ctober is National BreastCancer Awareness Month,and it is appropriate to dedi-cate this column to womenwho currently have or previ-

ously have had this disease. Statisticsfrom 2005 show that the estimated num-ber of deaths related to breast cancer is15% of the total cancer population, andnewly diagnosed breast cancer cases areapproximately 32% of all diagnosed can-cers.1 Data also reflect that in the UnitedStates, one woman is diagnosed withbreast cancer every two minutes.2

Ethnic and racial differences existregarding the incidence of breast cancer.Black women are three times more like-ly to develop breast cancer than whitewomen; and after the disease has beencontracted the death rate among blackwomen also is higher.3

It seems to me that breast cancer isonly three degrees removed from anyof us. Of course, those women whohave breast cancer are at ground zero.First-degree separation would be thosewho have had a primary family mem-ber with breast cancer. Second-degreeseparation describes those who haveextended family members with breastcancer, and third-degree separationwould be those who know friends, col-leagues, or neighbors with this dreadeddisease. This seems to account foralmost everyone.

PERSONAL REFLECTIONI am one who, by fate or fortune, is

three degrees separated from breastcancer, and it had a devastating effecton me. A very dear friend, who wasalso a faculty colleague, decided that itwas time to retire to the “good life,”and so she made plans to do so. Aftershe retired, she and her family intendedto travel and see the world. Fate movedin before her retirement, however, when

she discovered a breast lump. A lump-ectomy was performed, and duringsurgery, a second lump was found inher other breast. She subsequentlyunderwent many types of treatment,including chemotherapy and radia-tion. After completing these treat-ments, she appeared to be cured.

Months later, however, her blood can-cer markers skyrocketed, and new mass-es were identified in her lungs, pancreas,and liver. These were thought to havedeveloped through blood-stream metastasis. No-body was prepared forhow quickly her healthdeteriorated after this.

By the time her formalretirement drew close, shehad developed neurologi-cal and sensory impair-ments, but she insisted onattending a retirementluncheon given in herhonor. She also insisted onattending graduation, butthis was the last time shewas able to leave her bed.My cherished friend dieda few weeks after sheretired. All who knew andloved her were devastatedby her death and by theswift progression of herdisease. This incident reaf-firmed the seriousness ofbreast cancer to all of us. This incidentalso emphasized to me that we must notignore our own health and that we mustbe vigilant about self-examinations.

TREATMENTSToday, patients with breast cancer

have more effective treatment optionsbecause of the diligent efforts of manyresearchers. There are many new, non-surgical forms of treatment available for

OCTOBER 2006, VOL 84, NO 4 • AORN JOURNAL • 565© AORN, Inc, 2006

National BreastCancer Awareness Month

E D I T O R I A L

Nancy J. Girard,RN

Whether we haveexperienced itpersonally or

through a familymember or

friend, breastcancer is onlythree degreesremoved from

any of us.

O

566 • AORN JOURNAL

OCTOBER 2006, VOL 84, NO 4 Editorial

lations, it is believed that apatient’s family members or adesignated family spokes-person should be intimatelyinvolved in treatment or non-treatment decisions. As nurses,we can provide recommenda-tions, but it is ultimately thepatient who must make thetreatment decision.

IMPLICATIONS FORPERIOPERATIVE NURSES

Each day, perioperativenurses are involved in surgi-cal procedures performed totreat patients with breast can-cer. This type of surgery isquite common, especially inambulatory surgery settings,and nurses have the potentialto become rather blasé aboutbreast cancer. We must neverforget the bigger picture ofpatient support and caring forour patient’s emotional needs.A nurse may have little freetime during the short preop-erative period, but a patient’sfear should not be ignored.This is true whether the surgi-cal intervention is quick and

simple or a full day’s work. As nurses, it is vital that we

provide the highest quality ofcare to all patients. We alsomust maintain an ongoingawareness of the special needsof surgical patients with breastcancer. These patients are fac-ing not only the fear of sur-gery but also the fear of death.My friend told me after herfirst surgery that the presenceof caring and empathetic peri-operative nurses made all thedifference in the world, andshe was so glad to have themby her side as her advocates. Iimplore all of you to take thetime to • talk with these patients

and their family members, • consider ethnic diversity

and provide culturally rele-vant care, and

• provide the highest level ofnursing care that you wereeducated to give. During National Breast

Cancer Awareness Month, Iencourage you to refocus onthe needs of your patientswith breast cancer. I also hopethat all of you, whether youare at ground zero or threedegrees removed from thisdisease, will continue to per-form monthly breast self-examinations, contact a bud-dy to remind her to performbreast self-examinations, andsupport continuing efforts tocombat breast cancer. ❖

NANCY J. GIRARDRN, PHD, FAAN EDITOR-IN-CHIEF

In memory of Anne Garner, RN,PhD.

A nurse may havelittle free time

during the short preoperative period,but a patient’s fear

should never beignored.

breast cancer. Researcherscontinually are identifyingnew medications and nonin-vasive treatments that areeffective against this disease.Surgical procedures rangefrom minimally invasive tothe most radical surgery.These procedures includeneedle-localization biopsies;sentinel lymph node dissec-tions; lumpectomies; quad-rantectomies; and mastec-tomies, ranging from simpleto radical dissections.4 Thesurvival rate for women withbreast cancer in 1974 wasonly 75%. By 2000, however,the survival rate had risen to88%, and this statistic still isimproving today.1

Choosing the best treatmentoption sometimes is extremelydifficult for a patient withbreast cancer. The informationthat a physician gives to apatient should be as completeas possible, including all thepotential benefits and sideeffects that a patient mightexperience. Today, a patientwith breast cancer, like anyother person seeking medicalinformation, often turns to theInternet. Formal medical websites along with blogs and per-sonal web sites provide healthcare information and resourcesfor emotional and social sup-port. It is the responsibility ofhealth care providers to helptheir patients sort out the validfrom the erroneous informa-tion that is available.

We, as health care provi-ders, also need to provide cul-turally relevant care. Thisshould always be consideredbecause in some ethnic popu-

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Editorial OCTOBER 2006, VOL 84, NO 4

tics, causes, symptoms, surgeryoptions,” breastcancer.org, http://www.breastcancer.org/press_cancer_facts.html#statistics (accessed 14Aug 2006).3. “Statistics for 2006,” AmericanCancer Society, Inc, http://www.cancer.org/docroot/STT/stt_0.asp?gclid=CKSXy-CyoIYCFShFSgod8BFOtw (accessed 14 Aug 2006).

4. P K Bradley, “Racial and eth-nic disparities in cancer careand survivorship,” AmericanJournal of Nursing 106, supplAJN State of the Science on CancerSurvivorship (March 2006) 22-23.Also available at http://www.nursingcenter.com/library/static.asp?pageid=623591 (accessed 14 Aug2006).

NOTES1. American Cancer Society,“Cancer statistics 2005: A presen-tation from the American CancerSociety,” American Cancer Soci-ety, Inc, http://www.cancer.org/downloads/STT/Cancer_Statistics_2005_Presentation.ppt# (accessed14 Aug 2006). 2. “About breast cancer: Statis-

Results from a survey of patients with type 2 dia-betes and physicians who treat the disease indi-

cate that understanding of disease progression islimited and there is a disconnect between whatpatients and physicians believe is the state of dia-betes management, according to a May 31, 2006,news release from the American Association ofDiabetes Educators and the American Association ofClinical Endocrinologists. Patients with diabetes canhave an increased risk for mortality and can devel-op heart disease, kidney disease, blindness, andvascular or neurological problems that can lead toamputation. Diabetes affects 19.3 million people inthe United States, with type 2 diabetes accountingfor 90% to 95% of the cases.

The survey showed that physician understand-ing of the pathophysiology of type 2 diabetes maybe inconsistent. For example, although the incretinsystem plays an important part in regulating bloodsugar levels, 51% of physicians said that theincretin system is only somewhat important or isnot at all important in regulating blood sugar lev-els. In addition, although beta cell dysfunction is alarge contributor to progression of type 2 diabetes,only 20% of physicians believed it was the mostimportant contributor to type 2 diabetes progres-sion in their patient population, compared to 78%of physicians who named insulin resistance as themost important contributor to disease progression.

Of additional concern is an apparent discon-nect between how well patients think they areself-managing their diabetes and how well physi-cians think their patients are self-managing thedisease. For example, 83% of patients who saidthey eat a healthy, balanced diet thought they fol-lowed their health care providers’ instructions well

or very well, but only 29% of physicians believedthis to be the case. Of patients who engaged inregular physical activity, 77% said they complywell or very well with their health care providers’instructions for getting regular physical activity,but only 18% of physicians said this is the casewith their patients.

Although 69% of patients with diabetes saidthey felt knowledgeable or very knowledgeableabout managing their condition, 59% believed thattheir diabetes was only somewhat or not at all wellcontrolled. Glucose control is an important aspectof diabetes management, and A1C is a basic labora-tory test for evaluating glucose control. More thanhalf of the patients surveyed, however, had little orno understanding of their A1C level or had not hadit checked or were unsure if they had had itchecked in the past six months.

The survey also showed that 59% of patients sur-veyed had worked with a diabetes educator and thatdiabetes educators had a positive impact on howknowledgeable patients felt about managing their dia-betes. Of those patients who had not worked with adiabetes educator, 78% said they would like to learnsomething from one, including • how to reduce the risk of diabetes complications

(ie, 39%); • strategies for healthy eating (ie, 38%); and • information on new type 2 diabetes medications

(ie, 33%).

Growing Diabetes Epidemic: Patient/Physician Disconnecton Disease Management (news release, Chicago and Jack-sonville, Fla: American Association of Diabetes Educatorsand American Association of Clinical Endocrinologists, May31, 2006).

Management of Diabetes May Be Inconsistent