Assessment Tools and Diagnostic Tests

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Assessment Tools and Diagnostic Tests

Mammogram

A mammogram can refer as an X-ray picture of the heart that is helpful in the detection of breast cancer early on, even before some symptoms present themselves. Screening mammography is essentially a mammogram that checks or observes individuals with no signs (Henderson, 2015). A mammogram refers to a breast image in the form of an X-ray used in breast cancer screening (Shih, Huang, & Chan, 2016). It is through the mammogram that breast cancer is detected and deaths related to the disease decreased significantly. The process involves compression of the breasts between two surfaces that are firm in a bid to ensure the breast tissues are spread. 

Validity and reliability

The black and white images captured by the X-ray are later displayed on the computer screen after which the doctor assessing the patient will look for cancer signs. The test mainly used in the detection of abnormalities in the breast and any tumours that could be present. The mammogram X-ray is either for diagnostic and screening purposes. Screening is done for patients that do not have any noticeable signs for breast cancer while diagnostic mammography is used in the investigation of changes noted in the breast including pain, nipple discharge or thickening and unusual breast skin (Shih, Huang, & Chan, 2016). The use of mammograms can help lower the number of women aged between 40 and 70 who die from breast cancer. According to Glover (2015), women, especially those 40 years old and above, should participate in annual screening mammography. It is, therefore, essential to observe the validity and reliability of mammograms.

Validity and Reliability

Women, 40 years and older for five years to study and record the validity and reliability of mammography. 87 % accuracy and sensitivity are revealed in mammography. This sensitivity testing is higher in women over 50 years of age and more senior in women with fatty breasts, then dense breasts (Breast Cancer Foundation, 2019). A susceptible test will pick up even the slightest abnormal finding. These means it will miss a few cases of the disease, but it will also mistake some people as having the disease when they don’t. It was found that the percentage is 7 to 12 per cent of having a false positive after one mammography.

However, younger women are more likely to have false positives. After ten years of mammograms, a false positive is about fifty per cent. Many women use menopausal hormonal therapy, and this can increase the risk of breast cancer; thus, a low dose is recommended (Breast Cancer Foundation, 2019).  Mammography misses thirteen per cent of breast cancers, and some are much harder to detect. Mammography finds cancers that begin in the milk ducts very accurately, than the ones that start in the lobules (Breast Cancer Foundation, 2019). The reason is lobules do not always appear as a distinct mass on a mammogram and are harder to find.

Health assessments

Mammography can be used as a diagnostic tool when a patient presents with a lump in their breast that is a palpable mass and has nipple discharge.  To identify that this lump is indeed abnormal or to rule out a benign fibrous growth, a diagnostic mammogram will provide different views to assess the features of the mass and to pinpoint its exact location in breast tissue. This could include a spot compression, magnification, exaggerated craniocaudal to the medial or lateral side, tangential, and a ninety-degree lateral view (Dains, Baumann & Scheibel, 2016). Because the density of the breast tissue matters for identification, mammography is of less value in women younger than age thirty years of age. 

When women who have breast complaints and women who do not have complaints an x-ray is done. It is highly efficient because the procedure allows for the detection of cancers before palpation becomes a possibility. After mammography shows a mass on the x-ray, a tissue sample can be removed for testing of cancer by a procedure called biopsy (Qin, White, Sabatino & Febo-Vazquez, 2018). Mammography usage began thirty years ago, and in the past decade, the technique has improved drastically (Qin et al., 2018). Today, high-quality results can be obtained with a low radiation dose.  

Concepts

Mammography is of crucial importance in the detection and diagnosis of breast cancer and other breast diseases (Sardanelliet al., 2016). It usually follows a manual breast examination. A mammogram provides several different views of breast tissue which can give the doctor a better look of breast tissue enabling them to pinpoint a  specific area of muscle and possibly discover tumours that are too small to feel as well as identify cancer cells of the lining of the ducts of the breast tissue (National Breast Cancer Foundation, 2016). While screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms, diagnostic mammograms are used after suspicious results on a screening mammogram or after some signs of breast cancer alert the physician to check the tissue (National Breast Cancer Foundation, 2016).

The primary focus of performing a mammogram is early detection of breast cancer before symptoms (screening mammography) and secondly to make a diagnosis for patients with symptoms such as a palpable lump (diagnostic mammography) (Sardanelli et al., 2016). It is recommended that annual mammograms be performed for women after age 40 for routine screening or earlier if clinically indicated. One indication for earlier detection are women with a high frequency of breast cancer in their family should start even earlier with periodic imaging (Sardanelli et al., 2016). I have seen women in their twenties getting mammograms. But they don’t always go annually; some are examined every three years.

References

Shih, J., Huang, I., & Chan, S. (2016). Annotation System to Conducting a Mammography. 2016 International Conference on Educational Innovation through Technology (EITT). doi:10.1109/eitt.2016.50

Henderson, L. M., O’Meara, E. S., Braithwaite, D., & Onega, T. (2015). Performance of Digital Screening Mammography among Older Women in the United States. Cancer, 121(9), 1379-1386. Doi:10.1002/cncr.29214.

Glover, L. (2015). Access Denied. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2015/06/18/how-often-do-you-really-need-a-mammogram

National Breast Cancer Foundation. (2016). Mammogram. Retrieved from 

https://www.nationalbreastcancer.org/diagnostic-mammogram

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis. Advanced health assessment and clinical diagnosis in primary care (5th Ed.). St. Louis, MO: Elsevier Mosby.

Qin, J., White, M. C., Sabatino, S. A., & Febo-Vázquez, I. (2018). Mammography use among women aged 18-39 years in the United States. Breast Cancer Research and Treatment, 168(3), 687–693. https://doi-org.ezp.waldenulibrary.org/10.1007/s10549-017-4625-6

Sardanelli, F., Fallenberg, E. M., Clauser, P., Trimboli, R. M., Camps-Herrero, J., Helbich, T. H., 

Forrai, G. (2016). Mammography: an update of the EUSOBI recommendations on 

Information for women. Insights into Imaging, 8(1), 11-18. Doi: 10.1007/s13244-0160531

Respond to your colleagues  by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

At least 2 references in each peer responses!

  

   For a policy to be developed in nursing, both the competing needs and the agenda must align. For example, during the beginning stages of the COVID-19 outbreak, many students and trainees were going to be potentially involved in the care of infectious patients. Due to the virus, there was a huge probability that the students and trainees would be exposed, and the need to conserve the personal protective equipment (PPE) outweighed the need to provide an education to these students and trainees during this time (Gallagher & Schleyer, 2020). So, policies were made to stop and remove students and trainees from the hospitals. When the hospitals made this new policy, they inadvertently also created a shortage in workers, requiring many of them to work overtime, as well as created and increasing the risk for burnout on the existing staff. The new policy created will affect patients, because many of the hospital workers are overstressed and perhaps, less trained or qualified to care for the patient.

Sometimes a policy may seem to present a positive benefit, but have a negative impact on patients or even sometimes the workforce. According to Nancarrow (2015), what would work best is a flexible workforce, which has the potential to optimize our healthcare accessibility. A flexible workforce is one that can promptly respond to labor shortages and distribution of resources in an efficient way so that the needs of the staff and patients are met (Nancarrow, 2015). Resuming the training of new hires and students and starting up a residency program would help out the workforce shortage and ease some of the healthcare burnout (Wildermuth, Weltin, & Simmons, 2020). The COVID-19 pandemic is a chaotic time, but also a great time for educators. Educators can take this time to impart “strategies for improving end of life care, allocating scarce resources, and caring for patients who chose to be non-compliant during the self-quarantine recommendations (Gallagher & Schleyer, 2020).”