INTRODUCTION

Today we fight. Tomorrow we fight. The day after, we fight. And if this disease plans on whipping us, it
better bring a lunch, ‘cause it’s gonna have a long day doing it.” – Jim Beaver, Life’s That Way: A Memoir

The term “breast cancer” refers to a malignant tumor that has developed from cells in the
breast. Breast cancer is an uncontrolled growth of breast cells, whichoccurs as a result of
mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and
keeping them healthy. Usually breast cancer either begins in the cells of the lobules, which are
the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the
nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and
fibrous connective tissues of the breast. Breast cancer is always caused by a genetic abnormality
(a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality
inherited from patient ́smother or father. Instead, 85-90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

In the Philippines, cancer ranked third in the list of leading causes of death in the country in 2010, with
the following as the ten top causes of cancer deaths in the country for that same year: (1) Breast Cancer;
(2) Lung Cancer; (3) Liver Cancer; (4) Cervical Cancer, and (5) Colon Cancer.

Breast cancer is most common among women than most men. It is the leading killer of women aged
between 35 and 54. Over a million developed the disease without knowing it, and almost 500,000
women die from it every year (www.pinayinaction.com). Higher incidence rates were observed from
technologically advanced societies such as North America, Europe, and Australia, while lower rates were
observed in Africa and Asia. However, according to Narod et al (2006), there is a discrepancy in the
incidence rates of breast cancer among women in Asian countries. The Philippines has the highest
prevalence of breast cancer in Asia, and the 9th highest in the world today. Even with the successful
fertility reduction and change of lifestyles of Filipino women, the inadequate or lack of knowledge of
breast health contributed to the its recorded highest prevalence in Asia. This is due to limited income,
high costs of diagnostic tests and hospital care, low level of education, and lack of breast cancer
awareness. Approximately 70% of breast cancers occur in women with undetermined risk factors and
about five percent of breast cancers are hereditary. In the past, the risk of breast cancer was 1in 22.
Today, it is already 1 in 8 cases. The figures are alarming, this why the government and private
institutions have vowed to help fight off the disease.

EPIDEMIOLOGY

The global incidence of breast cancer in the past decades has increased significantly and it is the most
common female cancer in the world. It comprises approximately 23% of all female cancers in the
world. The increasing numbers of women are being diagnosed with breast cancer also in
Philippines. In the early 1980`s there were under 2,000 women diagnosed with breast cancer annually
while the annual incidence in the late 2000`s was approximately 4,500. The increase in extent could
be attributed to mammography screening programs. The increase in breast cancer occurrence,
though, is observed also in unscreened women, which may reflect time effects such as
population ageing, better awareness of the disease and modern and more accurate diagnostic facilities.
Notwithstanding, relative 5-year survival of breast cancer patient is 89% in philippines, 800-900
women die of the disease perennially

A global survey reported that among 15 Asian countries, the Philippines has the highest breast cancer
mortality rate and the lowest mortality-to-incidence ratio. This may be due to the fact that majority of
breast cancers are diagnosed in locally advanced or metastatic stages among low- and middle-income
countries (LMICs). Some studies show that in the Philippines more than half (53%) of patients with
breast cancer were diagnosed at stages III and IV, while only 2 to 3% of cases were treated at stage I.
This translates to a dismal 58.6% 5-year survival rate, much less than worldwide figures.

Hereditary mutations cause approximately 5-10% of all breast cancers the proportion being
probably larger in breast cancer patients aged under 30. Several gene mutations are identified of
which highly penetrant gene mutations in tumor suppressor genes BRCA1 and BRCA2 are the
most important. Variousother factors are also reported to be associated with the risk of breast cancer,
mostof them being related to the tissue levels of estrogens (nulliparity, late first childbirth, early
menarche, late menopause, hormone replacement therapy and postmenopausal obesity).

CAUSES

Age

Family history

Previous breast cancer or lump

Dense breast tissue

Hormones and hormone medicine

Hormone replacement therapy (HRT)

Contraceptive pill

Lifestyle factors

Being overweight or obese

Alcohol
Radiation

RISK FACTOR

Being female.

Increasing age.

A personal history of breast conditions.

A personal history of breast cancer.

A family history of breast cancer.

Inherited genes that increase cancer risk.

Radiation exposure.

Obesity.

SIGNS AND SYMPTOMS

New lump in the breast or underarm (armpit).

Thickening or swelling of part of the breast.

Irritation or dimpling of breast skin.

Redness or flaky skin in the nipple area or the breast.

Pulling in of the nipple or pain in the nipple area.

Nipple discharge other than breast milk, including blood.

NURSING INTERVENTIONS

1) Acknowledge the individual: Oncology nurses recognise the value of individualized patient education
and the importance of supporting the patients and their care givers.

2) Nursing interventions promotes efficient, patient centred care highlighting the need for the patients
to receive the treatment that they need in a timely and efficient manner.

3) Health functioning, socioeconomic, psychological/spiritual and family domains should be considered

when caring for breast cancer patients.
4) Central to each patients cancer journey is the need for accurate education and information presented
by culturally competent caregivers in a supportive environment.

5) As a skilled interviewer, listener, coordinator, and counsellor the oncology nurse practitioner can
guide and support the patient from diagnosis to survivorship.

6)

MEDICAL MANAGEMENT

1. Surgery. An operation where doctors cut out cancer tissue.

2. Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you
take or medicines given in your veins, or sometimes both.

3. Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.

4. Biological therapy. Works with your body’s immune system to help it fight cancer cells or to control
side effects from other cancer treatments.

5. Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer cells.

SUMMARY

Cancer is a journey both medical and emotional. Each cancer journey is unique. Through an
understanding of the process, patients and their caregivers can move through this journey meeting
challenges and preparing for various possibilities. Once a patient is diagnosed with cancer they leave
their life as they know it and move into a world of uncertainty for them and their loved ones.

The Department of Health (DOH) emphasized the importance of regular self-breast exam and the
critical role of screening in the early detection and treatment of breast cancer among women in
observance of Breast Cancer Awareness Month with this year’s theme, “United We Fight.”

A breast self-examination (BSE) is a method to detect any noticeable changes in one's breast. Early
detection of any changes in the breast and seeking immediate consultation will increase one's chances
of successful treatment. Ultimately, the main goal of this program is to improve early breast cancer
detection rates so cure can be given before it is too late.

We urge women to regularly do self-breast examination and immediately visit the nearest health center
should she notice any cause for concern. The health care professionals have the confidence to perform
breast screening. For those who are already diagnosed with the disease, we encourage you to get
treated at the DOH hospitals and receive holistic care through advocacy groups.