Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). INSTRUCTIONS: Based on their replies, discuss how health disparities in women could affect their ca

POST # 2 LEANNE

A 39-year-old female patient presents for her annual wellness exam. She reports she does monthly self-breast exams since a maternal aunt and cousin both have breast cancer. The patient asked about getting mammograms. The purpose of this discussion is to review the mammogram recommendations from the American College of Obstetrics and Gynecology (ACOG), American Cancer Society (ACS), and the United States Preventive Services Task Force (USPSTF) and explain how, as an advance practice registered nurse (APRN), I would counsel this patient. Recommendations for self and clinical breast exams and shared decision-making will be discussed. 

     The USPSTF (2016) recommends that the decision to screen women age 40-49 years using mammography should be individualized given that the number of averted deaths in this age group is smaller than with older women and the number of false positives is greater. Similarly, the ACS (2020) states that women age 40-44 should have the option to start mammogram screening, age 45-54 should have one yearly, and age 55 and older should either continue with yearly screenings or switch to every other year as long as they are expected to live at least 10 more years. Recently, ACOG (2017) updated their recommendations to reflect that screening be offered for average risk women beginning at age 40 and to utilize shared decision-making. Shared decision making indicated that the patient and their provider should engage in discussion regarding the woman’s health history, benefits, and harms of screening, and what the patient’s thoughts and values are on the benefits and harms (ACOG, 2017). This process is important to empower the patient in making an informed, educated decision based on their preferences and the appropriateness of the situation. 

     Recommendations for self-breast exams have changed regarding a woman at average risk. Ritual self-breast exams are no longer recommended due to the risk of harm from false positives and lack of evidence for benefit (Pearlman et al., 2017). Instead, Pearlman et al. (2017) explain the recommendation is for women to have self-breast awareness regarding the normal appearance and feel of their breasts and to report any changes to their provider. Clinical breast exams may be conducted for the asymptomatic, average risk woman as part of the shared decision-making process (Pearlman et al., 2017). Women should be in tune with their bodies and be able to recognize any changes, but do not necessarily have to conduct monthly self-exams. 

     APRNs need to consider their patient’s situation carefully. This patient is at a slight increased risk for developing breast cancer given that her maternal aunt and cousin have both been diagnosed. According to the ACS (2019), approximately 15% of women with breast cancer have a relative who also have the disease. Based on the recommendations from the ACOG, ACS, and USPSTF, I would not recommend mammogram screening at this time as the patient is only 39. I would provide her information on the benefits and risks of beginning screening at age 40 for her to consider. The patient should be advised that if she does recognize any changes in her breasts to call immediately, 
References
American Cancer Society. (2020, March 5). American Cancer Society recommendations for the early detection of breast cancer. Retrieved July 20, 2020 from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
American Cancer Society. (2019, September 10). Breast cancer risk factors you cannot change. Retrieved July 20, 2020 from https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/breast-cancer-risk-factors-you-cannot-change.html
American College of Obstetricians and Gynecologists. (2017, June 22). ACOG revises breast cancer screening guidance: Ob-gyns promote shared decision-making. ACOG website: https://www.acog.org/news/news-releases/2017/06/acog-revises-breast-cancer-screening-guidance-ob-gyns-promote-shared-decision-making
Pearlman, M., Jeudy, M., & Chelmow, D. (2017). Breast cancer risk assessment and screening in average-risk women. ACOG website: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women
United States Preventive Services Task Force. (2016, January 11). Breast cancer: Screening. Retrieved July 20, 2020 from https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening