Running Head: Prevention and Early Detection of Breast Cancer 1

Prevention and Early Detection of Breast Cancer in High Risk Patients

Mary Mercurio

Jackson College, School of Nursing

Prevention and Early Detection of Breast Cancer 2

Background

Breast cancer is the most common cancer in women independent of race or ethnicity.

In 2018, an estimated 266,120 new cases of invasive breast cancer are expected to be

diagnosed in women in the U.S., along with 63,960 new cases of non-invasive breast cancer.

About 40,920 women in the U.S. are expected to die in 2018 from breast cancer. Death rates

have been decreasing since 1989. Women under the age of 50 have experienced larger

decreases. As of January 2018 there are more than 3.1 million women with a history of breast

cancer. This includes women currently being treated and women who have finished treatment

(US Breast Cancer statistics 4/2018).

A Woman’s risk for breast cancer nearly doubles if she has a first degree relative who

has been diagnosed with breast cancer. Less than 15% of women who get breast cancer have a

family member diagnosed with it. 5-10% of breast cancers can be linked to gene mutations

inherited from one’s parent. Mutation of the BRCA1 and BRCA2 genes are the most common.

On average women with the BRCA1 mutation have a 55% lifetime risk of developing breast

cancer and for women with the BRCA2 mutation have a 45% risk. Those who test positive for

BRCA1 or BRCA2 mutation tend to develop breast cancer more often in women of younger age.

Approximately 85% of breast cancers occur in women who have no family history (US Breast

Cancer statistics 4/2018).

Prevention and Early Detection of Breast Cancer 3

While guidelines for breast cancer screening in average risk patients are well

established, screening in high risk women is not as clear. For patients with BRCA1 and BRCA2

mutations current guidelines recommend screening by a clinical breast exam and

mammography starting at age 30. For some high risk patients additional screening with MRI is

encouraged. While mammography is the only imaging modality proven to reduce mortality

from breast cancer an MRI can identify smaller malignancies at a greater resolution at an earlier

stage. MRI use would be more cost effective as there would be less need for invasive

procedures (Greenwald, 2012).

Management of women who are considered high risk for breast cancer is controversial.

This is because mammography alone has its limitations in screening younger women with more

dense breast tissue or with specific tumor phenotypes. For women with BRCA1 or BRCA2

mutations current guidelines recommend starting with MRI at age 25 and then adding

mammography at age 30 (Murray, 2015)

Most practitioners will screen women with annual MRI if they have a calculated

increased risk. Risk is calculated every year to determine who still needs annual MRI using a risk

model. One model used to calculate the risk for breast cancer is the Gail model which is used in

women with no history of breast cancer, another model is the Breast Cancer Consortium (BCCS)
Prevention and Early Detection of Breast Cancer 4

calculator or a new model called the Tyrer-Cuzick model which is the most consistently accurate

for prediction of breast cancer (Cass, 2017).

PICOT Question

To further understand how to prevent and detect breast cancer early in high risk

patients to have a better outcome. The PICOT question for this research paper focuses on:

What tools and resources are available for nurses and other medical staff to help high risk

patients know their risk and what to do about preventing and detecting breast cancer early?

For the purpose of this paper, “high risk” patients encompasses all women that have a

strong family history of breast cancer and those who have a positive BRCA 1 or BRCA 2 gene

that indicates they have the breast cancer gene mutation.

Diagnosis Question

The PICOT question being addressed in this paper is an Assessment type of question.

The type of question that will look at how best to assess how high the risk is, and how to best

prevent and detect breast cancer early for a better outcome when making decisions on what to

do with the information each patient is given.

Prevention and Early Detection of Breast Cancer 5

Evidence

The assessment type of question in this research is best answered by evidence that

focuses on development of tools for assessing, preventing, and detecting breast cancer early in

those who are at a higher risk for it. In this case, research articles focusing on tools for

assessment, prevention and early detection would be the most appropriate evidence to use in

answering this PICOT question.

Databases

The databases used for this paper were CINAHL, PUBMED, PMC US National library of

Medicine, The American Cancer Society, and Breast Cancer. Org. In my original search for

“prevention and early detection of breast cancer in high risk patients” it was a very broad topic

with 766,000 results. Changing the search to “prevention of breast cancer” and “detection of

breast cancer” helped narrow the articles down to more specific current and relevant articles.

Research Methods

Of the articles I used for this paper, two were statistical articles of the risk for detecting

breast cancer, three were full text descriptive articles of different assessment tools used in
Prevention and Early Detection of Breast Cancer 6

detecting breast cancer and the others were focused on screening and prevention. One clinical

trial, and the rest of the articles were descriptive journals from experts in the breast cancer

research field.

Level of Evidence

Based on the amount of research found on this subject, the level of evidence for the

PICOT question is high. There are many well-written articles, journals, and statistical findings.

While breast cancer research is ongoing and they are always coming up with new evidence

there is always a need for more research. There are still many articles and journals that are very

beneficial in helping a patient determine what is considered high risk and what screening is best

for each patient. I do feel that more research can always be done. I hope more research will be

done in the areas of prevention including a healthy diet, regular exercise and healthy living in

general to help in decreasing the risk of breast cancer, and to support this portion of the PICOT

question in the future.

Summary of Findings

Most of the articles I found for this PICOT question were very well written and had very

similar findings in correlation to the prevention and early detection of breast cancer in high risk

patients. It is not surprising finding all the research that has been done to help in preventing

and decrease the risk of breast cancer, as it is the most common cancer in women.
Prevention and Early Detection of Breast Cancer 7

Primary prevention involves health promotion and risk reduction in the general

population so that invasive cancers do not develop. Primary preventive measures include life

style changes such as smoking cessation, diet modifications, and vitamin supplements,

identifying genetic risk, understanding of carcinogens, and development of more effective

screening tools as ways of detection. Avoiding risk factors can lead to decreased morbidity and

mortality of breast cancer. Secondary prevention is the identification and treatment of

premalignant and subclinical cancers by means of mammography and MRI (Fisher, 2017).

Dietary Prevention of breast cancer consists of a low fat diet. There are indications that

breast cancer risk is increased with food consumption that is rich in fat and low in fiber. It has

been reported that dietary fat and post-menopausal estrogen levels are directly related. Low

fat and high carbohydrate foods lead to significant reduction in breast density. Lifestyle factors

which may affect breast cancer risk include sexual behavior pattern, alcohol intake, physical

activity and obesity. Epidemiologic data indicates that obesity increases the risk of breast

cancer (Boyd, 1997).

Prophylactic Mastectomy is also a preventative strategy for those with a high risk that

are influenced by a range of factors as well as women who carry the mutation BRCA1 or BRCA2.

Women who are considering bilateral mastectomy as preventative measure need to be

informed about the effectiveness along with possible morbidities of this procedure in

association with cancer risk assessment and other preventative strategies (Hartman, 1999).
Prevention and Early Detection of Breast Cancer 8

Finding breast cancer and getting state of the art cancer treatment are the most

important strategies to prevent deaths from breast cancer. Breast cancers that are found early

when small and have not spread are easier to treat successfully. Getting regular screening tests

is the most reliable way to detect breast cancer early. Doing self-breast exams and having

clinical breast exams are recommended, but studies have shown little evidence that doing self-

breast exams and having clinical breast exam help in find breast cancer early with women who

get regular screening mammograms (Huang, 1997). Overall, early detection and prevention of

breast cancer in high risk patients is a large ongoing issue. Nurses and other trained medical

staff should be aware of risk assessment tools to help patients identify their risk as well as

getting the proper testing to see if they may carry the gene mutations of breast cancer, staff

should also encourage routine screening to help in the early detection and prevention of breast

cancer. Nurses should be able to help in the education of preventative strategies to assist in the

decision process of what is best for each patient.

Clinical Implications and Conclusion

The clinical implications for prevention and early detection of breast cancer of high risk

patients would be to include a well-structured system of public awareness. This would be

significant as the best therapy is prevention. Detecting breast cancer early is how to have the

best prognosis, as treatment of breast cancer at an early stage will provide for maximum
Prevention and Early Detection of Breast Cancer 9

chance of survival. Breast cancer screening has a well-established role in the early detection of

breast cancer, with a reduction of cancer associated morbidity and mortality.

Myself (as a nurse) along with Doctors and other medical staff need help in continuing

to provide education to patients regarding the risk of breast cancer and prevention of it. We

need to encourage routine screenings along with yearly risk assessments to help in determining

the level of risk of patients so that they can be aware and get the proper screenings and

treatments for a better outcome. Providing patients with information on where to go for

routine testing and educating them on the importance of prevention and early detection is

crucial.

If I were given the opportunity I would focus on the education aspect so that I could

inform patients about prevention. I would educate them about a healthy lifestyle, and give

them resources so they would be aware of things to avoid doing and eating to give them a

better chance at lowering the risk for breast cancer. I would like to make sure patients that are

high risk know what options they have and what testing is out there that can be done. This

would allow them to know what their risk is and how having these tests done as recommended

by the guidelines provided by the different assessment tools available can lead them to a better

outcome if presented with breast cancer in their lifetime.

Prevention and Early Detection of Breast Cancer 10

References

Fisher, B. A.; Wilkinson, L; Valencia, A. (2017) Women’s interest in a personal breast cancer risk
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Cass, Ilana. (2017) Advances in breast cancer screening and prevention: New technologies offer
ob/gyns more tools to identify and treat patients at risk. Dec2017; v.62n.12, 7-14. (3p)

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Boyd NF, Greenberg C, Lockwood GA, et al. Effect of a low -fat, high carbohydrate diet on
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