BREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader. Two years ago, I was working as a bedside nurse. One of my colleagues felt

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1 Ali A. Kader, S. (2010). Breast cancer awareness for women and men. UCQ Nursing Journal of Academic Writing, Winter 2010, BREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader Two years ago, I was working as a bedside nurse. One of my colleagues felt uncomfortably sore and saw some redness in her right breast. In consultation, a physician assessed the area and examined her breast. She diagnosed her with mastitis. She prescribed antibiotics and recommended that she do monthly breast self examinations and follow up regularly with the well women clinic as a precautionary measure. My colleague was lucky that her diagnosis was not cancer, and that through self examination she will be able to detect any future problems very early. Yearly, millions of women in all over the world are diagnosed with breast cancer. There are different kinds of cancer; some of them are treatable if the tumor is detected in the early stages and other types of cancers are fatal because the cancerous cells can be located in very sensitive areas and it is very difficult to remove them, even in an invasive way. In each human body there are hundreds of types of cells and each cell has it is own function and plays an important role in producing other cells in an ordered and controlled way. In cancer, this control and order is lost. My colleague received excellent medical advice; however, if she had been a man, her experience could have been quite different. Men can have breast cancer too. This paper will argue that both genders need to raise their awareness of breast cancer to reduce mortality rates. Breast cancer is a complex disease and even now the primary causes unknown. So health professionals and nurses can play an important role in promoting breast awareness. They can provide educational programs to women during their visits to primary health care. These programs consist of teaching women how to detect unusual changes in the breast. Some example are: differences in the size or shape of the breast, changes in the skin 70

2 texture such as, redness or dimpling, nipple inversion or bloody discharge or have some rashes, and lumps or pain in the breast or under the armpit (Cant, 2008,p21). In addition, encouraging women to do monthly breast self examination as a regular habit can prevent more serious harm in the future. Most of us will thus readily agree that awareness can contribute to decreasing the mortality rate of cancer, so women should visit their physicians if they notice any unusual changes in their breasts. From my point of view, the breast self examination does not need to follow a strict and complicated routine, but it simply requires that women know how their breasts normally look and feel, and seek medical advice if they find any problems or concerns. Women can perform self examinations in any way they find easiest for instance, while taking a shower, laying on a bed, standing, or when dressing. Another important point is to do self test on regular time per month especially if woman has regular menstruation to recognize any changes that could happen in her breasts. Many problems are discovered early by women themselves, which shows how important it is for women to be clearly taught. Another point that can be presented while promoting breast awareness is the importance of mammogram screening to detect any cancerous tissues in the breast. A mammogram should be done for all women above forty as part of a regular check up, both for women with signs or presence of a lump, and for women without any signs and symptoms. Women with a high risk, for example, if there is family history, perceptible gene, radiation therapy, or long term post menopausal hormonal therapy, should seek medical advice on whether to do mammogram screening before the age of forty. Healthy women are usually advised to do mammogram every one two years for routine checkup. Many health care providers suggest women do screening to reduce mortality through early 71

3 detection. Increasing awareness among young women under thirty five can reduce the effects of breast cancer. Young women with breast cancer can face more physical and psychological disturbances than older women. In this case, the disease impacts on their quality of life and daily life need, for instance, child and family care, career and financial security. (McLachlan,2009). Also, they may panic about the disease itself and lose confidence in seeing their children grow up. Moreover, younger women are more likely to have a sense of isolation than older women, because in this age group it very rare to meet with other young women in similar situations and to share together their own experience. Further, breast cancer can affect women physically, functionally and sexually. Breast cancer treatments affect the general health of young women, for example, chemotherapy, radiation or hormonal therapies all have serious side effects. In addition, these treatments can quicken the onset of menopausal symptoms, notably hot flashes and disturbances in sleeping, which can also affect fertility after long periods of treatment. Providing information can contribute to young women s perceptions of the disease and give them the chance to communicate freely all their concerns. Also, providing information may reduce their anxiety and help them to use different strategies to adapt to their condition. While awareness is important for women, it is equally important for men. As Rudlowski observes, Relative to the disease in women, male breast cancer is rare, accounting for less than 1% of all cases of breast carcinoma, with an incidence of 1 in 100,000 men in Europe (Rudlowski, 2008, P184). In other words, breast cancer is a rare disease in men, and thus many health care providers are unaware of the details of the disease in men. There is lack of awareness of men with breast cancer, a point that needs emphasizing since so many people believe that breast cancer is only a women s disease. In 72

4 fact, the majority of men detect the signs of tumor in a late stage, which is associated with a worse prognosis (2008, p183). It is the responsibility of health care providers to increase public awareness about male breast cancer, paying special attention to men with high risk, to explain treatment options and to offer disease prevention strategies. In fact, yearly clinical breast examination can assist in early detection of the signs. Also, every male should be alert that any changes in the breast must be clinically evaluated by a physician. Most of the time the signs and symptoms of breast cancer in men are similar to those in women, for instance, a painless breast lump, swelling, nipple inversion, redness, or nipple discharge. But in males the breast tissues are of less mass than in females, which can help men to notice any abnormal changes easier. As McLennan writes, Nearly 20% of breast cancers are inherited in men, with defects usually in one of several genes, most commonly the breast cancer 1 gene (BRCA1) or breast cancer 2 gene (BRCA2). The BRCA2 gene has been associated with the mortality of inherited breast cancer in men. BRCA1 mutations are estimated to exist in less than 5% of all female breast cancers, and are rare in male breast cancers as well (2009, p18). McLennan s point is that abnormal genes can cause breast cancer particularly if there is history in the family, especially a mother or sister. Other risk factors include excessive alcohol intake, liver disease such liver cirrhosis, hormonal changes such as estrogen especially in patients who have received estrogen for prostate cancer, exposure to radiation at work, and recurrent medical x rays. Another factor is obesity; fatty cells can be converted from male hormones into female hormones, which could increase the incidence of breast cancer (2009, p18). Men should be aware of the signs and symptoms of breast cancer, and report them immediately. Also, they should have a basic knowledge of how to do breast self examination 73

5 either in a standing position using an up and down motion, or in a laying position, which is more clinically approved because it increases the ability to find any abnormal tissues. Further, health professionals should emphasize doing mammograms or ultrasounds yearly especially with high risk men (2009, p21). Basically, the treatment options for women and men are similar. There are invasive and non invasive therapies for breast cancer. Some patients need a surgical option, such as mastectomy, radical mastectomy or removing lymph nodes through biopsy, and other patients need surgery with additional treatment, for example chemotherapy, radiation, or hormonal therapy. Nurses are responsible to provide complete treatments options and work together to manage the side effect of each therapy. For example, Ixabepilone is an effective treatment for women with recurrent breast cancer or have contraindication to anthracycline and resistance to taxane. As any other medication Ixabepilone has adverse effect which can be controlled according to the developed effect. Ixabepilone has negative effects on peripheral neuropathy; therefore patients with associated disease with neuropathy are at more risk. An example diabetes mellitus, vitamin B12 deficiency, thyroid dysfunction or immune disorders e.g. HIV. Nurses need to explain these complex treatment options to patients so that they are more compliant. Patients who suffer from adverse effects need more supportive care to reduce their pain and enhance comfort. The nursing intervention is to assess the patient prior to administer medication, to modify the dosage of the medication according to the patient s need. Completing the treatment with controlled adverse effects can encourage the patient to fulfill the treatment period successfully with good quality of life. Patients are considered nonadherent to oral medication when they miss the medication or take it at wrong time or dose. Sometimes non adherence to medication can 74

6 lead to poor prognosis or to resistance to certain medications or even to death. Adherence to medication can be controlled by the patient only, and the nurse s role is to check the dose of the medication, side effects, any contraindications and the cost of the medication. There are some factors that can impact on breast cancer patients to adhere to medication. First, the side effects from particular medications for example, nausea and vomiting, diarrhea or stomatitis can to be added to the patient s original symptoms so the patient feels no direct benefit from the treatment (Moore,2009,p42). Therefore, the health care providers should work as a team to manage these adverse effects and to inform the patient of expected effects before starting the medication. Secondly, many studies show that younger patients adhere to treatment more than older patients for several reasons. Older patients may have complex medical conditions that require receiving multiple medications two or three times a day. Another reason is high cost of cancer treatments; many patients with economic limitations or poor access to health care providers especially if the patient doesn t have health insurance (2009, p43). Health care provider should build a strong communication strategy with cancer patients at each visit to significantly improve adherence to treatment. In addition, health education helps to encourage successful treatment. In conclusion, breast cancer is most common in women, but it also occurs in men. Increasing awareness between both genders is the key to early detection of the signs and symptoms, and avoiding worse prognosis. Young women with breast cancer can have psychological, psychological and sexual disturbances, the health professional play major role in education to enhance awareness and reduce anxiety. Effective communication and education between cancer patient and health care provider can improve adherence to medication and complete treatment successfully. 75

7 References Cant, S. (2008). TLC: promoting breast awareness. Primary Health Care, 18 (9), Ixabepilone. Clinical Journal of Oncology Nursing, 14 (1), McLachlan, K. (2009). Information and support needs of young women with breast cancer. Cancer Nursing Practice, 8 (8), McLennan, L., Van Sell, S., O'Quin, L., & Kindred, C. (2009). Awareness of breast cancer in men. RN, 72 (8), Morris, M. (2009). The influence of diet upon the risk factors for developing breast cancer. Nutritional Perspectives: Journal of the Council on Nutrition, 32 (4), 31. Moore, S. (2010). Nonadherence in patients with breast cancer receiving oral therapies. Clinical Journal of Oncology Nursing, 14 (1), Rudlowski, C. (2008). Male breast cancer. Breast Care, 3 (3),