Why should the nurse emphasize palpation of the axillary areas in teaching self breast examination to a patient? 2021

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Instruction on BSE should be prefaced with a discussion of risk factors for development of breast cancer, including patient age, family history (both paternal and maternal) for breast and ovarian cancer, menarche, menopause, obesity, alcohol consumption, and hormone replacement. Nội dung chính Breast Masses 1 What are the three parts of breast screening that assist in the early diagnosis of breast cancer? Breast Cancer General Rules Breast Conditions Breast Disorders in Females Breast Self-Examination Identifying and Managing the High-Risk Patient Breast Examination Breast Cancer and Benign Breast Disorders Examination Techniques Clinical Breast Examination Preventive Health Care Accuracy of Screening Tests Adolescent Medicine 68 Should breast self-examination be taught and emphasized for all teenage girls? Estimates of Screening Benefit CNBSS-1 and CNBSS-2 What is the reason for palpating axillary lymph nodes during a clinical breast examination? Why is it important to include the palpation of the tail of Spence in breast examination? When performing a breast examination what are important areas to palpate? How should the nurse position for palpation of the axillae and the breasts? From: The Breast (Fifth Edition), 2018 Breast Masses Ann Marie Kulungowski MD, Christina A. Finlayson MD, in Abernathy’s Surgical Secrets (Sixth Edition), 2009 1 What are the three parts of breast screening that assist in the early diagnosis of breast cancer? Breast self-examination (BSE) should begin at age 20 and be performed monthly. The breast is usually easiest to examine on the days immediately following the menstrual cycle. BSE can be frustrating to patients, particularly when they have fibrocystic change because they are not certain what they are feeling or supposed to feel. The technique of BSE should be taught early and reinforced regularly. If a palpable tumor develops, women who regularly perform BSE present with tumors 1 cm or smaller more frequently than women who do not perform BSE. Improvement in survival from breast cancer has not been demonstrated, however. Some women should not practice BSE because of the psychological trauma they suffer from repetitive false-positive findings. Those women need to rely on their physician to do a breast examination once or twice a year. Clinical or physician breast examination (CBE) also should begin at age 20 and be performed annually for women at average risk for breast cancer. Although tumors between 0.5 cm and 1.0 cm occasionally can be detected by an experienced physician, tumors between 1.0 and 1.5 cm can be detected 60% of the time. As the tumor grows, 96% of tumors larger than 2.0 cm can be identified on physician physical examination. Clinical breast examination should be part of the primary care physician’s health maintenance and screening program. Screening mammography has had the most substantial impact on the early diagnosis of, and subsequent decrease in mortality from, breast cancer. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323057110000628 Breast Cancer Aviva Romm, in Botanical Medicine for Women’s Health, 2010 General Rules • BSE should be done in a warm, comfortable, private place không lấy phí from distractions. This allows women to be mindful of the exam, and the warmth allows the breast tissue to relax, facilitating the exam. • BSE should be conducted using the pads, not the tips, of the three middle fingers. • The right hand should be used to examine the left breast, the left hand to examine the right breast. • The woman should examine all tissue from the midaxillary line to the clavicle and to the sternum. Evidence suggests that a vertical pattern (Fig. 10-2) is most effective for covering the entire breast without missing any breast tissue. • Three levels of pressure should be applied: light, medium, and firm. • The breast should be examined in small “massaging” circles when using the patterns shown in Figure 10-2. The fingers should maintain contact with the breast at all times. Lifting the fingers could lead to an area being missed. • BSE should be performed both lying down, and in an upright position. The upright portion of the exam can be done in the shower. Additionally, a visual inspection should be done in front of a mirror. • A small amount of oil, soap, or powder may be applied to the fingers to reduce friction and allow the fingers to glide more smoothly over the skin. • The following areas should be examined thoroughly with each BSE: • Outside: armpit to collar bone, and below the breast • Middle: the breast itself • Inside: the nipple area Although cancerous growths are most likely to be found in the upper, outer breast quadrant or behind the nipple, they can occur in any area of the breast, chest, or lymph network (Box 10-2); therefore, a thorough exam is essential. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B978044307277200012X Breast Conditions Tolu Oyelowo DC, in Mosby’s Guide to Women’s Health, 2007 Diagnosis • Women who regularly perform breast self-examinations may note changes in the breasts during the cycle. The breasts become more lumpy and tender before menses and less lumpy and less tender after menses. • Physician-administered breast examinations may reveal move-able, nonadhered, cystlike masses with clearly delineated borders in the breasts. • Fine-needle aspiration of the cyst can be used to both diagnose and treat fibrocystic changes. • Mammography may be used to differentially diagnose fibrocystic changes from breast cancer and other breast disorders. • Excisional biopsy of the tissue is used to differentially diagnose fibrocystic changes from breast cancer and other breast disorders. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323046015500083 Breast Disorders in Females Jill S. Huppert MD, MPH, Nichole Zidenberg MD, in Adolescent Medicine, 2008 Breast Self-Examination In the past, many experts recommended that adolescents be taught breast self-examinations to establish the health habit and promote an understanding of its importance in adulthood. However, there are no data to tư vấn breast self-examination during adolescence and there is concern that it may produce unnecessary anxiety, testing, and surgery. There is consensus in the literature that breast self-examination should be encouraged for all adolescents with a history of malignancy, adolescents who are at least 10 years post-radiation therapy to the chest, and adolescents 18–21 years of age whose mothers carry the BRCA 1 or BRCA 2 gene. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323040730100214 Identifying and Managing the High-Risk Patient Michael S. Sabel MD, FACS, in Essentials of Breast Surgery, 2009 Breast Examination There are minimal data either supporting or refuting the importance of self breast examination for women with a hereditary risk of breast cancer. For women at average risk, self breast examinations do not appear to be associated with a decrease in breast cancer mortality but are associated with an increase in breast biopsies. Clinical breast examination will detect additional cancer beyond mammographic screening, although the numbers are small; roughly 3% to 8% of cancers were detected solely by clinical examination. Even among women with a hereditary risk, clinical examination detects only a small number of cancers above and beyond imaging. However, there are benefits to both self breast examination and clinical breast examination beyond cancer detection and most cancer societies continue to recommend their use for all women, not just women with a hereditary predisposition. There is minimal evidence to tư vấn high-risk women undergoing a clinical breast examination more often than every 6 months. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323037587000089 Breast Cancer and Benign Breast Disorders Nancy Davidson, in Goldman’s Cecil Medicine (Twenty Fourth Edition), 2012 Screening Screening strategies for breast cancer have traditionally included the triad of breast self-examination (BSE), clinical breast examination (CBE) by a health care professional, and screening mammography in well women. Although widely promulgated as an important component of early detection, two large randomized trials of conventional BSE versus observation failed to show any clinical advantage with BSE. As a result, many experts now promote breast awareness rather than regular BSE. The independent value of CBEs has not been rigorously assessed. Rather, it has been studied in conjunction with screening mammography, in which case the two interventions appear to decrease mortality from breast cancer by 25 to 30% in women older than 50 years. Considerable controversy continues over the value of screening mammography in women 40 to 50 years of age and those over 70 years of age as well as the optimal interval between mammograms for women aged 50 to 70 years. Currently, the American Cancer Society and the National Cancer Institute recommend annual screening mammography for women older than 40 years of age who are at standard risk for breast cancer. In contrast, the U.S. Preventive Services Task Force, advising the Department of Health and Human Services, recommended in 2009 that women between 40 and 50 years of age be counseled about the risks and benefits of screening mammography and that screening mammography can be used at 2-year intervals for women aged 50 to 75 years (Table 204-7). A study of digital versus conventional film screen mammography failed to show an overall advantage for digital mammography but suggest that digital mammography may be more useful for women with dense breasts. The knowledge that screening mammography fails to diagnose about 10 to 15% of breast cancers has led to the evaluation of other imaging modalities. Of these, MRI is the most mature. MRI has been promoted as a useful screening tool for women at high risk by virtue of the BRCA mutation; indeed, the American Cancer Society has recommended consideration of screening MRI for women whose predicted risk for breast cancer exceeds 20%. MRI has been shown to detect breast cancer in the contralateral breast in 3% of women with a newly diagnosed breast cancer whose contralateral mammogram showed no abnormality. Use of MRI in the general population is limited by the fact that it is highly sensitive but lacks specificity. Insufficient information exists about other breast imaging modalities such as ultrasound and radionuclide imaging to tư vấn their use in screening asymptomatic women. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9781437716047002049 Examination Techniques Melissa Anne Mallory, Mehra Golshan, in The Breast (Fifth Edition), 2018 Clinical Breast Examination The role of CBE has a stronger foundation in the early detection of breast carcinoma than BSE; however, limitations in the evidence supporting its routine use are recognized by both the USPSTF and the ACS. The ACS notably shifted their stance away from recommending CBE for women at average risk of breast cancer regardless of age in their năm ngoái guidelines, citing a lack of evidence showing benefit for CBE performed either alone or in conjunction with mammography, concurrent with an increase in false-positive rates (based on moderate-quality evidence).5 The most recent USPSTF guidelines in 2009 concluded that the current evidence was insufficient to assess the additional benefits and harms of CBE beyond screening mammography in women 40 years or older; the USPSTF is in the process of updating the breast cancer screening guidelines; however, these are not yet available, and it remains to be seen how CBE will be regarded in their revisions.2 We continue to recommend CBE as part of our practice in our patient population. The technique of breast examination should include a thorough inspection and palpation of the entire breast and the draining lymph node–bearing areas. To perform a CBE, the physician should stand in front of the gowned patient. In a manner that allows for minimal disrobement of the patient, both breasts should be inspected with the patient’s arms by her side, with her hands over her head, and finally with her arms to her side with contraction of the pectoralis major muscle. Notes should be taken with regard to size, shape, and symmetry of the breasts. Attention should be made to any changes to the skin, including indentation, protrusions, or skin thickening. The nipple should be inspected for retraction, thickening, flaking, or erosions. After inspecting both breasts, palpation should be performed with the patient in both the sitting and supine position. The entire breast should be examined from the clavicle superiorly to the rectus sheath insertion inferiorly, extending from the latissimus laterally to the sternum medially. Palpation is performed using the pads of the fingers and may again be in the spoke-wheel, vertical-horizontal blind, or circular fashion and should be performed with light, moderate, and deep pressure. Special attention should be made to the lymph nodes in the sitting position. With one arm supporting the woman’s hand, the other hand examines the axilla. The supraclavicular and infraclavicular lymph nodes are best examined from behind with the woman in a seated position. Lymph nodes that measure greater than 1 cm in diameter or that are fixed or matted warrant further diagnostic workup. If a mass is found, a tape measure or caliper is used to estimate its size in two dimensions. The location should be either drawn on a diagram or referenced to a clock time and measured in centimeters from the nipple in a spoke-and-wheel fashion. For a woman who presents with a palpable lump, the detailed history should include length of time present, whether pain is associated with the mass, whether the lump has changed in size since identification, and, in a premenopausal woman, whether the mass changes after menses. During the examination of the breast, focused attention should be given to the nipple-areolar complex. Manipulation of the nipple should occur only if the patient reports nipple discharge. If present, the clinician should note whether the discharge occurs spontaneously or only with mild manual compression and indicate whether the discharge is unilateral or bilateral, involving one or many ducts. The color of the discharge can help with diagnosis and should always be noted, and accompanied with a description of the offending duct(s). A written description, which may also include a diagram or photograph, may be useful for objective reporting in the patient’s progress notes. Common discharge colors include clear, white, green, brown, black, and red (bloody). Fluid that is brown or black should undergo guaiac testing at the time of the examination to look for breakdown products of hemoglobin. Discharge that is unilateral and bloody or guaiac-positive has a malignancy risk of approximately 20% to 25%; however, the vast majority is caused by benign entities, such as papillomas.8 Discharge that is bilateral, multiductal, and milky, clear, green, or bluish in color is almost always benign. As many as 50% to 80% of women in their reproductive years may elicit discharge, and 7% of women referred for surgical evaluation have nipple discharge as their primary complaint.9,10 At the time of CBE, risk factors for breast cancer should be reviewed with patients, and the physician should perform a detailed assessment of breast cancer risk by obtaining relevant medical and family histories. It is estimated that 7% to 10% of carcinomas diagnosed in the United States result from an inherited predisposition to breast and ovarian cancer, the vast majority being BRCA1 and BRCA2 mutations.11 Clinicians should partner with their patients to keep accurate and updated family histories, including maternal and paternal incidences of breast and ovarian cancer dating back two or three generations. Reviewing this information will help identify patients who may benefit from genetic counseling. Age is an important risk factor for breast carcinoma; currently, a woman living in the United States has a 12.3% chance of developing breast carcinoma.12 Patients should inform their clinicians of any previous personal history of carcinoma or breast biopsy, and records should be obtained if needed to determine whether prior biopsy specimens contained atypia.13 A woman’s age at menarche and menopause, as well as parity should be recorded.14 The use of exogenous estrogen and/or progesterone in the premenopausal and postmenopausal setting should be ascertained.15 Physicians should discuss the importance of a healthy lifestyle with their patients, emphasizing the role that postmenopausal obesity16 and excessive or more than moderate alcohol consumption may play in the development of breast cancer.17 Although no direct evidence links inactivity to an increased risk of breast cancer, intensive physical activity has been linked to a reduced breast cancer risk, with a 2011 review suggesting a 25% risk reduction for the most physically active women compared with the least active women. Although results have varied widely regarding the role of smoking on breast cancer risk, numerous studies have suggested an increased risk of breast cancer among active smokers, and a 2013 meta-analysis found early-age at smoking onset (before menarche and before the first birth) was significantly associated with increased risk of breast cancer development.18 Clinicians should counsel their patients on the numerous adverse risks of smoking and alcohol use and provide counseling regarding cessation when appropriate. Once a palpable complaint has been interrogated or at the time of a woman’s CBE at age 40, diagnostic imaging should be initiated. Numerous breast imaging modalities exist to assist the clinician in screening for breast cancer and for diagnosing and managing breast abnormalities detected by both palpation and imaging. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323359559000258 Preventive Health Care Janelle Guirguis-Blake, … David Meyers, in Textbook of Family Medicine (Eighth Edition), 2011 Accuracy of Screening Tests The prevalent methods of breast cancer screening are mammography, clinical breast examination (CBE), and self breast examination (SBE), or breast self-examination (BSE). The sensitivity of mammography ranges from 77% to 95% for cancers diagnosed over the following year, and specificity ranges from 94% to 97%. Sensitivity is lower in women younger than age 50 and in women taking hormone replacement because of increased breast tissue density. Specificity increases with shorter screening intervals and availability of prior mammograms. Adequate evidence suggests that teaching BSE does not reduce breast cancer mortality. The evidence for additional effects of CBE independent of mammography on breast cancer mortality is inadequate. The sensitivity of CBE ranges from 40% to 69% and specificity from 86% to 99% (Humphrey et al., 2002). Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9781437711608100065 Adolescent Medicine Mark F. Ditmar MD, in Pediatric Secrets (Fifth Edition), 2011 68 Should breast self-examination be taught and emphasized for all teenage girls? Because the incidence of malignancy is very low in this age group, no data tư vấn benefits for breast self-examination, and indeed it may cause unnecessary anxiety and testing. Exceptions would be all adolescents with a history of malignancy, those who have had radiation therapy to the chest more than 10 years ago, and adolescents 18 to 21 years old whose mothers carry the BRCA1 or BRCA2 gene. Huppert JS, Zidenberg N: Breast disorders in females. In Slap GB, editor: Adolescent Medicine: The Requisites in Pediatrics, Philadelphia, 2008, Mosby Elsevier, p. 150. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B978032306561000001X Estimates of Screening Benefit Heidi D. Nelson, … Rongwei Fu, in Breast Cancer Screening, năm nay CNBSS-1 and CNBSS-2 The CNBSS-1 evaluated the effectiveness of mammography, annual clinical breast examination by physicians or nurses, and breast self-examination instruction compared with usual care in reducing breast cancer mortality among women age 40–49.7,8 The trial was conducted in 15 centers in Canada from 1980 to 1985. Volunteers without prior breast cancer or mammography in the prior 12 months were recruited using mass truyền thông advertising. After a clinical breast examination and instruction on breast self-examination, 25,214 women were randomized to receive two-view mammography plus clinical breast examination for 4–5 annual screens, and 25,216 women were randomized to usual care. Usual care was based on general care in the community that did not include routine mammography screening, and breast self-examination was reinforced for those returning to the clinical centers. Abnormalities detected during the study were evaluated through referral to the CNBSS review clinic, where the study surgeon reviewed the case and mammogram with the study radiologist and made recommendations to the participant’s physician for evaluation and follow-up. The CNBSS-2 was designed to determine the incremental benefit of adding mammography to annual clinical breast examination by physicians or nurses and breast self-examination instruction in reducing breast cancer mortality among women age 50–59.9,10 Study participants were recruited through mass truyền thông advertising and randomized after clinical breast examinations to either annual clinical breast examination alone (19,694 participants) or annual clinical breast examination plus two-view mammography (19,711 participants) for 5 annual screens. In addition, breast self-examination instruction was provided at the first visit and reinforced at each screening visit for participants in both screening and control groups. The Canadian trials differed from the other screening trials because they obtained medical histories and clinical breast examinations on all participants before randomization, and the trials enrolled volunteers with different breast cancer risk profiles and health habits than the general population, as detailed above in Limitations. Adherence for both trials was 85%. At the initial screen, more women age 40–49 had breast cancer with 4 or more positive nodes in the screening compared with the control group (17 vs 5),7 suggesting that groups may not have been entirely comparable. However, this could also be the result of mammography detection of advanced as well as early breast cancer and was observed in other trials as well. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780128022092000024 What is the reason for palpating axillary lymph nodes during a clinical breast examination? Following direct palpation of the breast, the axillary region should be palpated. This is because the axillary lymph nodes are usually the first site of spread in the setting of breast cancer. Why is it important to include the palpation of the tail of Spence in breast examination? A tail of breast tissue called the “axillary tail of Spence” extend into the underarm area. This is important because a breast cancer can develop in this axillary tail, even though it might not seem to be located within the actual breast. When performing a breast examination what are important areas to palpate? Following a complete exam of the breast, the axilla and supraclavicular area should be palpated for lymphadenopathy. Lymph node abnormalities may present in a variety of forms, but most often any palpable nodes of concern will be slightly enlarged and have a somewhat firmer texture than the typical soft, rubbery one. How should the nurse position for palpation of the axillae and the breasts? The patient’s arm should be relaxed at his/her side and the examiner cups his/her fingers, reaching as far into the axilla as possible reaching behind the pectoral muscle to palpate the lymph nodes. To do so, use your right hand to examine the left axilla, and the left hand to examine the patient’s right.

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