Breast cancer is now a serious concern for all community groups. Teenagers, parents and social institutions need to be involved in dealing with breast cancer. So that no more victims of this disease. If earlier can be overcome and prevented, then this breast cancer will not spend a lot of money for healing.


  1. One in eight women in the United States has a life-threatening mass to experience breast-cancer.
  2. Incidence continues to increase while mortality remains the same. The most common type of breast cancer is ductal infarction carcinoma (75% of cases).
  3. These tumors are hard on palpation, usually axillary to axillary nodes, and have a worse prognosis than other tilapia breast-cancer.
  4. Inflammatory lobular carcinoma is responsible for 5-10% of cases.
  5. These tumors come with multicenter tumors and clear-cut thickening.
  6. The axillary nodes are exposed equally to infiltrating ductal carcinomas, but different metastatic sites.
  7. Ductal carcinoma usually spreads in the lungs, lungs, liver, or brain, while lobular carcinoma metastasizes meningeal surface or in other unusual places.
  8. There are many other types of breast-cancer, indicated by various percentages and prognosis.
  9. Now there is no cure for breast cancer.
  10. There is no specific cause; it seems that genetic, hormonal, and environmental factors can support the development of this cancer.
  11. If the lymph nodes are not affected, then the prognosis will be better. The key to improved healing is early diagnosis before attacking metabolism.



  • Breast Cancer is one of the most common cancers found in Indonesia is usually found in cancer aged 40-44 years and most locations in the upper kernron laternal
  • The most common type of breast cancer is ductal infarction carcinoma (75% of cases). Inflammatory lobular carcinoma is responsible for 5-10% of cases. The affected nodusilaris is the same in the ductal carcinoma of the infiltrate, but the place of treatment is different, ductal carcinoma usually spreads in the liver, lung, liver, or brain, while lobular carcinoma metastasizes meningeal surface or in other unusual places.


The etiology of breast cancer is still developing. However, some patient risk factors are suspected to be associated with the incidence of the breast cancer, namely:

  1. Age> 30 years
  2. Delivery of the first child at age> 35 years
  3. Not married and nullipara
  4. Age menars <12 years
  5. Age of menopause> 55 years
  6. Have had an infection, trauma, or surgical operation of benign breast tumor
  7. Old hormonal therapy
  8. Have contralateral breast cancer
  9. Have had gynecological surgery such as ovarian tumor
  10. Ever experienced a radiation in the area of the chest
  11. Family history with breast cancer on mother, sister, mother, sister, brother/sister
  12. Oral contraceptives in patients with benign breast tumors such as malignant fibroctical disorders



The Breast Cancer is one of the most dangerous cancers in the world. The disease makes the life become unhappy  for the sufferers. But Breast Cancer is not coming suddenly. There are signs that can be destroyed earlier before become dangerous.

Breast cancer is also a frightening disease for sufferers. But breast cancer can be overcome properly if anticipated early. For that girls and women need to be given sufficient information to avoid this disease.

There are several categories of breast cancer stages. This is supposed to show the severity of the disease in a patient. 

The Stages 

The tumor has stage I-IV depending on size, affected lymph node, and metastasis (Other stages are expressed in TNM symbols: T = primary tumor, N = involved lymph node, M = metastasis).

The following is an explanation of the stage of breast cancer, namely:

  • Stage I: Small tumor less than 2 cm. Negative lymph node. There are no detected metastases.
  • Stage II: Tumor larger than 2 cm but less than 5 cm. Non-fixated lymph node negative or positive. Also no detected metastases.
  • Stage III: Tumor larger than 5 cm, or tumor of any size with a skin invasion or chest wall or positive fixed lymph nodes in the clavicular area without evidence of metastasis.
  • Stage IV: The tumor of any size with positive or negative lymph nodes with distant metastases.

The Management

  • Modified radical mastectomy: the entire breast tissue is removed together with the axillary lymph nodes.
  • breast-conservation surgery: segmental lumpectomy, or quadranectomy, and axillary dyslexery followed by radiation therapy against residual microscopic disease.
  • Mastectomy provides the maximum chance of removal of affected tumors and nodes.
  • A series of external beam radiation therapy on tumor mass to reduce the chances of recurrence and eradication of residual cancer.
  • Chemotherapy is very important for the eradication of the spread of micrometastases of the disease, eg, Cytoxan (C), Methotrexate (M), Fluorouracil (F), and Adriamycin (A).
  • CMF or CAF regimens are a frequent treatment protocol.
  • Autologous bone marrow transplants (ABMT) today often indicate an increase in their use. The use of growth factors to stimulate bone marrow has a high mortality decrease.
  • Hormonal therapy based on estrogen and progesterone receptor index.
  • Tamoxifen is the principal hormonal agent used to suppress hormone-dependent tumors.
  • Other hormonal preparations are Megace, DES, Halotestin, and Cytadren.
  • Elective reconstructive surgery provides psychological benefits. But is contraindicated if cancer is a local, metastatic, or inflammatory stage.

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Breast cancer is now increasingly happening. this disease is very dangerous. the culture of eating fast food, and canned foods containing preservatives, is one of the causes of this disease

Reduce Stress and Improve Koping Skill

  1. Preoperative, give patients time to absorb the meaning of the diagnosis and provide information to help evaluate the availability of treatment options.
  2. The best level of physical condition, psychology, and preoperative nutrition; consider the patient as an active member and healthcare team and allow to discuss with those who will provide care.
  3. Avoid pressing the patient to see where the incision is if the patient is not ready.
  4. Get help from family or friends who provide support to improve the acceptance of body change.
  5. Recognize that couples often need more guidance, support, and counseling to cope with the crisis.

Improved Self-Care

  1. Provide information on the development of postoperative surgical edema and strategies to prevent it; cuts, bruises, and infections in operative sites are dangerous that can trigger problems.
  2. Encourage to grab when free of post-anesthesia nausea and fluid tolerance; do range motion exercises fast, and prevent stiffness.
  3. Encourage self-care and exercise such as “climbing the wall” with the fingers to prevent contraction; pain other than a mild discomfort, there should be no therapeutic exercise; Radical mastectomy causes greater difficulty.
  4. Encourage normal work-related activities and arm-related work, arm motion when walking, cleaning operation spots, avoiding injuries with therapeutic exercises; loosen clothes that do not cause constriction.

Improving Sexual Function

  1. Talk about how the patient sees him and the libido-related decrease associated with exercise, nausea, or ancients.
  2. Clarify concept errors, eg, cancer can be sexually transmitted.
  3. Encourage an open discussion of fear.
  4. Provide suggestions that vary the time of the day for sexual activity (when not tired) or positions that most comfort, and position change, eg, hugging, kissing, manual stimulation.


That breast cancer is one of the most common cancers found in Indonesia, usually this cancer is found in women aged 40-49 years and located lateral up. The most common types of breast cancer, the infertile ductal carcinoma (75% of cases) and infiltration lobural lymphoma are responsible for 5-10% of cases.

The cause of breast cancer carcinoma with certainty. However, some risk factors in the client allegedly associated with the incidence of breast cancer, namely:

  1. Age> 30 years
  2. Delivery of the first child at age> 35 years
  3. Not married and nulipara
  4. Age of menopause <12 years
  5. ever has an infection, trauma, or benign tumor surgery
  6. Old hormonal therapy
  7. Have experienced chest radiation
  8. Family history with breast cancer in mother, mother sister, sister / brother

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Breast cancer is now a terrible disease for women, young and old. even many teenage girls began to experience this disease. that is why the case review of this disease needs to be informed to the public.

Assessment: Preoperative

  1. Assess the patient’s reaction to the diagnosis and ability to resolve the problem.
  2. Complete gynecology and complete.
  3. Ask related questions include the following: coping skills, support systems, lack of knowledge, and a sense of discomfort.
  4. Perform a complete physical assessment with special attention to breast and related signs and associated mass symptoms.

Post-operative Assessment

  1. Monitor pulse and blood pressure against signs of shock and hemorrhage.
  2. Avoid measuring blood pressure, injection, IV flow, and venous function on the operated side to prevent infection and disruption of circulation.
  3. Inspection of bandages against bleeding in a legislative manner; monitor drainage, pain, swelling, or drainage.

Nursing diagnoses

Diagnosis Preoperative Pregnancy

  1. Lack of knowledge about breast cancer and treatment options.
  2. Fear and ineffectiveness of coping associated with cancer diagnosis, treatment, and prognosis.

Postoperative Nursing Diagnosis

  1. Pain and discomfort.
  2. Damage to skin integrity due to surgical incision.
  3. Impaired self-image associated with loss of body parts, changes in self-image, and fear of the partner’s reaction to the loss experienced.

Nursing Intervention

Fixing Less Knowledge

  1. Teach follow-up through telephone connection for curiosity about incision, pain management, and family and patient adjustment; may permit the patient to make contact with the community nursing service if necessary.
  2. Teach how to empty the reservoir and measure the drainage if going home using drain.

Eliminate Pain and Discomfort

  1. Provide patient-controlled analgesia (PCA).
  2. Elevate moderately affected limbs only.

Maintenance of Skin Integrity

  1. Maintain the patency of the surgery to prevent fluid accumulation under chest wall incisions.
  2. Inform the decrease of sensation in the operative area due to neurological disorders; call for signs of infection or irritation.
  3. Teach to gently massage the surgery with vitamin E or other lotions to improve circulation and improve skin elasticity.

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Mothers and breastfeeding are very important things.  Mothers must breastfeed their children in order to grow optimally and always maintain their health.  Because there is no comparable food to replace breast milk/food.


  1. Breast Milk is a fatty emulsion in protein, lactose and inorganic salts secreted by the mother’s mammary glands, which are useful as food for the baby.
  2. Exclusive breastfeeding is breastfeeding without food and other supplementary beverages in infants aged 0 to 6 months.
  3. Even water is not given in this exclusive breastfeeding stage.
  4. Breast milk/food in sufficient quantities is the best food in infants and can meet the nutritional needs of infants during the first 6 months.
  5. Breast milk/food is the first and main natural food for the baby so as to achieve optimal growth.
  6. In 2001 the World Health Organization stated that exclusive breastfeeding during the first six months of life is best. Thus, the preceding provision (that the exclusive ASI is four months) is no longer valid.


WHO and UNICEF recommend the following steps to initiate and achieve exclusive breastfeeding by breastfeeding within one hour after birth Exclusive breastfeeding: only breast milk/food. That is, no added food or other drinks, even water. Breastfeed whenever the baby asks (on-demand), as often as the infant wants, day and night. Do not use bottles of milk or pacifiers.

Eating milk by pumping or blushing by hand, while not with the child and controlling emotions and thoughts to calm down.


After the exclusive breastfeeding of six months, it does not mean breastfeeding is over. Along with the introduction of food to the baby, breastfeeding is still going on, should breastfeed two years according to WHO recommendations.

Breastfeeding as baby food has the following virtues:

  1. Breast milk is a good natural food for babies, practical, economical, easily digested to have the composition, the ideal nutrient according to baby’s digestive needs and abilities.
  2. Breast milk contains higher lactose compared to artificial milk.

In the intestine, lactose will be fermented into lactic acid. which is useful for:

* Inhibits the growth of pathogenic bacteria.

* Stimulate the growth of microorganisms that can produce acids organic and synthesize some types of vitamins.

* Facilitate the occurrence of calcium-cassienate deposition.

* Facilitate the delivery of herbagai types of minerals, such as calcium,


  1. Breast milk contains protective substances (antibodies) that can protect the baby during the first 5-6 months, such as Immunoglobin, Lysozyme, Complement C3, Complement C4, Antistapiloccocus, Lactobacillus, Bifidus, Lactoferrin.
  2. Breast milk does not contain beta-lactoglobulin which can cause allergies baby.
  3. Breastfeeding process can establish a psychological relationship between mother and baby.

Another Benefit of Breastfeeding 

In addition to providing well for the baby, breastfeeding with a baby can also provide benefits for mothers, namely:

  • A sense of pride from mom, that she can give “life” to the baby.
  • A closer relationship due to the close natural contact of the skin, for psychic and emotional development between mother and child.
  • With breastfeeding for the mother’s uterus will contract which can lead to sized return before pregnancy
  • Accelerate cessation of postpartum bleeding.
  • By breastfeeding the mother’s fertility becomes reduced for several months (pregnancy rationing)
  • Reduce the chances of breast cancer in the future.
  • Increasing the length of postpartum fertility return, so
  • Giving distance between children is longer aka delay the next pregnancy
  • Because delayed menstrual returns, breastfeeding mothers do not require a lot of substances during menstruation
  • Mother slimmer faster. Research shows that nursing mothers six months slimmer than half a kg of mothers who breastfed for four months.

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Kudus City, a small town in Central Java Province, Indonesia, proudly declared their team of health promotion. There are 25 members of the team that come from different skills: Nurse, midwife and environment health promotion.

They have work for many years in the civil servant of the district government of Kudus City.

And the main goal of their duty now is keeping the public of Kudus City stay healthy.   And the population of the Kudus city is currently 800.000 peoples.  And at least 20% of them are still poor. Although it is not supported by an adequate health promotion budget, however, the determination and working spirit of the team of health promoters will keep strong.

The Duty oh Health Promoter

The duty of a Health Promoter when enjoyed is very pleasant. Why is that?
They went directly to the villages to provide counseling to the people in the interior to behave in a clean and healthy life. Obstacles and rural natural conditions that are not ideal become challenges for us public health workers. Roads are damaged, there is no electricity, and the absence of clean water facilities often occurs in villages.
Not only minimal public facilities, the low level of education of rural communities also greatly affects the behavior and culture of unhealthy communities. Burning garbage, defecating in an open place, also throwing garbage in the river happens a lot.
Health promoters must have a high spirit, perseverance and patience to carry out their heavy duties.
Voluntary souls, perseverance and dedication are the main capital.
In order to create a healthy society and to change the healthy behavior of the community, health promoters continue to work. Happiness will be felt when people become healthy and prosperous because of the hard work of the health promoter.

Congratulations on the duty of volunteer health promotion in the Kudus District. May God bless you and make your way easier.