Breast cancer is a complicated cancer whose root cause is not entirely understood in the medical community yet despite twenty years of research and its impact on the lives of sufferers and their families (Iles, & Dickinson, 2017; Lewis et al., 2019). The risk factors surrounding contracting breast cancer have a common link relating to a pathologic alteration in estrogen derived hormones, their blood concentration levels, and their respective receptors (Alkabban & Ferguson, 2019; Lewis et al., 2019; Shah, Balkrishnan, Diaby & Xiao, 2019). There are several existing interventions that can be taken depending on the stage of cancer diagnosis and include both pharmacological and nonpharmacological approaches (Lewis et al., 2019). Overall, the type of breast cancer is determined by which tissues are being affected and how the abnormal cells are behaving that determines a patient’s prognosis after a diagnosis as well as what treatment they choose and how well they adhere to it (Lewis et al., 2019; Shah, Balkrishnan, Diaby & Xiao, 2019).
The etiology of breast cancer is not completely known, however, there are risk factors that contribute to a higher probability of being diagnosed with breast cancer (Iles, & Dickinson, 2017; Lewis et al., 2019). These risk factors include the following: being female, being over 50, having a family or personal history of breast cancer, using progesterone and estrogen hormones in post-menopausal hormone therapy, menarche before age 12, menopause after age 55, being nulliparous, having first full-term pregnancy after 30, history of a previous benign breast disorder, having dense breast tissue, post-menopausal weight gain and obesity, exposure to radiation, excessive alcohol consumption, and having a sedentary lifestyle (Bavender, 2018; Iles, & Dickinson, 2017; Lewis et al., 2019; Sibbering & Courtney, 2019).
Overall, because the development of the breasts is intrinsically linked to hormone regulation an imbalance, excess, or deficit in estrogen and progesterone can alter a person’s risk of developing breast cancer because these hormones act as tumor promoters in already malignant cells (Lewis et al., 2019; Shah, Balkrishnan, Diaby & Xiao, 2019). A person can especially be predisposed to having these malignant cells if they have a germ-line mutation in BRCA1 or BRCA2 genes, so much so that people who have the detected mutation may have prophylactic interventions such as a bilateral oophorectomy, removal of both ovaries, or taking chemopreventive drugs as is recommended by the American Society of Clinical Oncology and The Canadian Cancer Society (Lewis et al., 2019; Prasad & Diener-West, 2015). In the pathophysiology of breast cancer there is an alteration of the cells of the epithelial lining of the breast ducts or lobules and can be either in situ, within the tissue, or invasive spreading beyond the tissue (Lewis et al., 2019; Sibbering & Courtney, 2019). Breast cancer can also become metastatic and spread to the bones, liver, lungs, or brain (Kosir, 2019; Lewis et al., 2019; Sibbering & Courtney, 2019). There are several factors that affect a breast cancer patient’s prognosis that include, but are not limited to, the following: tumor size; amount of axillary lymph node involvement; amount of tumor differentiation; and estrogen, progesterone, and human epidermal growth factor (HER2) receptor condition and status (Lewis et al., 2019; Shah, Balkrishnan, Diaby & Xiao, 2019).
Breast cancers are treated based on the type of cancer and the stage of diagnosis (Shah, Balkrishnan, Diaby & Xiao, 2019). A breast cancer diagnosis depends on assessing a combination of clinical, radiological, and pathological responses/assessments in specialty breast health clinics in the UK (Sibbering & Courtney, 2019). The treatments and interventions for breast cancer include pharmacological and non-pharmacological measures that target different stages and states of diagnosis to include both upstream and downstream approaches (Lewis et al., 2019). Patients with the BRCA1 or BRCA2 mutation or patients diagnosed with noninvasive breast cancer may receive chemotherapy drugs prophylactically to reduce the chances of developing cancer or minimize malignancy (Alkabban & Ferguson, 2019; Lewis et al., 2019; Prasad & Diener-West, 2015). However, a study by Prasad and Diener-West (2015) exploring the cost-benefit effects of taking chemopreventive drugs found that the costs of hot flashes, depression, sweating, insomnia, vaginal dryness, and decreased libido outweigh the benefits of psychological comfort and possible prevention.
Additionally, the specific chemoprevention drug tamoxifen was found to increase the incidence of endometrial cancer while decreasing the rate of future invasive breast cancer but not impacting the chances of distant metastasis and resulting death (Prasad & Diener- West, 2015). Like taking chemopreventive drugs, diet and exercise are used similarly but as a non-pharmacological preventative approach to improve patient prognosis (Lemanne & Maizes, 2018; Meneses-Echávez, González- Jiménez & Ramírez-Velez, 2015). It was found in an article by Lemanne and Maizes (2018) that 35% of breast cancer patient deaths were actually not related to cancer but to cardiovascular disease; this further supports the benefit of implementing a diet and lifestyle change for breast cancer patients. Through evidence-based research,it was also found that that breast cancer patients should adopt a primarily plant-based diet and for those with estrogen receptor- positive postmenopausal breast cancer to significantly reduce the amount of carbohydrates consumed (Lemanne & Maizes, 2018). The exercise recommended for breast cancer patients includes aerobic and resistance training to increase overall cancer survival and yoga to increase quality of life and mood (Lemanne & Maizes, 2018; Meneses-Echávez, González-Jiménez & Ramírez-Velez, 2015). It was also recognized in an article by Lee, J. (2018) that using exercise along with other breast cancer interventions, also known as adjuvant therapy, was found to improve both the patient’s physical and psychological symptoms of having breast cancer.
Once a patient has a diagnosis of breast cancer 80% will have surgery as their first intervention after which they will then have further tests done to determine if adjuvant therapy is required or if the surgery completely removed the cancerous tissue (Sibbering & Courtney, 2019). When patients have inoperable tumours neoadjuvant therapy via the administration of chemotherapy drugs is done in an attempt to make the tumor operable (Sibbering & Courtney, 2019). After surgery is completed adjuvant treatments reduce relapse and recurrence of breast cancer and can be either local treatments via radiotherapy or systemic treatments via chemo or hormone therapy (Flatley & Dodwell, 2016). Before any decision is made to use adjuvant treatments various factors are considered which include: the size of tumor, type of cancer cell, number of nodes involved, menstrual status of the patient, overall health of the patient, age of the patient and the absence or presence of estrogen, progesterone and human epidermal growth factor receptors (Flatley & Dodwell, 2016). Adjuvant radiotherapy is used to remove any tumor deposits that are remaining after surgery or as a routine treatment in certain, more aggressive types of cancer such as high- grade ductal carcinoma in situ (DCIS) (Flatley & Dodwell, 2016).
However, whole adjuvant radiotherapy for breast cancer leads to acute or even longer-term problems such as fatigue, skin reactions, lymphoedema, breast skin fibrosis, pneumonitis, rib fracture, cardiotoxicity and angiosarcoma (Flatley & Dodwell, 2016). Hormonal therapy is increasing in use amongst breast cancer patients due to the fact the 2 out of 3 breast cancers are hormone receptor positive and the use of hormonal therapy has led to a 40% reduction in recurrence (Shah, Balkrishnan, Diaby & Xiao, 2019). An article by Shah, Balkrishnan, Diaby and Xiao (2019) cited the data from the Medical Expenditure Panel Survey (MEPS) that was collected from 2011 to 2015 that highlighted the fact that the patient’s level of education is a key indicator for the level of treatment adherence and that unfortunately adherence is currently low. It is through this notion that nurses can improve their patient’s prognosis by providing education on treatments that ranges from upstream to downstream, pharmacological to non; all in an attempt to maximize adherence, understanding, and autonomy in decision making. A patient’s individual risk factors as well as their lifestyle affects their chances of receiving a breast cancer diagnosis (Bavender, 2018; Lewis et al., 2019; Sibbering & Courtney, 2019).
Treatment can range from prophylactic upstream approaches or downstream interventions and their success depends on the characteristics of the cancer and the patient’s commitment to therapy (Lewis et al., 2019; Shah, Balkrishnan, Diaby & Xiao, 2019). Once the exact etiology of breast cancer is understood it will hopefully come with a better understanding of interventions and lead to successful remission and treatment of sufferers (Iles, & Dickinson, 2017; Lewis et al., 2019).
References
- Alkabban, F. M. ,& Ferguson T. (2019). Cancer, breast. StatPearls. Treasure Island, Florida: Stat Pearls Publishing, Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482286/
- Bavender, K. L. (2018). Hormonal havoc: Alternative therapies to hormone replacement. Nutritional Perspectives: Journal of the Council on Nutrition, 41(3), 18-23. Retrieved from http://search.ebscohost.com.libproxy.stfx.ca/login.aspx?direct=true&db=rzh&AN=131588998&site=ehost-live
- Flatley, J., & Dodwell, J. (2016). Adjuvant treatment for breast cancer. Surgery (Oxford), 34(1), 43-46. https://doiorg.libproxy.stfx.ca/10.1016/j.mpsur.2019.02.005
- Iles, K. M. , & Dickinson, D.A. (2017). Carcinogens, Environmental. In International Encyclopedia of Public Health, Retrieved from https://www.sciencedirect.com/science/article/pii/B9 780128036785000539
- Kosir, M.,A. (2019). Breast Cancer. Merck manual. Retrieved from https://www.merckmanuals.com/en-ca/professional/gynecology-and-obstetrics/breast-disorders/breast-cancer
- Lee, J. (2018). Effects of Exercise Interventions on Breast Cancer Patients During Adjuvant Therapy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Cancer Nursing, Cancer Nursing, 2018.
- Lemanne, D., & Maizes, V. (2018). Advising Women Undergoing Treatment for Breast Cancer: A Narrative Review. The Journal of Alternative and Complementary Medicine, 24(9-10), 902–909. doi: 10.1089/acm.2018.0150
- Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M., Barry, M., Lok, J., Tyerman, J., Goldsworthy, S. (2019). Medical-surgical nursing in canada: Assessment and management of clinical problems (Fourth Canadian ed.). Milton, Ontario: Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
- Meneses-Echávez, J., González-Jiménez, E., & Ramírez- Velez, R. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: A systematic review and meta-analysis. BMC Cancer, 15(1), 77. doi:10.1186/s12885-015-1069-4
- Prasad, V., & Diener-West, M. (2015). Primary chemoprevention of breast cancer: Are the adverse effects too burdensome? Canadian Medical Association.Journal, 187(9), E276-E278. doi:10.1503/cmaj.141627
- Shah, H., Balkrishnan, R., Diaby, V., & Xiao, H. (2019). Examining factors associated with adherence to hormonal therapy in breast cancer patients. Research in Social and Administrative Pharmacy, Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2019.08.005
- Sibbering, M., & Courtney, C.-A. (2019). Management of breast cancer: basic principles. Surgery (Oxford), 37(3), 157–163. doi: 10.1016/j.mpsur.2019.01.004 N307 Group Theory Project
