Question

When teaching about cancer detection, which factors should the nurse identify as predisposing a woman to breast cancer? (Select all that apply.) a. Family history of breast cancer, particularly in first-degree maternal relatives (mother, sister, and/ or maternal aunt) b. Positive tests for genetic mutations (BRCA 1 and BRCA 2) c. Long menstrual cycles d. Early menarche, late menopause e. Dysmenorrheas f. Nulliparous or first pregnancy after the age of 30 years g. Multiple sexual partners h. Extended breast-feeding

Short answer

The predisposing factors are (a), (b), (d), and (f).

Step-by-step solution

- Identify family history as a factor

A family history of breast cancer, especially in first-degree maternal relatives such as the mother, sister, and/or maternal aunt, is a significant predisposing factor. This means choice (a) is correct.

- Consider genetic mutations

Positive tests for genetic mutations, particularly BRCA 1 and BRCA 2, significantly increase the risk of breast cancer. This makes option (b) correct.

- Analyze the menstrual cycle factors

Long menstrual cycles are not specifically associated with an increased risk of breast cancer, so choice (c) is incorrect. However, early menarche and late menopause result in a longer lifetime exposure to estrogen, a risk factor for breast cancer. Thus, option (d) is correct.

- Examine reproductive factors

Being nulliparous (never having given birth) or having the first pregnancy after the age of 30 increases breast cancer risk. Therefore, option (f) is correct.

- Evaluate other factors

Dysmenorrhea (painful menstruation) and having multiple sexual partners are not identified as predisposing factors for breast cancer, so options (e) and (g) are incorrect. Extended breast-feeding is actually considered to reduce breast cancer risk, making choice (h) incorrect.

Key concepts

Family History of Breast Cancer

A family history of breast cancer significantly increases the risk of developing breast cancer. If you have first-degree relatives, such as a mother, sister, or maternal aunt, who have been diagnosed with breast cancer, your risk is higher. This is because you might share genetic factors that predispose you to the disease. Furthermore, the risk is even higher if the relative was diagnosed at a young age.
Knowing your family history and discussing it with your healthcare provider can help you take necessary preventive measures or consider early screening options.
Monitoring any changes in breast tissue and regular mammograms can also be particularly beneficial for individuals with a strong family history of breast cancer.

Genetic Mutations (BRCA 1 and BRCA 2)

Genetic mutations, especially in the BRCA1 and BRCA2 genes, play a significant role in increasing breast cancer risk. These genes typically help repair DNA and ensure the stable growth of cells, but mutations can hinder these processes and lead to cancer.
Women with BRCA1 or BRCA2 mutations can have up to a 70% risk of developing breast cancer in their lifetime.
If you have a family history suggestive of these mutations, genetic testing can provide valuable information.
There are various preventive options available, including enhanced screening, prophylactic surgeries, and medications to mitigate the risk.
Consulting with a genetic counselor is a good step if you think you might carry these mutations.

Early Menarche and Late Menopause

Early menarche (first menstrual period before age 12) and late menopause (after age 55) can increase the risk of breast cancer. This is because they prolong the body's exposure to estrogen, a hormone known to play a role in the development of breast cancer.
The longer duration of menstrual cycles translates to more estrogen being present, creating conditions favorable for cancer cell growth.
Though these factors are beyond your control, staying informed about them can lead to more vigilant health monitoring and timely interventions.
Incorporating a healthy lifestyle, such as maintaining a balanced diet and regular exercise, can also help reduce overall cancer risk.

Nulliparity or Late First Pregnancy

Nulliparity (not having given birth) and having a first pregnancy after the age of 30 are associated with an increased risk of breast cancer. During pregnancy, women experience hormonal changes that may provide some protection against breast cancer.
Conversely, never giving birth or delaying the first pregnancy means missing this protective effect. It is believed that full-term pregnancy has a lasting impact on breast cells, making them less susceptible to cancerous changes.
Nonetheless, being aware of this risk factor encourages mindful decision-making and promotes proactive use of breast cancer screening tools.
Adopting lifestyle changes such as limiting alcohol intake and managing weight can also greatly contribute to breast cancer risk reduction.