Running head: BREAST CANCER CASE STUDY 1
Breast Cancer Case Study
Pamela Dozier
Liberty University
Running head: BREAST CANCER CASE STUDY 2
Background
Ms. J is a 30- year old African American female who discovered a palpable mass to her
left breast in the upper quadrant while she was showering. Ms. J immediately contacted her
physician and requested a diagnostic exam that later determined that she had breast cancer. Prior
to discovering the mass, Ms. J had on occasion tenderness and soreness that she thought was due
to her menstrual. Ms. J family history consist of lung cancer with grandfather and older sister
breast cancer with no metastasis. Ms. J smokes approximately a pack of cigarettes daily. She
does not drink alcohol or use any illegal drugs. Ms. J takes no daily medications but does take a
multivitamin daily. She denies any allergies to any medications and no seasonal allergies.
Pathophysiology
Breast cancer is the most common invasive cancer in females and usually presents with a
lump in the breast with or without manifestations (Kabel, et al., 2015). Breast cancer most often
develops in cells inside layering the milk channels and the lobules that supply the ducts with
milk.
According to the Kabel and Baali (2015), “breast cancer usually occurs due to an
interaction between environmental and genetic factors. PI3K/AKT pathway and RAS/MEK/ERK
pathway protect normal cells from cell suicide. When the genes encoding these protective
pathways are mutated, the cells become incapable of committing suicide when they are no longer
needed which leads to cancer development.”
“The familial tendency to develop breast cancers is called hereditary breast-ovarian
cancer syndrome and some mutations associated with cancer, such as p53, BRCA1 and BRCA2,
Running head: BREAST CANCER CASE STUDY 3
occur in mechanisms to correct errors in DNA leading to uncontrolled division, lack of
attachment and metastasis to distant organs. The inherited mutation in BRCA1 or BRCA2 genes
can interfere with repair of DNA cross links and DNA double strand breaks. GATA-3 directly
controls the expression of estrogen receptor and other genes associated with epithelial
differentiation and poor prognosis due to increased cancer cell invasion and distant metastasis
(Kabel and Baali, 2015).
Around 6.6% of all breast cancer cases are diagnosed in women less than 40 of age, 2.4%
in women less than 35, and 0.65% in women less than 30 if plotted on a curve, the cumulative
incidence of breast cancer seems to follows an exponential function below the age of 40 after
which it seems to rise linearly (Assi et al., 2013).
Signs of breast cancer include a lump in the breast, a change in breast shape, dimpling of
the skin, nipple discharge or a red scaly patch of skin (Kabel et al., 2015). Breast cancer is
known to be the most aggressive cancer in women. The first sign of breast cancer is usually a
lump that is different from the rest of the breast tissue.
Numerous risk factors have been shown to associate with the development of breast cancer and
include age, reproductive factors, exo-endogenous hormonal exposures, personal and family
history of cancer, lifestyle and environmental factors such as alcohol consumption and diet (Ng
et al., 2017).
Running head: BREAST CANCER CASE STUDY 4
Holistic Plan of Care
Ms. J who discovered a palpable mass to her left breast in the upper quadrant while she
was showering. She immediately contacted her primary care physician and a scheduled biopsy
and diagnostic imaging was performed of the lump found on her left breast. The biopsy was
performed and sent for pathology testing. The well- being of a cancer patient is determined by
how well her physical, psychological, emotional, and spiritual needs are being met and these
needs are mirrored in Maslow’s hierarchy (Ng et al., 2017).
Genetic/Genomic Counseling
Genetic counseling was recommended due to the family history of breast cancer and
other cancers. Identifying unaffected individuals with hereditary risk is of critical importance,
whether they are identified due to a known genetic mutation in a family or due to suggestive
family history (Agnese et al., 2016). Ms. J consented to BRCA 1 and 2 testing to determine her
risk for breast cancer and management options if she was diagnosed with breast cancer. The
benefits of genetic testing include the ability to make medical and lifestyle decisions while
reducing the anxiety of not knowing their genetic background along with that benefit is the
ability to make proactive decisions regarding prophylactic surgery or chemoprevention (Agnese
et al., 2016).
Patient Education
Thorough education and communication with Ms. J in regards to breast cancer is
essential to her care. Pamphlets and brochures on breast cancer are needed to provide education
on treatment options. Educational videos should be displayed for education on the different
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stages of breast cancer. Ms. J should have knowledge on treatment options such as lumpectomy,
chemotherapy, radiation, with emphasis on the positive and negative aspects of these treatments.
Most importantly education on psychosocial, religion and ethical considerations with genetic
testing. Support group locations and information should be provided. She should also have
education on diet and exercise. Verbal and written information on what changes to expect for
example body image, and what to do to treat if changes occur. Continuous teaching and
monitoring throughout Ms. J care and treatment is vital.
Treatment
The pathology report showed that Ms. J mass was Stage 1 invasive breast cancer, tumor
1.5 cm with no metastasis to lymph nodes or other parts of the body. The cancer had not spread
passed the breast so Ms. J decided to have a lumpectomy and radiation treatments. Lumpectomy
(partial or segmental mastectomy) is defined as complete resection of a primary tumor with a
goal of achieving widely negative margins ideally 1cm (Shah et al., 2014). Radiation treatment
usually begins three to four weeks after surgery. Radiation therapy plays a crucial role in
successful breast cancer treatment and has long been recognized to reduce local recurrence risk
by approximately 50% (Shah et al., 2014).
Psychosocial Care
A diagnosis of breast cancer can bring on many distress that includes emotional,
cognitive, social and functional issues. Additional support is needed such as family members,
caregivers and social groups to overcome these barriers that can interfere with healing. Concerns
with their physical health, alterations in their normal development, emotional or mental health
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problems, and social problems (e.g., financial concerns/economic burden, reemployment/early
retirement, stigma of disability, social and spiritual support concerns) have been identified (Weis,
2015). Ms. J after lumpectomy was scheduled an appointment with a social worker that referred
her to a therapist to begin counseling due to her emotional state with the diagnosis of breast
cancer.
Spiritual Care
Religion is put first before anything in Ms. J life. She is very involved in church by
teaching Sunday School. She is a member of the Usher Board, and assist the Youth Choir as
needed. So then, as we have opportunity, let us do good to everyone, and especially to those who
are of the household of faith (Galatians 6:10, KJV). Ms. J carries a small bible in her pocketbook
and she read scripture anytime that she is feeling depressed. She continues to smile through all
that is going on in her life and often say “No worries because God has me.” Ms. J faith was very
strong and when diagnosed with a deadly disease as cancer sometimes all you can do is believe
in faith. Nurses and doctors should always provide a sense of peace and spiritual wellbeing by
being honest with the patient at all times in regards to treatments and the patient’s health.
Cultural Factors
Cultural shapes beliefs about health, illness, death, and dying; expectations concerning
disclosure of diagnosis and prognosis; family decision making roles; language; and perspectives
concerning complementary and alternative medicine (Chaturvedi et al., 2014). Ms. J has a very
supportive family which includes her mother, two brothers and extended family. Ms. J will attend
support groups where other women will express their own experiences with breast cancer. She
Running head: BREAST CANCER CASE STUDY 7
has a great team of doctors, nurses, counselors, and dietician that collaborates a team approach
with care. She has a strong belief in God. Continued education throughout the treatment process,
genetic and genomic counseling and stages of breast cancer. Ms. J will receive thorough
education on diet and exercise to help with the healing process. Education from the beginning of
diagnosis, during treatment and after treatments are imperative for a breast cancer patient. Turn
to me and be saved, all the ends of the earth! For I am God, and there is no other (Isaiah 45:22,
KJV).
Agnese, D. M., & Pollock, R. E. (2016). Breast Cancer Genetic Counseling: A Surgeon’s
Perspective. Frontiers in Surgery, 3, 4. http://doi.org/10.3389/fsurg.2016.00004
Ahmed M. Kabel, and Fahad H. Baali, “Breast Cancer: Insights into Risk Factors, Pathogenesis,
Diagnosis and Management.” Journal of Cancer Research and Treatment, vol. 3, no. 2
(2015): 2833. doi: 10.12691/jcrt-3-2-3.
Assi, H. A., Khoury, K. E., Dbouk, H., Khalil, L. E., Mouhieddine, T. H., & El Saghir, N. S.
(2013). Epidemiology and prognosis of breast cancer in young women. Journal of
Thoracic Disease, 5(Suppl 1), S2–S8. http://doi.org/10.3978/j.issn.2072-1439.2013.05.24
Chaturvedi, S. K., Strohschein, F. J., Saraf, G., & Loiselle, C. G. (2014). Communication in
cancer care: psycho-social, interactional, and cultural issues. A general overview and the
example of India. Frontiers in Psychology, 5, 1332.
http://doi.org/10.3389/fpsyg.2014.01332
Holy Bible (KJV)
Running head: BREAST CANCER CASE STUDY 8
Kabel, A. M., & Baali, F. H. (2015). Breast Cancer: Insights into Risk Factors, Pathogenesis,
Diagnosis and Management. Journal of Cancer Research and Treatment, 3(2), 28-33.
Ng, Z. X., Ong, M. S., Jegadeesan, T., Deng, S., & Yap, C. T. (2017). Breast Cancer: Exploring
the Facts and Holistic Needs during and beyond Treatment. Healthcare, 5(2), 26.
http://doi.org/10.3390/healthcare5020026
Shah, R., Rosso, K., & Nathanson, S. D. (2014). Pathogenesis, prevention, diagnosis and
treatment of breast cancer. World Journal of Clinical Oncology, 5(3), 283–298.
http://doi.org/10.5306/wjco.v5.i3.283
Weis, J. (2015). Psychosocial Care for Cancer Patients. Breast Care, 10(2), 84–86.
http://doi.org/10.1159/000381969
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