Specific

Content
Objectives
After 15 20I. Parts and Functions of the Breast
minutes
of
A.
discussion the
participants will
be
able
to
understand the
anatomy
and
physiology
of
the breast.

Time Frame
15 20 minutes
External Parts
1. Nipp
le

raised conical or pointed projection visible on the breast

surface.
2. Areola is the dark circle that surrounds the nipple. It is
slightly raised above skin surface and contains many
sebaceous glands which secrete sebum which lubricates
the nipples.
B. Internal Parts
1. Fibrous Tissue
a. Coopers Ligaments these are bands of connective
tissue which give the breast support by connecting the
skin of the breast to the pectoralis muscles below
them.
2. Adipose Tissue contains collagen and elastin fibers
surrounding the mammary glands to provide strength and
protection to the delicate glands and to project the glands
outward from the chest.
3. Glandular Tissue
a. Lobes milk producing part of the breast.

Methodology
Discussion;
Powerpoint
presentation

Resources
Innerbody.com
Healthhype.com
(Dr. Chris)
John
Hopkins
Medicine
webmd.com
mayoclinic.com
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Evaluation
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b. Lobules smaller structures found within each lobe

where milk is produced.
c. Ducts network of tiny tubes where the milk travels.
The ducts connect and come together into larger ducts
which eventually exit the skin in the nipple.
C. General Function of the breast
The female breast is an organ whose structure reflects its
special function: the production of milk for lactation. It has
a role in both nourishing the baby as well as offering
imunological protection to the newborn baby. To some degree
the breast also has psychological function in that is associated
with sexuality.
D. Lymph Nodes found under the armpit, above the
collarbone, behind the breastbone and in other parts of the
body which trap harmful substances that maybe in the
lymphatic system and safely drain them from the body.
1. Axillary
a. Anterior (pectoral) lymph node found in the inferior
border of the pectoralis minor.
b. Posterior (subscapular) lymph node are located on
the lower part of the underarms posterior wall.
c. Central (midaxillary) found in the armpit
d. Lateral (brachial) - found behind the axillary vein.
2. Supraclavicular lymph node found above the collarbone
3. Infraclavicular lymph node found below the collarbone.
4. Internal mammary lymph node lymph nodes found within
the breast tissue.

E. Quadrants of the Breast and Tail of Spence

Tail of Spence is the extension of upper outer tissue of the

breast in the axillary direction.

After
10-15II. Breast Cancer
A. Definition- breast cancer is a common cancer among
minutes
of
women. It is a disorder characterized by a presence of mass
discussion the
in the breast which may spread to the adjacent and distant
participants will
body parts such as the liver, lungs and brain. Simply, breast
be
cancer is a cancer that forms in the tissues of the breast.
knowledgeable
about
the
B. Incidence. According to the World Health Organization
definition
and
(WHO), it is estimated that 508 000 women all over the world
incidence
of
died in 2011 due to breast cancer. In Eastern Africa
breast cancer.
incidence rate is 19.3 per 100 000 women and in Western
Europe the incidence rate is 89.7 per 100 000 women.
Generally, incidence rates are lower than in the Western

10 15 minutes

Discussion;
Powerpoint
presentation

Brunner and Suddarth's

Textbook of MedicalSurgical Nursing
www.who.org
www.breastcancer.org
Student nurses

Post-test

countries. In Eastern Asia there are 18 per 100 000 cases of

breast cancer and in South Central Asia there are 22 cases
per 100 000.

After
15-20
minutes
of
discussion, the
participants will
be
able
to
identify
the
different
risk
factors of breast
cancer.

In the Philippines, breast cancer is the most common cancer

comprising of 16% of the 80 000 cases of cancer. According
to the Philippine Society of Medical Oncology, the country
has the highest incidence of breast cancer in Asia. An
estimate made by the Society shows that 3 out of 100 will
contact the disease before the age of 75 and 1 out of 100
will die before the age of 75.
C. Risk Factors
1. Age
According to the American Cancer Society, about 1 out of 8
invasive breast cancers develop in women younger than 45.
About 2 out of 3 invasive breast cancers are found in women
55 or older.
In fact, the aging process is the biggest risk factor for breast
cancer. That's because the longer we live, there are more
opportunities for genetic damage (mutations) in the body. And
as we age, our bodies are less capable of repairing genetic
damage.
2. Gender
Simply being a woman is the main risk factor for developing
breast cancer. Men can develop breast cancer, but this
disease is about 100 times more common among women than
men. This is probably because men have less of the female
hormones estrogen and progesterone, which can promote
breast cancer cell growth.

15 20 minutes

Discussion;
Powerpoint
presentation

http://www.breastcancer
.org
http://www.nationalbrea
stcancer.org
http://www.cancer.org
http://www.cancer.ca
http://www.cancer.net
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Post test

3. Reproductive History
a. Early menarche
Women who started menstruating (having periods)
younger than age 12 have a higher risk of breast cancer
later in life. The increase in risk may be due to a longer
lifetime exposure to the hormones estrogen and
progesterone.
b. Late Menopause
Women who went through menopause later (after age 55)
have a higher risk of breast cancer. The longer a woman
menstruates, the higher her lifetime exposure to the
hormones estrogen and progesterone.
c. Nulliparity
Pregnancy interrupts the exposure of breast cells to
circulating estrogen. It also lowers the total number of
menstrual cycles a woman has in her lifetime.
Not becoming pregnant at all (called nulliparity) increases
the risk of breast cancer.
d. Age at first full term pregnancy
Women who have their first full-term pregnancy after the
age of 30 have a slightly higher risk of breast cancer than
women who have at least one full-term pregnancy at an
earlier age. Becoming pregnant at an early age (such as
before age 20) reduces breast cancer risk.
When breast cells are made in adolescence, they are
immature and very active until the first full-term pregnancy.

The immature breast cells respond to the hormone

estrogen as well as hormone-disrupting chemicals in
products. The first full-term pregnancy makes the breast
cells fully mature and grow in a more regular way. This is
the main reason why pregnancy helps protect against
breast cancer. Being pregnant also reduces the total
number of lifetime menstrual cycles which may be another
reason why earlier pregnancy seems to offer a protective
effect.
4. Hormonal Exposure
a. Hormonal Replacement Therapy
Research shows that taking hormone replacement therapy
(HRT) for a long time increases the risk of breast cancer.
This is especially true for HRT that uses estrogen plus
progestin (called combined HRT).
b. Oral Contraceptive Pills
Oral contraceptives that contain both estrogen and
progesterone can slightly increase the risk for breast
cancer, especially among women who have used oral
contraceptives for 10 or more years. The increased risk
disappears after the woman stops taking oral
contraceptives. However, current and recent (less than 10
years since last use) users have a slight increased risk
compared with women who have never used oral
contraceptives.

5. Family History

Women with close relatives who've been diagnosed with

breast cancer have a higher risk of developing the
disease. In some cases, a strong family history of breast
cancer is linked to having an abnormal gene associated
with a high risk of breast cancer.
6. Lifestyle
a. Drinking Alcohol
Drinking alcohol increases a womans risk for breast
cancer. Even low levels of alcohol consumption (just over
1 drink per day) can increase a womans risk. The risk
increases with the amount of alcohol consumed.

One possible reason for this is that alcohol is thought to

cause higher levels of estrogen. Alcohol may also lower
levels of some essential nutrients that protect against cell
damage, such as folate (a type of B vitamin), vitamin A
and vitamin C.

b. Being obese or overweight

Being overweight or obese can increase the risk for breast
cancer. The risk is increased if a woman has already gone

through menopause.

Ovarian hormones, estrogens in particular, play an

important role in breast cancer. Many of the risk factors for
breast cancer are believed to result from the overall dose
of estrogen the breast tissue receives over time. The
ovaries make most of the bodys estrogen, but after
menopause fat tissue produces a small amount of
estrogen. Having more fat tissue can increase estrogen
levels and so increase the chance that breast cancer will
develop.

c. Physical Activity

Increased physical activity is associated with a decreased

risk of developing breast cancer and a lower risk of having
the cancer come back after treatment. Regular physical
activity may protect against breast cancer by helping
women maintain a healthy body weight, lowering hormone
levels, or causing changes in a womens metabolism or
immune factors.

After
15-20
minutes
of
discussion, the

D. Manifestations
1. Bleeding discharge from the nipples
- a bloody discharge may be produced when pressure is
placed on one area at the edge of the areola. Bleeding

15 20 minutes

Discussion;
powerpoint
presentation

Brunner and Suddarth's

Textbook of MedicalSurgical Nursing

Post -test

participants will
be
able
to
identify
and
understand the
different
manifestations
of
breast
cancer.

occurs with any trauma, and the blood collects in the duct
until it is pressed out at the nipple.
2. Retraction of nipple
- Signs include skin dimpling, creasing, or changes in the
shape of the breast or nipple. Secondary to scar tissue
formation in the breast. Retraction signs may appear only
with position changes or with breast palpation.
3. Elevation
-the presence of lump or mass that is palpated in the breast.
4. Asymmetry
-Its widely accepted that few women on the planet can
boast a pair of identically sized breasts. In fact, slight
asymmetry is considered the norm. However, while this
anatomical nuance is of little concern to the majority of
women, there are some for whom the size difference is so
pronounced that it impacts heavily on their body image and
can seriously affect their self-esteem. The term
Asymmetric Breasts usually refers to breasts that differ in
size by at least one cup size, which may become
noticeable during puberty as the breast tissue starts to
develop. Subsequently, as the years progress, the
asymmetry may become more obvious to the point were it
is unflattering and even embarrassing for a woman.
5. Skin dimpling
-The breast starts to appear dimpled and uneven, rather like
cellulite and the skin pores might be enlarged. This could
be a sign of breast cancer, but other innocent causes can
produce the same effect. To check your breast for
dimpling, raise your arms as high as you can to stretch the
skin. Any dimpling will become more apparent. Dimpling
caused by cancer is usually a late sign, and suggests an
inflammation or malignant mass below the skin. A doctor

Mayoclinic.com
Merriam Websters
Dictionary
WebMD.com

Student nurses

will check for any other signs such as nipple discharge or

nipple retraction. Prominent visible veins on the surface of
the breast should also not be ignored. This is also a
common sign of breast cancer recurrence
6. Tenderness
-is pain or discomfort when the breast is touched. A new lump
or mass with the onset of the pain; lump does not go away
after menstrual period.
7. Peau d orange
- Breast skin has orange peel appearance. Skin pores
enlarge, May be noted on the areola, Skin becomes thick,
hard, immobile, Skin discoloration may occur.
8. Increased venous prominence
- Unilateral localized increase in venous pattern associated
with malignant tumors, Normal with breast enlargement
associated with pregnancy and lactation if
bilateral and bilateral symmetry.
9. Mass
-The most common physical sign of breast cancer is a lump
or mass. A breast lump which is rock-hard, painless and
has irregular sharp edges is likely to be cancerous.
However breast cancer lumps can also be soft and
rounded. For this reason it is important to have all lumps
checked out by a doctor as soon as possible. Fortunately 9
out of 10 turn out to be benign (non-cancerous) after a
biopsy.
10. Axillary lymphadenopathy
-Normally axillary lymph nodes are not felt. However,
sometimes in normal people, they are felt as small (less
than 1cm in diameter), soft, non-tender swellings. Large
tender but mobile lymph nodes usually indicate infections

After
30-45
minutes
of
discussion the
participants will
be
knowledgeable
on
the
preventive
measures
of
breast cancer.

or small wounds of the arm (as a skin infection or a cat

scratch). Harder, fixed or matted axillary nodes often
indicate malignancy usually from the lung or breast.
11. Lymphedema
- Occasionally breast cancer spreads to the underarm lymph
nodes causing a lump or swelling in the armpit, even
before the original tumor in the breast is large enough to
be felt. Swollen lymph nodes may be one of the first things
a doctor notices and this can lead to an early breast
cancer diagnosis. A breast biopsy, taking a sample of
axillary (underarm) lymph nodes, will be necessary.
E. Prevention
1. Primary Prevention
a. Exercise- an activity which makes use of the body to
perform steps of stretching or any movements by
means of exerting force or energy.
b. Diet- recommended quantity and quality of foods
which can prevent breast cancer.
c. Chemoprevention a modality which was proven to
reduce development of breast cancer by giving
medications such as raloxifene or tamoxifen for
postmenopausal women.
i.
Purpose: It is used to prevent occurrence of
breast cancer.
ii.
Schedule: As early as postmenopausal
period of a woman.
iii.
Procedure: Raloxifene or tamoxifen is given
to a woman as early as postmenopausal.
d. Prophylactic Mastectomy- the removal of breast
tissue only and usually followed with an immediate
breast reconstruction which is also called riskreducing mastectomy.
i.
Purpose: It reduces the risk of breast cancer

30-45 minutes

Discussion;
Powerpoint
presentation

Brunner and Suddarth's

Textbook of MedicalSurgical Nursing
www.nationalbreastcanc
er
org./clinical-bestcancer
www.webmd.com
Student nurses

Post-test

ii.
iii.

especially those women with strong family

history of breast cancer.
Schedule: Procedure: The breast tissue is removed
then followed by a flap of skin, fat and muscle
with its attached blood supply is rotated to the
part of the breast which is removed.

2. Secondary Prevention
a. Mammography a breast imaging technique. It
uses x-ray and the principal method of screening for
breast cancer.
i.
Purpose: It is use to detect non-palpable
lesions and assist in diagnosing palpable
masses.
ii.
Schedule: As early as 25 years old until 50
years old, then follow-up every two years
rather than annually.
iii.
Procedure: The procedure takes about 20
minutes. Two views are taken on each breast:
craniocaudal view and a mediolateral oblique
view. For these views, the breast is
mechanically compressed from top to bottom
and side to side. Women may experience
some fleeting discomfort because maximum
compression is necessary for proper
visualization.
b. Ultrasonography- imaging technique for diagnosing
breast disease such as cancer.
i.
Purpose: It is used in conjunction with
mammography to distinguish fluid filled cyst
from other lesions.

ii.
iii.

Schedule: As early as 25 years old then

annually.
Procedure: A transducer is used to transmit
high frequency sound waves through the skin
and into the breast, and an echo signal is
measured. The echo waves are interpreted
electronically and then displayed on a screen.

c. Breast-Self Exam (BSE) - a check-up a woman

done at home to look for changes or problems in the
breast tissue.
i.
Purpose: It is done to detect early breast
cancer.
ii.
Schedule: BSE is best performed after
menses (day 5-7 counting the 1st day menses
as day 1).
iii.
Procedure:
a. Inspection of the breast
1. Stand in front of the mirror with arms
relaxed at the sides or hands resting on
the hips, then turn to the left or right for a
side view.
2. Do several maneuver while standing in
front of the mirror.
a. Raise arms over the head and move
the arms slowly up and down at the
sides.
b. Press both hands together at chin
level while elbows are raised at
shoulder level.
c. Lower hands and press against the
hips while slightly leaning forward and
stretch the arms forward.

b. Palpation of the breast

1. Assume a comfortable or proper position.
a. Lying: place a pillow under the left or right
shoulder and place the right or left hand
behind the head.
b. Sitting/standing: while in an upright
position, raise the right or left arm and
place the right or left hand behind the
head. (BSE can also be done in the
shower, soapy hands glide more easily
over wet skin.)
2. Use of the finger pads of the 3 middle fingers
held together of one hand to feel for lumps.
Press the breast tissue against the chest wall
firmly enough to know how the breast feels. A
ridge of firm tissue in the lower curve of each
breast is normal.
3. Palpate the breast using one of the three
different patterns or techniques. Accepted
techniques:
a. Circular: palpate in clockwise direction,
following imaginary concentric circle from
other limits of the bones towards the
nipples.
b. Wedge: palpate from each number in the
face of the clock toward the nipple in a
clockwise fashion.
c. Vertical strip: Palpate following imaginary
vertical lines on the breast starting outer
upper quadrant or inner upper quadrant.
4. Be sure to palpate every square inch of the
breast. If circular technique is applied use
small circular motion systematically all the

way around the breast as many times as

necessary until the entire breast is covered.
Be sure to palpate the tail of Spence.
5. Squeeze the nipple gently with the thumb and
index finger. Note for any discharges.
6. Bring the arm down to the sides and feel
under the armpit where breast tissue is
located. Palpate firmly the axillary lymph
nodes.
7. Repeat the same procedure on the other
breast.
d. Clinical Breast Exam- performed by a health care
professional who is trained to recognized many
different types of abnormalities and warning signs.
i.
Purpose: it is done to check-up for lumps and
physical changes of the breast.
ii.
Schedule: At least every 3 years for women
ages 20-40, the n annually.
iii.
Procedure:
1. Health care professional looks at the
breast. This should be done with the
person sitting and then when the patient is
lying down, the health care professional
looks for:
changes or differences in the
shape of the breasts
areas or fullness/ thickness in only
one breast
differences
in
skin,
color,
temperature, and texture of the
breast
rashes
lumps/swelling

 discharges
nipple changes
2. Health care professional palpates the
breast and the nipple. The HCP feels for:
lumps, including size and shape
hardening or thickening of the
breast tissue
tenderness/pain
*lymph nodes are also examined
underarm area
area above and below the collarbone