Bakgrund Bröstcancer är den vanligaste cancerformen som förekommer bland kvinnor. Kvinnor i den fertila åldern som drabbas av bröstcancer upplever oftast en mer omfattande stress med både psykisk och fysisk påverkan inför hur livet kommer bli nu. Många kvinnor drömmer om ett liv med barn och familj. För dessa kvinnor kan bröstcancer samt behandlingen försvåra chanserna till en eventuell graviditet samt utveckla en påverkan på sexuallivet med minskad sexlust. Det resulterar i en mängd känslor och ett lidande hos kvinnorna. Sjuksköterskor har en viktig del i vården för dessa kvinnor. Omvårdnad omfattar främjande av hälsa, lindra lidande, förebygga ohälsa samt återställa hälsa. Syfte Syftet var att beskriva kvinnor i den fertila ålderns upplevelser av omvårdnaden vid bröstcancer. Metod Denna studie genomfördes som en litteraturöversikt innefattande 15 vetenskapliga artiklar av kvalitativ och kvantitativ design. Databassökningar utfördes i både PubMed och CINAHL samt genom manuell sökning. Materialet har genomgått en kvalitetsgranskning enligt Sophiahemmet Högskolas bedömningsunderlag. Resultat Huvudteman som identifierades var; omvårdnad som inte möter kvinnans behov samtomvårdnad som möter kvinnans behov. Subteman som växte fram var; avsaknad av information gällande fertilitet och sexualitet, brist på information och kommunikation,otillräckligt stöd, positiva upplevelser av omvårdnad samt upplevelser av god omvårdnad gällande fertilitet. Slutsats Fynden visade att kvinnor med bröstcancer saknar information angående fertilitet och sexualitet, önskar mer stöd från sjuksköterskan och hälsorelaterad information samt kommunikation och även brister i omvårdnad som skapat lidande och vårdlidande hos kvinnor. Det har även visat att en del kvinnor har upplevt en god omvårdnad av sjuksköterskan med bra bemötande och varit tillfredsställda med informationen som givits. / Background Breast cancer is the most common form of cancer found among women. Women in childbearing age who suffer from breast cancer can experience extensive stress with both psychological and physical impact on their present and future lives. Many women dream of a life with children and family life. Breast cancer, as well as treatment, can hamper the chances of a possible pregnancy. Breast cancer can also impact the woman’s sexual life with reduced sexual desire. This can result in emotional reactions and suffering for the women concerned. Nurses have an important part in the care provided for these women. Nursing care incorporates promoting health, relieving suffering, preventing ill health and restoring health. Aim The aim was to describe women in childbearing age experiences of nursing care in breast cancer. Method This study was conducted as a literature review comprising of 15 scientific articles of qualitative and quantitative design. Database searches were performed in both PubMed and CINAHL as well as by manual search. The material has undergone a quality review according to Sophiahemmet University's assessment documentation. Results Main themes identified were; nursing that does not meet women's needs and nursing that meets women's needs. Sub-themes that emerged were; lack of information regarding fertility and sexuality, lack of information and communication, insufficient support,positive experiences of nursing and experiences of good care regarding fertility. Conclusions The findings showed that women with breast cancer lack information about fertility and sexuality. Furthermore desires for more support from the nurse, health-related information and communication. The lack of care creates suffering and health distress in women with breast cancer. It has also been shown that some women have experienced good nursing care meeting their needs and satisfied with the information provided.

Objective: Background: Rare disease An epithelial inclusion cyst within a lymph node denotes a heterotopic phenomenon. Nodal epithelial inclusion cysts have been reported in a variety of anatomical locations including pelvic, abdominal, mediastinal, and axillary regions. While nodal melanocytic nevus (also known as nevus cell aggregates) is the most common heterotopic phenomena involving the axillary lymph nodes, the presence of benign epithelial inclusion cysts in axillary lymph nodes is a rare but well-reported finding. Such documentation is in part due to assessment of sentinel lymph nodes in breast cancer becoming standard of care. These epithelial inclusion cysts offer a diagnostic pitfall in evaluation of sentinel lymph node in the setting of breast carcinoma. They also complicate assessment of sentinel lymph node during intraoperative frozen sections analysis. Case Report: We report a case of co-existent of benign squamous-type and glandular-type epithelial inclusions cysts in 2 sentinel lymph nodes in a patient with grade III invasive ductal carcinoma involving the left breast. There have been at least 4 cases reported in literature in which benign epithelial inclusion cysts in sentinel lymph nodes were first mistakenly diagnosed as metastatic carcinoma both during intraoperative frozen section analysis and during review of permanent sections. The missed diagnosis could potentially occur intraoperatively during frozen section sentinel lymph node analysis secondarily due to lack of availability of the primary tumor for comparison and inability to use immunohistochemical stains. Conclusions: Pathologists should be aware of this pitfall especially in frozen section analysis of sentinel lymph node to avoid misdiagnosis and its associated potential grave consequences.

The integrin α6β4 (referred to as β4) is expressed in epithelial cells where it functions as a laminin receptor. Integrin β4 is important for the organization and maintenance of epithelial architecture in normal cells. Particularly, β4 is shown to be essential for mammary gland development during embryogenesis. Integrin β4 also plays important roles in tumor formation, invasion and metastasis in breast cancer. However, the mechanism of how integrin β4 mediates breast tumor formation has not been settled. A few studies suggest that integrin β4 is involved in cancer stem cells (CSCs), but the mechanism is not clear. To address this problem, I examined the expression of β4 in breast tumors and its potential role involved in regulating CSCs. My data shows that β4 is expressed heterogeneously in breast cancer, and it is not directly expressed in CSCs but associated with a basal epithelial population. This work suggests that β4 can regulate CSCs in a non-cell-autonomous manner through the interactions between β4+ non-CSC population and β4- CSC population. My data also shows that β4 expression is associated with CD24+CD44+ population in breast tumor. To further study the role of β4 in breast cancer progression, I generated a β4 reporter mouse by inserting a p2A-mCherry cassette before ITGB4 stop codon. This reporter mouse can be crossed with breast tumor models to track β4+ population during tumor progression.

The aim of this study is to describe breast cancer survivors' experiences and the associated meanings participating in their important activities during and after breast cancer treatment and the relationship among the survivor, environment, occupation, and performance, using a concurrent mixed method design. Ten survivors between the ages of 45 and 64 with Stage I, II, or III breast cancer who had been treated consecutively with surgery, chemotherapy, and radiation therapy were recruited for the study. Each survivor completed the Activity Card Sort-modified scoring system (ACSm) during the first and last week of radiation therapy and 3 and 6 months post radiation therapy. Additionally, each survivor participated in a semi-structured interview at the end of radiation therapy and 6 months afterwards. Qualitative data was analyzed using interpretative phenomenological analysis (IPA) to understand the survivors' experiences participating in their most important activities. The means and standard deviations of the proportion of activities resumed for the participants' global and category activities were calculated at each time point. A desire to resume participation in meaningful activities emerged from the data and demonstrated the interrelationship between environment, person, and occupation. Themes from the last week of radiation were (a) individual outlook influences how activities are approached, (b) social support reduces the stress of life, (c) side effects influence how activities are completed, and (d) personal and treatment stresses and struggles influenced their perspectives on life. At 6 months post radiation therapy, the themes were (a) emotional effect on activities, (b) life after cancer has changed due to cancer diagnosis and treatment, and (c) side effects continue to influence daily activities. Using the seven stages of analyzing mixed method data developed by Onwuegbuzie and Teddlie (2003), the qualitative and quantitative data were integrated. The results illustrated that the participants resumed a greater proportion of instrumental activities, which were reported consistently as one of their five most important activities. Additionally, supportive extrinsic factors appeared to be more influential in resuming participation important activities than intrinsic factors. Findings from this study support using the Person-Environment-Occupational-Performance (PEOP) model to develop treatment plans for women undergoing or recovering from breast cancer treatment.

Bakgrund Fysisk smärta är vanligt förekommande hos personer med bröstcancer, dels på grund av sjukdomen, dels på grund av behandlingen. Som komplement till den farmakologiska smärtlindringen finns icke-farmakologiska smärtlindringsmetoder som exempelvis massage, akupressur, reflexologi, yoga, fysioterapi, akupunkturvarianter, meditation och mindfulness.  Syfte Att undersöka evidensbaserade icke-farmakologiska smärtlindringsmetoder för personer med bröstcancer. Metod En litteraturöversikt med deskriptiv design. Samtliga inkluderade artiklar var randomiserade kontrollerade originalartiklar med kvantitativ ansats. Sökningarna av resultatstudier genomfördes i PubMed och CINAHL och valdes baserat på denna studies inklusions- och exklusionskriterier. Kvalitetsgranskningen genomfördes med hjälp av SBU:s mallar för randomiserade studier. Resultat Litteraturstudiens resultat baseras på 13 vetenskapliga originalartiklar. Resultatet visar att icke-farmakologiska smärtlindringsmetoder har en effekt på smärta hos vuxna personer med bröstcancer. Tio studiers resultat visade en statistisk signifikant effekt hos interventionsgruppen, dessa tio undersökte massage, akupressur, reflexologi, akupunktur,elektroakupunktur, fysioterapi, mindfulnessbaserad-KBT (MKBT) och lovingkindness-meditation (LKM). Tre studiers resultat såg ingen statistisk signifikant effekt av deras interventionsmetoder, de undersökte massage, yoga och elektroakupunktur. Slutsats Sammanfattningsvis har tio av 13 resultatartiklarna resulterat i statistiskt signifikant minskning av smärta genom icke-farmakologiska smärtlindringsmetoder, och därmed minskat fysisk smärta hos personer med bröstcancer. Att lindra den fysiska smärtan är en central del för att minska lidandet. Icke-farmakologiska behandlingsmetoder är ett av sjuksköterskans expertisområden och därmed kan resultatet eventuellt bidra till fler metoderoch mer kunskap att implementera i det kliniska arbetet för att smärtlindra personer med bröstcancer.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20999号 / 医博第4345号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 萩原 正敏, 教授 武田 俊一, 教授 高田 穣 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund  Bröstcancer drabbar cirka 2,1 miljoner kvinnor världen över varje år. En bröstcancerdiagnos kan innebära många känslomässiga och sociala utmaningar vilket kan leda till ångest och oro. Coping är en process där individen beteendemässigt och kognitivt anstränger sig för att hantera inre och yttre krav utöver det vanliga, vilket vid en bröstcancerdiagnos kan anses aktuellt. Det är betydelsefullt att sammanställa förekommande copingstrategier hos kvinnor med nydiagnostiserad bröstcancer för att identifiera eventuellt behov av stöd och information.  Syfte  Syftet var att beskriva copingstrategier som förekommer hos kvinnor med nydiagnostiserad bröstcancer. Metod Denna studie genomfördes i form av en icke-systematisk litteraturöversikt. Datainsamlingen genomfördes i databaserna PubMed och CINAHL. De 15 valda artiklarna kvalitetsgranskades och analyserades genom integrerad analysmetod.  Resultat  Resultaten indikerade att acceptans som copingstrategi förekom på medelnivå samt hög nivå. Positiv omvärdering/positiv tolkning förekom på medelnivå. Exempel på positiv tolkning var att se mastektomi som en livräddande åtgärd. Spirituell coping visades ha en hög förekomst hos religiösa kvinnor. Användning av copingstrategier i form av undvikande sågs i en studie tyda på ett ökat lidande i form av ökade symtombesvär. Informationssökande från vårdpersonal, internet och böcker ansågs i en studie vara exempel på socialt stöd i instrumentellt syfte. I en studie visade sig informationssökande ha en effekt av att minska bland annat ångest och oro.  Slutsats  Kvinnor med nydiagnostiserad bröstcancer verkar vidta en rad olika former av copingstrategier som gensvar på diagnos och dess följder. Utifrån kunskap om dessa kan sjuksköterskan vidta lämpliga omvårdnadsåtgärder för att främja anpassning och god hälsa. / Background Breast cancer annually affects about 2.1 million women worldwide. A breast cancer diagnosis may imply various emotional and social challenges which may lead to anxiety and distress. Coping is a process in which an individual undertakes emotional and behavioural efforts to manage internal and external demands beyond her resources, which often may be relevant following a breast cancer diagnosis. It is of interest to compile coping strategies used by women with newly diagnosed breast cancer in order to determine potential needs of additional support and information among these women. Aim The aim was to describe coping strategies that occur among women with newly diagnosed breast cancer. Method This study was conducted in the form of a literature review. The data collection was carried out in the databases PubMed and CINAHL. The 15 selected articles underwent a quality review and were thereafter analysed according to integrated review method. Results The results indicated that acceptance as a coping strategy occurred at a medium and high level. Positive reappraisal/positive reinterpretation occurred at a medium level. An example of positive reinterpretation was to see mastectomy as a lifesaving measure. Spiritual coping was shown to occur at a high level in religious women. The presence of avoidance coping was identified in one study to indicate a higher level of symptom bother. Seeking information from healthcare professionals, the Internet and books was considered in a study to be an example of seeking social support for instrumental reasons. Seeking information was shown in one study to have an effect of reducing the level of distress among women. Conclusions Women with newly diagnosed breast cancer seem to adopt different coping strategies as responses to diagnosis and its consequences. Relevant nursing interventions can be applied to support adaptation and good health based on identified knowledge.

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