Week 14 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios

Scenario C on breast cancer

The purpose of this discussion is to determine preventative guidelines that are consistent with identifying breast cancer and the presence of risk factors and create a treatment plan for breast cancer for both patients identified in the scenario. In addition, differentiate if they will receive different treatment plans or if the same plan can be used for both patients. The first patient in the scenario is a 72-year-old African American that consistently is seen in the office that is experiencing breast tenderness from a fall recently but has not had a breast exam in 30 years or ever had a mammogram. The second patient is a 48-year-old that is homeless and is concerned about an STI, however, she reveals her extensive history and states that she has had a mammogram approximately 2 years ago with a concerning spot that the doctor wanted to evaluate, but she never returned for ultrasound.Breast cancer is one of the most common malignancy in women of Western area and affects millions of women worldwide. This cancer is common through familial descents in families (Gagnon, Levesque, Breast, Screening, 2016). The goals that are associated with breast cancer screening apply to women who are at average risk of breast cancer and early detection refers to finding and diagnosing the condition earlier than waiting to symptoms to appear (American Cancer Society, 2020). The risk factors associated with developing breast cancer is being a woman, increased age, family history of breast cancer, genetic BRCA gene, personal history, radiation exposure to chest, white race, being overweight, and pregnancy history. In addition, starting a period earlier and using hormone replacement therapy can increased the likelihood of developing breast cancer (Gagnon, Levesque, Breast, Screening, 2016).There a specific screening guideline in place for breast cancer. The CDC (2020) stated that the USPSTF recommends that women who are ages 50-74 years old at average risk for breast cancer should receive a mammogram every two years. Women that are age 40-49 should discuss with their doctor when to receive a mammogram and how often. They should continue to discuss this and weight risks versus benefits when determining if a mammogram is necessary before age 50 (Center for Disease Control and Prevention, 2020). Both patients will be treated differently due to their significantly different history. The first patient is 72 is experiencing breast tenderness from a fall, however, she has never had a mammogram. The second patient is 48 years old and stated that she has had a mammogram in the past about 2 years ago, but there was an area of concern. According to the guidelines, both individuals should receive a mammogram in the mobile clinic, but the second patient will receive further education related to the primary reason she presented to the mobile clinic. The 72-year-old has never had a history of mammograms and is still within the age guidelines consistent with the CDC for screening for breast cancer. However, if the patient does not feel it is necessary, she can decline receiving a mammogram because she is almost out of the age range for screening. Determining if the risks outweigh the benefits for patients is one of the most critical pieces of information and education to provide them with (USPSTF, 2016). Screening for the second patient in the scenario is critical to address at the mobile clinic due to her extensive history and homelessness.My treatment plan for the first patient discusses in the scenario would be to do a manual exam and reevaluate the patient later to address if it is necessary to complete a mammogram. The patient is older and has never received one, however breast tenderness is present and may make it difficult to complete the exam due to her recent fall with her grocery cart. As an APRN, I would recommend screening this patient if symptoms persist and if there is any abnormal changes. USPSTF (2016) conducted a study that determined that women ages 70-74 with moderate to severe comorbid conditions negatively affecting their everyday life would likely not benefit from mammography. It is unknown based on the information provided if this patient has severe comorbidities, but I would educate the patient on screening and risks versus benefits and allow her to make an educated decision on her health. The second patient’s treatment plan would be different. Due to her concerning areas on her last mammography two years ago, I would order a mammogram STAT to determine if there are still any concerning areas present. I would also conduct a manual breast exam on the patient. Based on the results of that, I would follow the appropriate treatment regimen, biopsy, or continue to monitor the patient as necessary. In addition to breast screening, I would evaluate for STI presence and determine if treatment is necessary for that patient. This patient would require more frequent health care visits and need additional support because she is homeless and has limited access to health care.In summary, although there are guidelines present for this cancer, every patient is different. Some patients may fit the guideline, but not necessarily require the intervention that is discussed in the recommendation. Being transparent with patients and educating them is important. Making an educated decision is necessary to appropriately treat patients and avoid over screening or performing unnecessary medical interventions. These two patients are both appropriate candidates for receiving a mammogram based on guidelines, but for two very different reasons.ReferencesAmerican Cancer Society. (2020). American cancer society breast cancer screening guideline. Retrieved from https://www.cancer.org/latest-news/special-coverage/american-cancer-society-breast-cancer-screening-guidelines.htmlCenter for Disease Control and Prevention. (2020). Breast cancer: what is breast cancer screening? Retrieved from https://www.cdc.gov/cancer/breast/basic_info/screening.htmGagnon, J., Lévesque, E., on Breast, T. C. A. C., & Screening, C. (2016). Recommendations on breast cancer screening and prevention in the context of implementing risk stratification: impending changes to current policies. Current Oncology, 23(6), e615.U.S. Preventative Services Task Force (USPSTF). (2016). Final recommendation statement: breast cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/breast-cancer-screening