Clinical update

Clinical update: Breast cancer

Clinical update on breast cancer, including latest guidelines, signs and symptoms, advice on helping your patient and expert opinion
Breast cancer care

Essential facts

Breast cancer is the most common cancer in the UK, with around 60,000 new cases diagnosed each year, according to the charity Breast Cancer Care. Over a lifetime, women have a one in eight risk of developing it.

Nurses should encourage patients to check their own breasts Photo: Science Photo Library

Whats new

In June this year, the National Institute for Health and Care Excellence (NICE), published an updated quality standard on breast cancer.

It covers the management of early, locally advanced, advanced, recurrent and familial breast cancer in adults. It also covers cases identified through screening and by assessment of symptoms, encompassing care from initial referral to a specialist team.

Revised quality statements include offering those referred to specialist services a triple diagnostic assessment in a single hospital visit. This includes examination, screening and a biopsy.

NICE

...
Essential facts

Breast cancer is the most common cancer in the UK, with around 60,000 new cases diagnosed each year, according to the charity Breast Cancer Care. Over a lifetime, women have a one in eight risk of developing it.


Nurses should encourage patients to check their own breasts                      Photo: Science Photo Library

 

What’s new

In June this year, the National Institute for Health and Care Excellence (NICE), published an updated quality standard on breast cancer.

It covers the management of early, locally advanced, advanced, recurrent and familial breast cancer in adults. It also covers cases identified through screening and by assessment of symptoms, encompassing care from initial referral to a specialist team.

Revised quality statements include offering those referred to specialist services a triple diagnostic assessment in a single hospital visit. This includes examination, screening and a biopsy.

NICE says that alongside reducing anxiety and stress, this approach also helps ensure rapid diagnosis.

Causes/risk factors

More than 80% of breast cancers occur in women aged over 50. Alongside gender and age, the third main risk factor is significant family history. This means a number of cases of breast and ovarian cancer in the family and/or male relatives with breast cancer.

Breast Cancer Care says several other factors may increase the risk, including being overweight, drinking more alcohol than recommended limits, smoking, not having children or having a first pregnancy after 30, a menopause later than the average age of 52 and periods beginning before the age of 12.   

Signs/symptoms                

These include: a change in the size or shape of the breast, a lump or thickening that feels different, redness or rash on the skin or around the nipple, changes in skin, such as puckering or dimpling; nipple discharge, inversion or a change in position or shape, underarm swelling and constant pain in the breast or armpit.

How to help your patient

Nurses are crucial to encouraging patients to examine their own breasts regularly, looking and feeling to see if they detect any changes. They can also remind patients that if cancer is detected in its early stages, there is a good chance of recovery. Breast screening is beneficial in early identification.

By Lynne Pearce

 

Expert comment

Carolyn Rogers, senior clinical nurse specialist, Breast Cancer Care

‘Anything that helps to improve the quality of care and consistency for those diagnosed with breast cancer is a good thing. Each of the standards draws on existing guidance and describes priority areas for improvement. Having said that, a lot of what they are talking about is already happening.

'For example, many places already provide a triple diagnostic assessment on the same day, rather than patients having to wait for further appointments. Waiting to find out whether or not you have been diagnosed with cancer causes huge anxiety for patients, so speeding up the process is welcome. Whether all breast clinics will have the resources to achieve this remains to be seen.'

 

Find out more

NICE Breast cancer (published September 2011, updated June 2016)

NICE Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (updated August 2015)

NICE Early and locally advanced breast cancer: diagnosis and treatment (February 2009, currently being updated)

breastcancercare.org.uk

Breast Cancer Care nursing network

 

RCNi article

Value to patients of a breast cancer clinical nurse specialist

Hardie, H and Leary, A

Nursing Standard (2010)  dx.doi.org/10.7748/ns2010.04.24.34.42.c7720

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