Azadeh Stark, PhD, MEd

Nursing Professor
University of Texas at Dallas
Professiona &
Senior Scientist
ls Holds Dept. of Pathology
Henry Ford Health System
the Key in &

Reducing Visiting Professor

Faculty of Nursing
the Impact Chiangmai University
astark1@hfhs.org

of Cancer starkazadeh@gmail.com
248797-3048
Global Top Ten Cancers
New Cases of All
Cancers for Men
and Women in
Indonesia, 2018
 Indonesia
New Cases of Cancer: A Comparison
Between Indonesia and US

Indonesia:
New Cases of All Cancers (Both Sexes)= 136.2 per
100,000 persons

USA: USA
New Cases of All Cancers (Both Sexes)= 352.2 per
100,000 persons

Ratio: Indonesia/US= 136.2/352.2 = 0.39

Or US/ Indonesia = 2.56
What is a risk factor?
Risk factor: Any attribute, behavior,
characteristics or exposure to an
agent that can increase the likelihood
of a disease.
 1. Age: Risk of breast cancer increases with age.
- The majority of breast cancer are diagnosed among women age 50 and older.

2. Genetic Predisposition: Inherited mutation to certain genes such as BRCA1,

BRCA2, ATM, BARD1, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, RAD51D, STK11,
TP53, can increase the risk of breast cancer.
- Genes attribute to 5-10% of all breast cancer in women

Non-modifiable risk 3. Early menstruation (first period): Menarche before age 12 and menopause after
age 55 increases the risk of breast cancer
factors for breast
4. Having Dense Breast: Women whose breasts contain more connective tissue than
cancer fatty tissue are at increase risk of breast cancer. Women with level 4 breast density
have 4 times higher risk for breast cancer than women with level 1 breast density.

5. Medical treatment using radiation therapy; Women who were treated with
radiation therapy to their chests or breast for treatment of diseases, i.e. Hodgkin’s
lymphoma before age 30 are at increased risk for breast cancer.
Breast Density, is a Non-Modifiable Risk Factor for
Breast Cancer.
- Breast tissue composition become more fatty tissue with age
- Breast tissue composition is hereditary.
- Women with level 4 breast tissue density are at higher risk
(4X) relative to women with level 1 breast tissue density.
 1. Physical Activity: Women who are not physically active are at increased risk for
breast cancer.

2. Poor Dietary Habits: Women who do not consume 6-8 servings of fruits and
vegetables per day are at higher risk for breast cancer.

3. Body Weight: Women, especially post menopausal women, who are over weight
or obese are at increased risk for breast cancer.

Modifiable risk 4. Exogeneous Hormones: Women who abstain from oral contraceptives (birth
control pills) and post menopausal hormones are at higher risk of breast cancer.

factors for breast 5. Late First Pregnancy: Women who postpone their first pregnancy to after age

cancer 30, have higher risk for breast cancer.

6. Alcohol and Tobacco: Women who drink alcohol regularly and use tobacco
(cigarettes or other forms) have higher risk for breast cancer.

7. Environmental Contaminants: Chemicals such as DDT, PCB and plastics can

increase the risk of breast cancer.

8. Stress: Women who are under pernicious stress have higher risk for breast
cancer and many other chronic health conditions.
Curb the Impact of Cancer by
adopting healthy personal habits
Nurses are the
most trusted
professionals.
 With this trust,
comes grave
responsibilities.
  Profession of nursing is more than providing of
healthcare services. Nurses are the holders of a
Nurses can universal language that supersedes all borders and
political boundaries and translators of a language that
make a big expands beyond all cultures.

impact on Nurses can facilitate, guide and teach their patients,

the other healthcare professionals and community
breast cancer members to assume behaviors to reduce the impact
of breast and other cancers.
 1. Fruits, vegetables and legumes and low fatty food
It is recommended to increase daily intake of fruits and vegetables to 6-8
servings.

It is recommended to substitute legumes (bean, soybean), nuts for

red meat, pork and poultry.

It is recommended to decrease the quantity of cooking oil and fried

Physical Activity, food.

Poor Dietary Habits 2. Physical activity

It is recommended to exercise a minimum of 40 minutes each day.
and Body Weight
3. Body Weight
It is recommended to prevent gaining body weight, especially after
menopause.
Per 100 gm Passion Fruit French Fries
Calories 43 365
Total fat 0.26 g 17 g
Sugar 7.82 g 0.4 g
Protein 0.47 g 4 g
Vit. A47 µg
ß-Carotene 274 µg

Indonesian
Lutein 89 µg
Thiamine (B1)0.023 mg
Riboflavin (B2) 0.027mg
Fruits vs.
Niacin (B3) 0.36 mg
Pantothenic acid (B5) 0.191 mg

American
Folate (B9) 38 µg
Vit. C 62 mg 12 mg
Vit. E 0.3 mg

French Fries
Vit. K 2.6 µg
Calcium 20 mg 20 mg
Iron 0.25 mg 1 mg
Magnesium 0.04 mg
Phosphorus 10 mg
Potassium182 mg 677 mg
Sodium 8 mg 246 mg
Zinc 0.08 mg
Lycopene1,838 µg
 Real
Food

Junk
Food

To Prevent Breast Cancer And Other Cancers:

Eat Real Food not Junk Food!

Junk
 1. Exogeneous Hormones: For family planning purposes, it is best to use
mechanicall means to prevent pregnancy; Young women with family history of
breast cancer (mother, sister, first degree cousins) or family history of prostate or
colorectal cancers it is best to avoid oral contraceptives and adhere to mechanical
means to prevent pregnancy.

Post-menopausal women, it is best to avoid hormonal replacement therapy.

2. Environmental Contaminants: Governmental regulations to reduce chemicals

Modifiable risk and environmental contaminants are very important

factors for breast - Personal habits to reduce waste can lead to collective action.
- Recycling
cancer - Reducing plastic waste
- Avoid microwaving food in plastics

5. Stress: Meditation and praying have been shown to reduce the risk of breast and
other cancers and most likely many of chronic diseases.
Early Detection of
Can Reduce the
Long-Term Impact
of Breast Cancer
 Early Detection for Breast
Cancer: Mammogram,
Tomosynthesis, MRI
Clinical Breast Exam and
Self Breast Exam

• Radiographic screening for breast cancer

among asymptomatic women is the most
common method for early detection of breast
cancer.
- Minimization of medical interventions.
- Reduces the impact on women and their
families.
- Reduces the cost of healthcare
intervention
 Screening
Mammogram
: Digital Two-
Dimensional
Mammogram
 Tomosynthesis Or 3-Dimensional Imaging

 Tomosynthesis is a
better choice to
screening for breast
cancer for younger
women and women
with radiographic
dense breast .
  Imaging technology is not very effective for
younger women.
Health  Higher breast density tissue; therefore, lower likelihood
of detection of BC
Concerns  Harms of exposure to radiation (X-ray)
 Repeated screening mammogram can
About increase risk of BC in younger women,
Imaging especially if they have family history of
breast cancer.
Technology  Many women with benign breast conditions
undergo unnecessary breast biopsy which
increases the risk of future breast biopsies.
  MRI provides the option for non-ionizing radiation imaging
technology to detect breast cancer.
- Useful for younger women
Magnetic Resonance  Problems
- Very expensive
Imaging (MRI): An - Invasive; requires intravenous contrast administration
Alternative to - Many women are claustrophic and require to be medicated
Radiographic Imaging - High rate of false positive: Many women with no breast
cancer can be screened as
positive for breast cancer
 Clinical Breast
Examination
• Evaluation of breast and assessment for
changes by trained nursing professionals and
physicians

• An accurate method of screening for

breast cancer, if examination is done
correctly and carefully.

• No side effects or harms due to

exposure to harmful ionizing radiation,
i.e. X-ray

• Can be performed at any clinical setting

• CBE by a trained healthcare provider at

least every 3year starting at age 20
until age 40.

• CBE by a trained healthcare provider

every year after age 40.
Early Detection: Can Reduce the Impact of Breast Cancer
 Nurses are the most trusted
professionals.

Teach Your Patients to Perform Monthly

Breast Self Exam.
Breast Self Examination: Once per month in privacy of your
home
 Breast Self Exam:
What to Look for
• Non-painful lumps or masses
• Lumps or swelling under the arms
• Nipple skin changes or discharge
• Noticeable flattening or indentation of the
breast
• Change in the nipple
• Unusual discharge from the nipple
• Changes in the feel, size, or shape of the
breast tissue
• Thickening of skin
• Unusual lesion
• Inflammation and erythema
• Painful chronic pain
Peau d’Orange And Extreme Inflammation
Inflammatory
Breast Cancer
 A rare type of breast cancer that
develops rapidly
 The affected breast is tender, swollen
and red
 Cancer cells block the lymphatic
system of the skin
 Inflammatory breast cancer can be
mistaken for infection
  Rapid change in the appearance of one breast,
usually over a course of several weeks
Thickness, heaviness or visible enlargement one of
the breasts
Signs and Discoloration, giving the breast a red, purple or

Symptoms of bruised appearance

The affected breast feels unusually warm
Inflammatory  Change of skin texture: dimpling or ridges on the

Breast Cancer affected skin

Tenderness or pain in the affected breast
Enlarged lymph nodes under the arm, above or
below the collarbone
Flattening or turning inward of the nipple
Risk Factors for  African heritage
Inflammatory
Breast Cancer Obesity
 Evidence-Based Nursing Practice
Offers Exceptional Opportunities
for Innovation in Nursing Research
and Reducing Impact of Breast
Cancer and Other Cancers.
 Evidence-Based Nursing Practice:
The Optimal Decision: Interaction of the Three Domains

What does What does

your patient Patient values research tell
want? and cultural you?
Research
preferences
Optimal evidence
Decision

What does your

clinical experiences
Clinical tell you? Or what do
experience your colleagues
and expertise suggest based on
their clinical
experiences?
Florence Nightingale: The pioneer in
nursing profession; she had the passion
for reducing the impact of diseases
through education, research and
high-quality patient care.
 Nurses Because of the
Trust that Has Been
Bestowed on Them Can Trust is the foundation for success of an
Reduce the Impact of organization, relationship between two or among a
group of individuals and of course development of
Breast Cancer through successful and productive clinical-based and
Patient Education, community activities.
Prevention and Early
Detection
 Vision should be translated into behaviors
and
behaviors should yield productive and positive outcomes.
 धधध
धधधध

Thank-you

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