Moving people into their optimal health by changing their lifestyles (Dunphy, Windland- Brown, Porter, & Thomas (2011).

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2 Enabling people to improve and increase their control over their health, not only on individual behavior but to a vast range of environmental and social interventions (World Health Organization, 2012). Moving people into their optimal health by changing their lifestyles (Dunphy, Windland- Brown, Porter, & Thomas (2011). Balance of Psychological, physical, and spiritual health

3 Breast cancer happens when breast cells divide and grow, not having usual control (Susan G. Komen for the Cure, 2012). Most begin in the ducts and a smaller percentage are in the lobules and various breast tissues (Susan G. Komen for the Cure, 2012).

4 In women most common cancer, regardless of ethnicity or race, and in Hispanic women, it is the most common cause of death (Centers for Disease Control (CDC), 2011) second leading cause of death from a cancer In white, Asian/Pacific Islander, black, and American Indian/Alaska Native women (CDC, 2011).

5 Risk Factors: Age Early menarche Chest wall radiation Family history Atypical hyperplasia Late menopause Sex Race Hormone therapy Obesity Parity Alcohol consumption (Ko, et al., 2012)

6 Age itself is the greatest risk factor The older a woman gets, the more at risk she is (Ko et al., 2012) Signs and symptoms Hard, painless mass with irregular edges Soft, tender mass New lump or mass Skin irritation Dimpling Swelling Nipple or breast pain Redness Thickening of nipple Nipple retraction or discharge (ACS, 2012).

7 Because breast cancer is the most common cancer in women and the first and second leading cause of cancer related deaths, women need to be taught how to act early by utilizing appropriate screening and detection techniques

8 Clinical Breast Exam (CBE) Breast Self-Exam (BSE) Mammogram

9 Performed by health care provider Provider begins by looking at breasts checking for changes/abnormalities Gently palpates both breasts using the pads of fingers, paying attention to texture, shape, lumps Attention is given to the under arm area lymph nodes there Women should have CBE beginning in the 20s and 30s at least every 3 years Beginning at age 40, CBE should be yearly (ACS, 2012)

10 Having a woman use her own eyes and hands to examine her breasts for skin changes, shape changes, and for unusual lumps and/or masses (Corbex et al., 2012). Providers should teach methods of BSE and then review the woman s technique (ACS, 2012).

11 Performed in good light, involving standing in front of a mirror to look and then lying on the back to feel the breast (ACOG, 2012). Performed monthly a few days after a woman s monthly period Breasts are not tender during this time

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13 Diagnostic or screening breast x-ray 2 plates compress breast, spreading and flattening the tissue for a good view Approximately 20 minutes, compression only lasting a few seconds (ACS, 2012).

14 Do not determine if an abnormal area is cancerous Biopsies determine if cancerous Performed every year for women age 40 and up and these women should continue to get screened as long as they can (ACS, 2012)

15 2 local clinics 1 OBGYN and 1 family practice Determined that women were not always performing BSE and did not know how (K. Hensarling and H. Patel, personal communication, August 27, 2012 and October 30, 2012). Population mostly Caucasian and African Americans with insurance Most patients state they do not remember to perform BSE; however, they want providers to perform CBE Education on BSE and breast cancer awareness took place at annual well-woman exams

16 Focused on annual well-woman exams Goal: Educating patients on benefits of BSE, CBE, and mammograms Upon entering the room, the PCNP student explained that they would perform CBE verbal consent was obtained While performing the CBE, the student educated the patient on how to perform BSE and importance of mammograms beginning at 40

17 Common breast cancer risk factors were reviewed with the patients Handout on SBE was given to the patients to refer back to Q&A time was given to the patients

18 Handout was given from ACOG as a reference for the patient Shows patients how to perform SBE and includes fast facts Pender s Health Promotion Model was used for teaching 3 components Individual experiences, behavior specific perceptions and cognitions, and behavioral outcomes (Pender, Murdaugh, & Parsons, 2011). Time was given for patients to ask questions and receive answers

19 30 patients total Aging from patients at family practice, 27 at OBGYN Most common question asked was if they were performing BSE correctly Another question was what to do if they felt something abnormal No patient reported that they would not perform BSE, no patient refused CBE, and for the patients 40 and above, no patient refused scheduling a mammogram BSE techniques were watched by the PCNP student

20 Most patients aware of breast cancer prevalence; not all realized they could perform BSE monthly One change would be to allow more time minute appointments Would extend time 5-10 more minutes so that the Q&A time would not be rushed Patients were receptive to the information and agreed to do their part in detecting breast cancer

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22 American Cancer Society (ACS). (2012). Breast cancer: early detection. Retrieved from cid/documents/webcontent/ pdf.pdf American Congress of Obstetricians and Gynecologists (ACOG). (2012). The breast self-exam. Retrived from The_Breast_Self-Exam Centers for Disease Control and Prevention (CDC). (2011). Breast cancer: fast facts. Retrieved from breast/basic_info/fast_facts.htm Corbex, M., Burton, R., & Sancho-Garnier, H. (2012). Breast cancer early detection methods for low and middle income countries, a review of the evidence. Breast (Edinburgh, Scotland), 21(4), doi: /j.breast Dunphy L M Winland-Brown J E Porter B O Thomas D J 2011 Primary Care: The Art and Science of Advanced Practice NursingDunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2011). Primary Care: The Art and Science of Advanced Practice Nursing (3rd ed.). Philadelphia, PA: F. A. Davis Company.

23 Ko, M. G., Files, J. A., & Pruthi, S. (2012). Reducing the risk of breast cancer: A personalized approach. Journal of Family Practice, 61(6), Kosters, J. P. and Gotzsche, P. C. (2008). Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews, 2003 (2). doi: / CD003373/abstract Pender N J Murdaugh C L Parsons M A 2011 Health Promotion in Nursing PracticePender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health Promotion in Nursing Practice (6th ed.). Boston, MA: Pearson Smith, R. A., Duffy, S. W., & Tabar, L. (2012). Breast cancer screening: The evolving evidence. Oncology ( ), 26(5), Susan G. Komen for the Cure (2012). Understanding breast cancer: what is breast cancer? Retrieved from BreastCancer/WhatisBreastCancer.html Well-Woman Visit. (2012). Obstetrics & Gynecology, 120(2), Susan World Health Organization 2011 Definition of healthworld Health Organization (2012). Health topics: health promotion. Retrieved from