting for 25% of all cases.[15] In 2018 it resulted in 2 million new cases and 627,000 deaths.[6] It is more common in developed countries[2] and is more than 100 times more common in women than in men.[14][16]