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CLINICAL: WOMEN’S HEALTH


BENIGN BREAST DISEASE Nine out of 10 lumps are benign10


with benign referrals making up


the biggest percentage to a breast unit. Just as breast cancer is common, so are benign conditions (see Box 1). Diagnosis of a benign lump will require the same assessment as for a suspected cancer. This will include a clinical examination, mammography if a woman is over 35 years old, an ultrasound scan and a biopsy for a discrete lesion.


THE ROLE OF THE PRIMARY CARE NURSE The primary care nurse, once empowered with knowledge and skills, can educate and support women in being breast aware by encouraging and teaching health promotion. Evidence exists that education in breast awareness has profound effects on compli- ance11


and the practice nurse is ideally placed as the first point of


contact and can influence the prompt and appropriate referral to a dedicated breast unit. With the support of teaching aids, time and the abundance of written literature available for women, nurses can easily facilitate breast awareness as it is such an important health promoting behaviour. Breast pain in the young woman for example in the absence of a lump could be managed by the primary care nurse. Caffeine, an ill fitting bra, costo-chondritis and hormonal changes are all causes of breast pain.


BREAST AWARENESS Since 1991, ‘breast awareness’ has been the current advocated policy. This involves knowing your breasts and how they look and feel. Breast self-examination is incorporated into breast aware- ness, but breast awareness is not merely the monthly repetitive palpation of the breasts to a rigorous set method. There is also a belief that women and nurses should be properly trained in order to perform BSE.12


This is further supported by the RCN who


recommend specialist training for nurses involved in diagnostic examinations and who issued an educative document for nurses in 2002 entitled Breast palpation and breast awareness.2 Education for breast awareness follows a five-point plan (see


Box 2). The RCN emphasises the role of the nurse in educating and encouraging women to be familiar with their breasts. It advocates written information as well as verbal and stresses the importance of nurses being aware of the management of breast problems.2


Therefore, if a woman notices any of these changes,


she should see the GP or practice nurse and be referred on to a specialised breast unit. This also applies to pregnant women.


BOX 3. CHANGES TO LOOK FOR


Size: if one breast becomes larger or lower. Nipples: if a nipple becomes inverted or changes shape or position. Rashes: on or around the nipple. Discharge: from one or both nipples, especially blood. Skin changes: any puckering or dimpling; appearance similar to the skin of an orange. Swelling: either under the armpit or around the collarbone where lymph glands are. Pain which is continuous in one part of the breast or armpit. A lump or thickening which is different to the rest of the breast. A red swollen painful breast.10


There are referral guidelines available for GPs and nurses in every practice. Leaflets and information on breast awareness, from charities like Breast Cancer Care and Breakthrough Breast Cancer, are also available for women and healthcare profession- als.


EFFECTIVE BREAST SELF-EXAMINATION When examining the breast, women should be advised to perform the examination at the same time each month. If pre-menopausal this should be after menstruation when the breasts are soft. If post-menopausal this should be the same time each examination. It can be performed lying down, standing up or in the shower. The flat parts of the fingers are used using the opposite hand to examine each breast. It is important not to pinch the breast tissue between the fingers as this could feel like a lump.


CONCLUSION This article has discussed the importance of breast awareness for cancer and benign conditions of the breast, how to be breast aware and the role of the primary care nurse in promoting this behaviour. Breast awareness should be incorporated into the activities of


normal everyday living and not be seen as a threatening chore. Empowering the patient to take control over their health and wellbeing is every nurses business and the primary care nurse is vital in this process.


REFERENCES 1. Department of Health. The NHS Cancer Plan: A plan for investment, a plan for reform. London: HMSO; 2000.


2. Royal College of Nursing. Breast Palpation and Breast Awareness; The Role of the Nurse. London: RCN; 2002.


3. Cancer Research UK. Breast Cancer - UK Incidence Statistics. London: CRUK; 2009. Available at: http://info.cancerresearchuk.org/ cancerstats/types/breast/incidence


4. Cancer Research UK. Breast Cancer – UK Mortality Statistics. Available at: http://info.cancerresearchuk.org/cancerstats/types/ breast/mortality


5. Mayor S. UK Improves Cancer Control. BMJ. 2003;326:72. 6. Bailey K. The nurses role in promoting breast awareness. Nursing Standard. 2000;14(30):34-6.


7. Banning M. Perceptions of Breast Awareness in Black British Women. Eur J Onc Nursing 2011:15;173-77.


8. NHS breast screening programme. Screening for Breast Cancer in England: Past and Future. London: NHSBSP; 2006. Available at: tinyurl.com/NHSBSP-screening


9. Kosters JP, Gotzsche PC. Regular Self-examination or Clinical Examination for Early Detection of Breast Cancer. Cochrane Database Syst Rev. 2003;(2):CD003373.


10. Breast Cancer Care. Your Breasts, Your Health Throughout Life. London: Breast Cancer Care; 2009. Available at: tinyurl.com/ breast-care


11. Funke L, Krause-Bergman B, Pabst R, Nave H. Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness. Eur J Cancer Care 2008;17:371-76.


12. Thornton H, Pillarisetti RR. Breast awareness and breast self-exami- nation are not the same. What do these terms mean? Why are they confused? What can we do? Eur J Cancer 2008;2118-21.


13. Department of Health. Be Breast Aware. London: DH; 2006. Available at: http://tinyurl.com/breast-aware


62 Nursing in Practice March/April 2012


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