In Blog

Breast Cancer Awareness Month October 2020

October is always Breast Cancer Awareness Month, but for a survivor, patient or family member, awareness is every day. With awareness, there is hope, and Christopher Reeve had this to say about that, “Once you choose hope, anything’s possible.” Although COVID-19 has dominated the world spotlight, media focus and medical attention of late, breast cancer is still there and a very real presence in the lives of those affected. A shocking 1 in 8 women will be diagnosed with breast cancer in their lifetime and about 1% of cases occur in men. Early detection remains the number 1 best defense. Mammograms are recommended for women over 40 and earlier for women who are at higher risk, either through family history (grandmother, mother, sister) or knowledge gained from genetic testing.  Familiarity, comfortability and commitment to regular self-exams is paramount.

There are 5 main types of breast cancer:

Ductal

The most common form, which originates in the lining of the breast ducts.

Lobular

Also a common form which occurs in the milk-producing glands called lobules.

Paget Disease

A rare form of the cancer which begins in the glands in or under the skin and often originates as ductal breast cancer. It is characterized by inflamed red patches on the skin. This eczema-like cancer usually appears around the nipple.

Inflammatory

A rare invasive form that usually has no accompanying lump or tumor. It makes the skin look red, warm to the touch, thick and pitted like an orange peel.

Triple Negative

These are invasive, ductal carcinomas that do not have estrogen (ER), progesterone receptors(PR) and no excess of the human epidermal growth factor receptor (HER2) protein. More on this later. This type occurs more frequently in younger women or African-American women. This type can also grow and spread faster than other forms. This is known as metastasizing and it often first affects the lymph nodes under the arm. It may also mean it has metastasized to other locations throughout the body. Regardless of that, the cancer retains the name of the original site and it called Metastatic Breast Cancer.

Traditional treatments for breast cancer involve surgery, chemotherapy and radiation often in conjunction with one another. Surgery is often the first part of the plan of care. Lumpectomy is the least invasive option and involves removing only the cancerous tumor, conserving as much healthy breast tissue as possible. Mastectomy is the option where the entire breast or a significant portion is removed. Chemotherapy is the use of medications to attack the cancer, often used in tandem with surgery. Chemotherapy is a systemic therapy that works throughout the body. Traditionally it was administered in a hospital or clinic through an IV but now it can often be done on an outpatient basis using pills or an infusion pump.

There are 6 types of radiation therapy:

Standard Whole Breast Radiation

Also known as external beam radiation therapy (EBRT) and is the most common. A beam is typically aimed at the entire breast, 5 times per week for 6 weeks.

Accelerated Whole Breast Radiation

This uses slightly larger doses per day with fewer treatments and is more convenient for patients.

Prone Breast Positioning

Radiation is delivered while the patient is laying on the stomach. This improves delivery while sparing surrounding tissue.

Respiratory Gating

This involves continuously monitoring the movement of the tumor during respirations. This allows the beam to only be delivered when the tumor is in the correct position and turned off when the tumor moves out of the target.

Brachytherapy

A cutting edge radiation treatment given inside the body as close to the tumor as possible. The dose is concentrated specifically on the cancer cells reducing collateral tissue damage.

Partial Breast Radiation Techniques

This involves Intensity Modulated Radiation Therapy (IMRT). Another cutting edge treatment that involves shaping the beam to target the tumor to again improve the delivery system and spare the healthy tissue.

Other cutting edge treatments that are used with more traditional treatments include breast MRI, axillary ultrasound of lymph nodes, genetic testing (BRCA), oconoplastic surgical techniques, genomic breast cancer assays and neoadjuvant chemotherapy. The most promising involves the use of biomarkers. Each patient’s tumor expresses these and are used to develop custom anticancer treatment plans. As mentioned before, the most common biomarkers are the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2). Katherine H.R. Tkaczuk, M.D., professor of medicine-University of Maryland School of Medicine and Director of Breast Cancer Evaluation and Treatment Program at the University of Maryland Comprehensive Cancer Center says that “By testing the tumor tissue for these biomarkers, we can better tailor the systemic anticancer treatment for these patients. Breast cancer is not just one disease. It’s many different sub-types of breast cancer that are treated in a different way.” For example, the use of Herceptin or Kadcyla which specifically target the HER2 biomarker have been approved by the FDA as effective treatments. HER2 was formerly a devastating illness but the use of these treatments has rendered this one of the more treatable and curable forms of breast cancer.

In addition to medical intervention, many patients turn to the use of oils, massage, meditation, yoga, exercise and positive imaging for assistance with side effects and overall mental, physical and emotional well-being. Healthy attitudes of hope and control and thinking in terms of ‘victor not victim’ have proved beneficial to countless patients. Covid-19 has changed the way people can participate in Breast Cancer Awareness Month. The American Cancer Society’s campaign, Making Strides Against Breast Cancer has organized walks again this year. Instead of meeting in a large group, they are encouraging participants to map their own trail.  People are being creative and proactive, both attributes that are key in personal battles with breast cancer as well as the overall fight for a cure.

NHS Solutions has a growing pool of Interim Oncology Nurse Leaders. We are always looking for more leaders in this specialty who are considering a new career move. In our experience, oncology departments become a tight-knit team and so when there is a leadership gap or void, this can be a difficult position to fill. Our excellent recruiting department works with our client managers to quickly fill these roles. Contact us if you are interested in becoming an Interim Nurse Leader or if your hospital is experiencing a need in this area.