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51 Cards in this Set
- Front
- Back
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What is the leading cause of cancer death for women age 35-52?
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Breast cancer
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What is the risk of getting breast cancer assuming you live till 85?
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1 in 8
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Why have estrogen positive rates dropped since 2003?
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Because women have stopped taking hormone replacement therapy.
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What percentage of women have no other risk factors when diagnosed with breast cancer?
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75% of women diagnosed have no other risk factors other than being a women
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How do the odds increase as you age of getting breast cancer?
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to age 39: 1/227
40-59: 1/25 60-79: 1/15 |
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What are some other major predetermining risk factors?
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-personal hx of breast cancer (having it in one breast increases chance of getting it in the other)
-family hx of breast cancer, mother or sister (2x risk) -history of biopsy showing atypical changes -5-10% of breast cancer patients carry BRCA 1 for 2 genes |
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Other risk factors for breast cancer:
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-first pregnancy after age 30
-family history of more distant relative, grandmother or aunt -early age of menarche -menopause after age 50 (mean age in US is 52) and (no rest from period cycle) -Weight gain -family history of colon and prostate cancer |
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What are some of the risks for breast cancer that have conflicting opinions?
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-high fat diet
-high use of alcohol -obesity (later in life gain) -exogenous hormones (HRT) -breast trauma -viral infection -lactation - this is not really associated because we do not breastfeed enough in US to decrease risk -higher socioeconomic at lower risk |
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What are some of the demographic risks of getting breast cancer?
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-increased for women living in the US
-increased for white women in the US -Black women have it less, but it is more lethal -Increased for Jewish women living in NY |
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What are the incidences of breast cancer among different ethnicities?
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Caucasian 137/100,000
African America 120.7/100,000 Asian 93.4/100,000 Latina 82.6/100,000 |
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What is the mortality rate of breast cancer among different ethnicities?
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African American 37.3/100,000
Caucasian 29.3/100,000 Latina 17.5/100,000 |
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What are the screening recommendations for breast cancer?
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-Breast self-exam: Every month after age 20
-Clinical breast exam: Every three years ages 20-39, yearly after 40 -Mammograms yearly after 40 because incidence increases -Mammograms earlier |
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How do benign breast lumps feel?
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-Discreet-feel around edges
-Regular shape -Mobile-you can move them around -Tender-fibrocystic |
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How do malignant breast lumps feel?
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-Firm
-Irregular -Attached -Non-tender |
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What other findings might you see in the nipple with breast cancer?
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-Nipple retraction or elevation
-Bloody discharge -Spontaneous discharge -Eczema of the nipple |
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What other findings might you see in the skin with breast cancer?
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-Asymmetry between breasts
-Redness with edema -Skin changes |
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You should encourage client to examine breast in mirror because?
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They will notice differences much quicker than anyone else
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Which women do breast cancer screening?
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-Well educated
-Living in urban areas -Have private health insurance - |
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Who doesn't do breast cancer screening?
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-Rural
-Not educated -Uninsured |
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Why don't women follow mammogram recommendations?
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-Less than 50% of women follow mammogram screening recommendations
-No family history of breast cancer -Cost -Time -Lack of recommendation -Fear -Embarrassment -Previous negative mammogram |
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Why do women say they don't do breast self-exam?
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-I don't know how
-I don't think I can do it right -I'm afraid I'll find something -I think it is embarassing |
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What are the different ways to evaluate lumps?
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-Mammogram
-Possibility of digital mammogram for younger women -Ultrasound (is it cystic) -Fine needle aspiration -Excisional biopsy -Sentinel node biopsy |
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How do they decide what surgery to perform for breast cancer?
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-Depends on size of tumor
-How to control spread of cancer -Satisfactory cosmetic results -Psychological satisfaction of patient -Conserve as much of the breast as possible, still works as well as radical mastectomy |
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What are the different types of surgery for breast cancer?
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-Lumpectomy-just tumor is removed
-Lumpectomy w/lymph node dissection- tumor and lymph nodes removed -Partial mastectomy-removal of the portion of the breast that contains the tumor -Simple mastectomy- breast tissue and nipple are removed -Modified radical mastectomy-breast tissue, nipple, lymph nodes are removed, but muscle is spared -Radical mastectomy-breast, nipple, lymph nodes and pectoral muscle are removed |
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How does the number of nodes affect survival rates?
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-No nodes (10yr survival) 80%
-1-3 nodes 40-50% -4 or more nodes 25% -Metastasis (5yr survival) 10% |
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What is the follow up after surgery for breast cancer?
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-Follow breast conserving surgery with radiation.
-Chemotherapy for positive nodes -Tamoxifen for 5 years -Aromatase inhibitor -Herceptin for HER2 expressing cancers -Continue to be followed with mammograms |
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What is another management option for women that are at high risk?
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Chemoprevention-this has been found to significantly reduce the incidence of breast cancer
-Tamoxifen (works well, but main side effect is endometrial cancer) -Prophylactic mastectomy, should also have ovaries out as well, but usually women don't want to go through menopause |
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How can you improve women's health management?
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-Teach all women BSE and screening guidelines
-Take good health histories Use either the Gail or Claus model to screen for risk |
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Cervical cancer incidence statistics
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-55,000 cases of carcinoma in the U.S.
-worldwide it is the leading cause of cancer death -In US we use cheap screening the pap smear |
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What are the risk factors for cervical cancer?
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-Young age at first intercourse (more likely to get HPV)
-Multiple partners (more likely to get HPV) -High parity -Lower socioeconomic status (less likely to get screened -Smoking -Non-barrier contraception |
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What are the screening guidelines for cervical cancer?
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-All Women-yearly beginning at 21 or before if they are sexually active
-Once a woman has 3 sequential neg paps, chances are decreased -A woman with 2 atypical paps should be referred to colposcopy |
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Connections between cervical cancer and HPV
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-Strong association between HPV and cervical cancer
-Screening for cervical cancer in younger women with a history of HPV |
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HPV Vaccine
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-Gardasil approved by the FDA last summer for use in HPV
-Incidence of HPV: highest 20-24 y/o -Prevalence of high-risk types that vaccine protects against 0.5%-1.5% |
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How is cervical cancer managed?
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-Once diagnosis is made if CIS, local removal of cancerous cells-LEEP procedure
-Hysterectomy is done for recurrent dysplasia |
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What is the primary prevention for cervical cancer?
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-Health promotion and disease prevention
-Encourage young women to use condoms -Encourage women to be screened annualy -Get a good history from patients |
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Incidence of Endometrial Cancer
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-Most common gynecologic cancer
-4th most common for women overall -1 per 100 women -Most common for women between 50-65 |
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What are the risk for endometrial cancer?
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-Older women
-Unopposed estrogen (HRT) -Polycystic ovarian syndrome -Obesity -Prolonged reproductive years -Diabetes -Tamoxifen |
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What decreases the risk of endometrial cancer?
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The use of oral contraceptives. The protection seems to last for 10 years.
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What are the symptoms of endometrial cancer?
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-Post menopausal bleeding, often spotting, 90% of endometrial cancers present this way
-In pre or peri menopausal women, see abnormal bleeding (Not diagnosed by Pap smear) |
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When is screening done for endometrial cancer?
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-Only done to symptomatic patients using endometrial biopsy or transvaginal ultrasound
-The older a woman is with unexplained bleeding, the more likely it is cancer |
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How endometrial cancer spread?
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From the myometrium; through the ovary to abdomen; through lymphatic system
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What is the treatment of endometrial cancer?
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-TAH/BSO
- <50% invasion=radioactive implant - >50% invasion=external pelvic radiation and pelvic nodes -Chemo including progestin therapy is used for advanced disease |
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What are the survival rates for endometrial cancer?
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-94% - early stage
-69% - regional stage |
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What is the primary prevention for endometrial cancer?
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-Identify high risk women
-Place on oral contraceptives -Do not give unopposed estrogen -Teach peri-menopausal women signs and symptoms (bleeding & spotting) -Make sure to question menopausal women about symptoms -Screen for women on Tamoxifen |
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Incidence of Ovarian Cancer
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-2nd most common gynecological cancer
-Leading cause of gyn cancer deaths -26,000 cases per yr/15,000 deaths (higher ratio of death as opposed to breast cancer) -75% are diagnosed in stage 3 or 4 -Very non-specific symptoms, spreads easily by lymph system |
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What are the risks for Ovarian Cancer?
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-Age 50 or great
-Incessant ovulation (nulparity) -Caucasian -Family history of ovary, endometrium, breast or colon cancer -Talc? -Fertility drugs? (overstimulation of ovaries, could be the correlation) |
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What are some protective factors against ovarian cancer?
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-Ovulation suppression
-Oral contraceptive pills -Breast feeding (only if it is done for long long periods) |
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What is the screening process for ovarian cancer?
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NONE AVAILABLE
-but you can use pelvic exam, transvaginal ultrasound or CA-125 (used to see if cancer has come back, not a good screener, lots of false positive) |
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What are the symptoms of ovarian cancer?
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They are very non-specific: GI complaints-fullness, early satiety, bloating, constipation, urinary frequency
-Irregular bleeding is uncommon |
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What is the treatment for ovarian cancer?
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-Referral to gynecologic oncologist
-Staging done with surgery -TAH/BSO -Omentectomy: Surgery to remove part or all of the omentum, a fold of the peritoneum (the thin tissue lining the abdomen) that surrounds the stomach and other organs in the abdomen. -Explore upper abdomen for signs of cancer |
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What are th survival rates for ovarian cancer?
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-5 year survival is 39%
-If found locally 88% -Extremely deadly cancer |
