1. Lacovara, Jane MSN, RN, BC
  2. Arzouman, Jill MS, RN-APRN, CNS

Article Content

Mammograms are considered the gold standard for screening the general population of women older than 40 years for breast cancer. When a woman is younger, or has particularly dense breast tissue, the sonogram may be the first diagnostic tool used to evaluate specific breast abnormalities. When neither tool is suitable, an magnetic resonance imaging (MRI) is used to help locate and evaluate abnormalities. However, additional screening considerations may be necessary for a patient who has a known familial genetic mutation but no active disease. For example, the BRCA(or BRCA2 mutation, if inherited, may place the patient at an 87% lifetime risk of developing breast cancer. The breast cancer associated with this mutation also tends to occur at a much younger age (<50) and many times in the 30s. Ductoscopy is the use of a very thin fiberoptic scope inserted into a fluid-producing breast duct to look for abnormalities. The scope is threaded through the milk ducts inside the breast. An attached camera and imaging system magnify the video images, and display these pictures on a video screen, allowing visualization inside the duct. During the ductoscopy procedure, intraductal biopsies may be retrieved and sent off for analysis. In addition, the general health of the duct may be observed, noting any inflammatory or cytological changes. It is believed that up to 80% of breast cancers originate within the breast duct. Mammograms and MRIs rarely identify tumors until they are at least 5 mm in size. Most often, tumors have grown for several years (up to 10) before they are large enough to be noted on the mammogram. The ductoscopy can identify tumors at a much smaller stage, hopefully decreasing the morbidity and mortality of breast cancer. CNS interested in cancer prevention and/or genetic counseling should be aware of this newly emerging technological screening option.


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.