Peer resp. #1
Many factors such as genetics or radiation exposure could place women at risk for breast cancer (BC). However, age is the most important factor that puts women at risk for BC. That is the reason of guidelines for breast cancer screening being geared toward women over the age of forty. In fact, according to Faguy (2017), the American Cancer Society recommends annual mammography screening for women at average risk of breast cancer beginning at age forty-five, and at age fifty-five women can do biennial screening or continue with annual testing. On the other hand, The U.S, Preventive Services Task Force recommend that asymptomatic women ages forty to forty-nine could decide if they need to or want to be screened. On the other hand, women between ages, fifty to seventy-four should be screened every two years (US Preventive Services Task Force, 2016). Since there are many variations of risks based on age, genetic factors or suspicious symptoms, it is up to the practitioner to evaluate the problem and recommend the appropriate test for more accurate diagnosis. For patients who present with symptoms such as nipple discharge or pain, breast swelling, skin changes or dimpling as well as masses, they should have a diagnostic mammogram instead. Depending on the symptoms or severity of the problem, a breast sonogram and/or a biopsy are recommended for a more accurate diagnosis of the problem (Faguy, 2017).
In the clinical setting, women complaining of breast problems should always be taken seriously, and a thorough evaluation should be done. Practitioners need to do a complete breast examination and physical exam and ask questions regarding current medications including over the counter and herbal supplements. Also, a history of previous breast problems, the use of hormone therapy and health and social habits should be evaluated. A family history of breast cancer with close relatives such as a mother or sister is a red flag as a potential risk. In some cases of family history of breast cancer, genetic testing is recommended (Ozanne, Howe, Omer, & Esserman, 2014). At my clinical setting, many women just come with concerns regarding different breast conditions; which is good, because it demonstrates that women are more active when it comes to their health status. Most of the time, breast conditions could be addressed and treated promptly, having good health outcomes. Once there was a patient with a family history of breast cancer, that came after discovering a little lump in her right breast. The patient was examined, and diagnostic tests were ordered. In this case, patient education was vital to ease patient’s anxiety.
As with any other patient, we educate women on risk factors and explain their problem, and most importantly, we must involve them in the decision-making process of testing and treatment. Education is essential to make sure our patients make informed decisions. We must approach the subject with sensitivity, allow privacy and ensure them of confidentiality and their rights. Ozanne, Howe, Omer, & Esserman (2014) explain that breast cancer patients need unbiased, comprehensive education, personalized risk assessment, and allow the opportunity for meaningful consideration of their risks and benefits.
Peer resp. #2
Breast complaints are a common issue in the clinic I am currently in, and I have gotten to do a good number of breast exams. There have been a few that have been interesting and drive home the need for education along with a thorough and proper interview. Two patients had an interesting presentation of breast lumps. The first stated that she started feeling this lump on her lateral left breast about a week ago, and thought she should come in to get it looked at. Upon talking to the patient, she denies an trauma to the breast, but states the breast is painful at the site of the lump. She was 55, and therefore was going to be scheduled for a mammogram anyway, but a breast exam is always a necessary part of the exam. The exam revealed an obvious golf ball sized, moderately healed, bruise with a hematoma in the breast tissue. The patient denies hitting anything, and states she never tried to look at the breast tissue as she couldn’t see under her large breasts. This put the patient at ease and was less worried about breast CA.
The second patient had a large lump in her Right breast and was 44years old. She stated in her interview that she has had breast abscesses before, and this feels slightly like that. Extremely painful and developed over the past month. Her breast exam was otherwise unremarkable, without dimpling, discharge or discoloration of the skin. Cancer is always the main concern when there are lumps fond in the breast, but the majority of breast complaints are benign (Seltzer, 2004). Education on proper screening and reassurance that most breast cancers are painless and are incidentally found on exams or found by patients diligently looking for lumps. Breast CA in symptomatic patients under 50yrs of age is the minority (Seltzer, 2004).
