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Breast cancer is the most common cancer in women and the leading cause of death. Thus, the burden of this disease is overwhelming. Identification of women at risk for breast cancer and prompt evaluation of these women is important to diagnose and treat this condition early. Physical assessment proves to be an important tool in the diagnosis of breast cancer. The management of breast cancer is a holistic approach involving the nurse, the doctor, the oncologist and the surgeon. The nurse plays a major role in the entire treatment process of a cancer patient

Ms. Williams has several factors exposing her to breast cancer. She had her first pregnancy at an age above 30. Ms. Williams is taking birth control pills. Oral contraceptives are known to increase the risk of developing breast cancer. She also has a family history of breast cancer- a maternal aunt who had breast cancer. She is taking an over-the-counter antihistamine. In a study by Bens (2020) in the British Journal of Cancer, the use of antihistamines has been associated with breast tumor proliferation and thus the development of cancerous growths.

A detailed physical assessment of Ms. Williams has to be done for diagnostic purposes. The nurse should check the color of the skin of the breast and the nipple and note any discharge from the nipple. The discharge in breast cancer is mostly bloody. She should observe for changes in the size of the affected breast. Redness and warmth of the breast area would denote an inflammatory process. After palpation of the breast; the nurse should denote the quadrant in which the lump is, determine its size and shape (regular or irregular). The nurse should also try to move it to feel if it is attached to the chest or the skin. Palpation also reveals tenderness. Normally lumps are painless. The nurse should also assess the respiratory and cardiovascular systems state as there could be metastatic spread into the lungs and heart in the event of breast cancer. Palpation of the supraclavicular nodes for tenderness and enlargement should be done.

The management of Ms. Williams shall require a team approach by the health care providers. The doctor is necessary for the diagnosis of the disease and referral to an oncologist. The oncologist, after his assessment, determines the best treatment method. Tumors with regular edges can be removed by surgical excision. The surgeon and his teams prepare for the surgery and advice on post-operative care.  The nurse carries out the pre-operative and post-operative care required by this patient. The psycho-oncologist is very important in arraying anxiety and teaching life coping mechanisms. Sometimes, radiation might be the best option and the radiological team may need to be informed about Ms. Williams’s case.

Breast cancer can cause anxiety, fear and worry. The nurse should explain to Ms. Williams that a breast lump is not definitive that she has cancer. It could also be caused by local inflammation and blockage of the ducts. The nurse should reassure her. The nurse should teach Ms. Williams the disease process and how to cope effectively. The nurse should advise her to go for mammography.

As seen above, the diagnoses and management of breast cancer require a multidisciplinary team. Evaluation of risk factors should be taken into account during the care of this patient. Patient education and also public awareness are important preventive measures.