Peer Response
Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
· Do you agree with your peers’ assessment?
· Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
· Share your thoughts on how you support their opinion and explain why.
· Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Reply from Whitney Reeves
Discussion 5: Levels of Prevention
For a woman aged 32 with a firm mobile breast lump, two questions are crucial to ask. The first question is how many years have you had the lump, and has the size or character altered over the years? This helps to confirm chronicity and progression. The second question is do you have any concomitant symptoms such as nipple discharge, pain, or skin change? Such concomitant findings could be indicative of underlying pathology such as malignancy or infection.
The two key risk factors to consider are history of breast or ovarian cancer among first-degree relatives, as inherited gene mutations like BRCA1 and BRCA2 significantly increase the risk of breast cancer, and reproductive history, such as age of menarche, age of first birth, and history of breast-feeding (Sessa et al., 2023). This is because they influence lifetime estrogen exposure and therefore the risk of breast cancer.
The prevention levels in this case are primary, secondary, and tertiary prevention. Primary prevention aims at the prevention of modifiable risks, which entail maintaining a healthy lifestyle, limiting alcohol consumption, and regular exercise encouragement. Secondary prevention includes early detection, including clinical breast exam and mammography when indicated, to identify malignancy earlier, when it is still curable (Loibl et al., 2024). Tertiary prevention would be applied if a breast cancer diagnosis were made, focusing on treatment (surgery, chemotherapy, radiation) and rehabilitation to reduce morbidity and recurrence. Finally, taking a sufficient history, evaluating risk factors, and maintaining awareness of appropriate levels of prevention are all fundamental steps in the management of a young woman with a breast lump. These interventions provide for comprehensive care including immediate
presentation and long-term health states.
References:
Loibl, S., André, F., Bachelot, T., Barrios, C., Bergh, J., Burstein, H., Cardoso, M., Carey, L.,Dawood, S., Del Mastro, L., Denkert, C., Fallenberg, E., Francis, P., Gamal-Eldin, H.,Gelmon, K., Geyer, C., Gnant, M., Guarneri, V., Gupta, S., … Harbeck, N. (2024). Early breast cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Annals of Oncology, 35(2), 159-182.
to an external site.
Sessa, C., Balmaña, J., Bober, S., Cardoso, M., Colombo, N., Curigliano, G., Domchek, S., Evans, D., Fischerova, D., Harbeck, N., Kuhl, C., Lemley, B., Levy-Lahad, E., Lambertini, M., Ledermann, J., Loibl, S., Phillips, K., & Paluch-Shimon, S. (2023). Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO clinical practice guideline. Annals of Oncology, 34(1), 33-47.
to an external site.
Reply from Jacie Lara Gamez
Patient Presentation:
A 32-year-old female presents with a 2 cm, firm, mobile lump in her right breast, discovered on self-examination. There is no associated adenopathy.
Two Questions to Ask the Patient:
“Have you noticed any changes in the lump over time, such as growth, pain, or changes during your menstrual cycle?”
This question helps determine if the lump is hormonally influenced (e.g., fibroadenoma or cyst) or more suspicious for malignancy. Benign breast conditions often fluctuate with hormonal changes, whereas cancerous lumps tend to remain fixed and grow over time (American Cancer Society (ACS), 2023).
“Do you have any nipple discharge, skin changes over the breast, or a family history of breast or ovarian cancer?”
Nipple discharge or skin dimpling may be signs of malignancy. A family history, especially involving BRCA1/BRCA2 mutations, significantly raises suspicion and may necessitate genetic counseling and earlier imaging (National Comprehensive Cancer Network (NCCN), 2023).
Two Risk Factors to Assess:
Family History of Breast or Ovarian Cancer:
A first-degree relative with breast cancer, particularly at a young age, increases the patient’s risk. Genetic predisposition, including BRCA mutations, is a major consideration in younger patients (Nelson, 2019).
Reproductive History (age at menarche, parity, age at first full-term pregnancy):
Early menarche, late menopause, nulliparity, and older age at first childbirth are all known risk factors due to prolonged estrogen exposure (Centers for Disease Control and Prevention (CDC, 2022).
Levels of Prevention for This Patient:
Primary Prevention:
Educating the patient on modifiable risk factors such as alcohol consumption, obesity, and physical inactivity. While not directly preventing the current lump, this helps reduce future cancer risk (CDC, 2022).
Secondary Prevention:
Timely clinical breast exam, imaging (such as ultrasound or mammography), and possible biopsy if indicated. This targets early detection and diagnosis, which is crucial for improving breast cancer outcomes (ACS, 2023).
Tertiary Prevention:
If diagnosed with a malignant lesion, this involves treatment to prevent complications and recurrence. Follow-up care, lifestyle modifications, and potential genetic counseling are part of this phase (NCCN, 2023).
Reference
American Cancer Society. (2023). Breast cancer early detection and diagnosis.
to an external site.
Centers for Disease Control and Prevention. (2022). What are the risk factors for breast cancer?
to an external site.
National Comprehensive Cancer Network. (2023). NCCN clinical practice guidelines in oncology: Breast cancer screening and diagnosis.
to an external site.
Nelson, H. D., Fu, R., Cantor, A., Pappas, M., Daeges, M., & Humphrey, L. (2019). Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer: A systematic review to update the U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine, 160(4), 255–266.
