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ONCC CBCN Certified Breast Care Nurse (CBCN)

- Breast Health, Screening and Early Detection, Risk Assessment and Reduction
- Issues related to special populations (e.g., male, elderly, disabled, adolescent, pregnancy, cultural, ethnicity, healthcare disparities)
- Breast health
- breast anatomy
- breast development across the life span
- hormonal influences
- Benign pathology
- anomalies (e.g., asymmetry, nipple deviation)
- conditions (e.g., mastodynia, fibroadenomas, infection)
- Screening and early detection
- imaging modalities
- screening recommendations based on risk
- Elements of a clinical breast exam and lymph node examination
- abnormal physical findings
- education related to breast awareness (self-breast exam)
- Risk assessment
- epidemiology (population-based risk factors)
- breast cancer risk prediction models (e.g., Gail Model, Tyrer Cuzick)
- high-risk lesions (e.g., LCIS, ADH)
- Risk factors
- hereditary (e.g., germ line mutations in BRCA1, BRCA2, TP53)
- non-modifiable (e.g., age, gender, prior radiation)
- modifiable (e.g., lifestyle behaviors)
- Risk reduction
- interventions to modify risk (e.g., chemoprevention, prophylactic surgery, clinical trials)
- education to reduce risk (e.g., lifestyle modification)

- Diagnosis and Staging
- Process of carcinogenesis
- Diagnostic procedures and tests
- imaging modalities (e.g., mammogram, US, MRI)
- imaging results (e.g., BI-RADS)
- Biopsies (e.g., FNA, core, surgical)
- Pathology and tumor characteristics
- cellular (e.g., grade, histology)
- Tumor features (LVI, margins)
- Prognostic and predictive markers
- ER/PR
- Her-2
- Ki-67 (MIB or MIB-1)
- gene assay (e.g., Oncotype DX)
- Staging criteria (AJCC)
- clinical (e.g., TNM)
- pathological (e.g., pTMN)
- additional staging studies (e.g., PET, bone scan, chest x-ray, LFT, CT scan)

- Treatment Modalities: Local and Systemic
- Local treatment modalities: Surgery
- treatment considerations (e.g., performance status, comorbidities)
- breast (e.g., breast conservation, mastectomy)
- axilla (e.g., SLNB, ALND)
- Local treatment modalities: Surgical reconstruction
- autologous (e.g., DIEP, TRAM flap)
- implant
- Local treatment modalities: Radiation therapy
- treatment considerations (e.g., range of motion, wound healing, comorbidities)
- external beam
- brachytherapy
- Systemic treatment modalities
- treatment considerations (e.g., cardiac status, vascular access, bone health, fertility, comorbidities)
- neoadjuvant
- adjuvant
- metastatic
- Treatment considerations for:
- special populations (e.g., male, elderly, disabled, adolescent, pregnancy, cultural, ethnicity, healthcare disparities)
- triple-negative
- inflammatory breast cancer
- Paget’s disease
- local recurrence
- phyllodes tumor

- Symptom Management (assessment, risk factors, pathophysiology, prevention, education, and management)
- Surgical
- wound complications
- arm and shoulder dysfunction
- cording
- lymphedema
- pain
- neurosensory changes
- Medical
- alopecia
- fatigue
- gastrointestinal complications
- myelosupression
- menopausal symptoms
- cardiovascular complications
- peripheral neuropathy
- cognitive dysfunction
- sleep disturbance
- skin changes
- pulmonary complications
- musculoskeletal issues
- pain
- Radiation
- skin changes
- pain
- fatigue
- range of motion
- pulmonary issues
- lymphedema
- infection
- Complementary and integrative modalities (assessment, risk factors, pathophysiology, prevention, education, and management)

- Psychosocial and Spiritual
- Influence of culture, spirituality, gender, sexual preference, age, and healthcare disparities on psychosocial response across the continuum of breast care
- Psychosocial components accompanying hereditary predisposition to cancer (e.g., survivor guilt, transmitter guilt, family conflict)
- Altered body image
- Sexual health
- Emotional state (e.g., anxiety, depression, fear of recurrence, family conflict)
- Socioeconomic considerations related to screening, diagnosis, treatment and follow-up
- Coping strategies
- Principles of stress response and crisis management
- Psychosocial assessment techniques (e.g., related to spiritual, sexual, distress, coping, family function)
- Communication strategies and issues (e.g., active listening, clarification, family dynamics)

- Survivorship
- Physical issues
- breast fibrosis and scarring
- brachial plexopathy
- breast asymmetry and skin changes
- cardiac toxicity
- fatigue
- fracture (rib and other)
- genitourinary dysfunction
- implant rupture, contracture and displacement
- infertility
- lymphedema
- menopausal symptoms
- neuropathy
- osteonecrosis of the jaw
- osteoporosis
- pain
- pulmonary fibrosis
- range of motion limitations
- secondary malignancy
- sexual dysfunction
- weight gain
- Psychosocial issues
- body image changes
- cognitive changes
- emotional distress
- fear of recurrence
- financial, employment, and insurance issues
- loss of libido
- quality of life (physical, spiritual, cultural, emotional)
- relationship role changes
- survivorship guilt
- Surveillance for recurrence
- breast cancer screening
- symptom-directed work-up
- physical examination
- screening for second primaries
- General knowledge
- familial risk assessment and implications for genetic counseling
- rehabilitation (pain, range of motion, lymphedema, cognitive impairment)
- survivorship care plan

- End-of-Life Care
- Legal and ethical issues (e.g., advance directive, medical power of attorney, DNR)
- Philosophy of hospice care
- End-of-life care principles (e.g., pathophysiology, symptom management, family and caregiver support, cultural diversity, education)
- Palliative care services
- Financial issues (e.g., hospice care benefits, insurance, reimbursement)
- Spirituality, grief, and bereavement

- Professional Performance
- Scope and standards of nursing practice
- Professional practice guidelines (e.g., ONS, NCCN, ASCO, ACR)
- Teaching and learning principles (e.g., adult learning)
- Patient navigation
- Community assessment, program planning, and health promotion
- ONS standards of education: Patient/significant other and public
- Professional development activities (e.g., continuing education)
- Advocacy and legislative issues impacting breast care delivery and access
- Resources (e.g., local, state, federal, institutional, internet)
- Clinical trials (e.g., phases, accessing trials, elements of informed consent)
- Quality improvement process (e.g., evidence-based practice)
- Regulatory requirements (e.g., mammography standards, compliance issues)
- Accreditation standards (e.g., NAPBC)