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Susan had her first mammogram at age 40. The mammogram revealed a solid lesion measuring 3 cm located in the 3:00

position in the left breast. Susan was stunned. She did all the right things. She breast-fed her children for 2 to 3 months each and she tried to remember to check her breasts monthly. She was a Caucasian, with small dense breasts and her only vice was cigarette smoking. Susan underwent a fine-needle aspiration biopsy, which revealed a fibroadenoma plus atypical hyperplasia. Susan was recommended to get a mammogram in 6 months as part of a "planned watchful waiting." At her subsequent 6-month visit, the test revealed two additional lesions adjacent to the primary lesion. Susan underwent a lumpectomy to remove the three masses, which were all classified as fibroadenomas. Six months later, two new lesions were identified in the left breast and three were located in the right breast. After consultation with a vascular surgeon, Susan elected to have a bilateral mastectomy with reconstruction. She underwent a skin-sparing bilateral mastectomy and when the pathology results were in, the specimens contained proliferative masses with atypical, hyperplastic cells. The surgeon told Susan, "If you had waited another 6 months, we would be doing chemotherapy and radiation." Susan was started on an antidepressant a month later and reconstruction was completed. Susan returned to the office for her annual MRI of her breasts. (Learning Objectives 1, 3, and 4)

 A. What risk factors did Susan have that placed her at increased risk for developing breast cancer?

 B. What is the nurse's role in caring for women like Susan?

 C. What nursing diagnoses are appropriate for Susan?

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