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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • List the known risk factors in the development of breast cancer

  • Assess the manifestations of locally advanced and metastatic breast cancer

  • Identify the goals of therapy for a patient with locally advanced and metastatic disease

  • Choose an appropriate personalized monitoring plan for patients on multimodal therapies for breast cancer

  • Devise educational information for patients on systemic therapies for breast cancer

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PATIENT PRESENTATION

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Chief Complaint

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"I noticed a lump on my breast. It doesn't hurt, but I am worried it might be cancer."

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History of Present Illness

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Cindy Thomas is a 56-year-old premenopausal woman who presents to her primary care physician (PCP) complaining of a new breast lump. She noticed this while trying on new clothes a week ago. There does not appear to be any pain associated with the lump. She last had a mammography 3 years ago, which showed no evidence of breast cancer.

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Past Medical History

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Depression diagnosed 14 years ago

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HTN diagnosed 12 years ago

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Family History

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Her mother was diagnosed with early breast cancer at age 64. She underwent a total mastectomy followed by adjuvant chemotherapy and is currently free of cancer at age 78. Her father is currently in excellent health. She currently has no children.

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Social History

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She is married to her husband of 34 years. She has lived outside of San Francisco for nearly all of her life. She is the head of a small IT company and works 60–80 hours per week.

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Tobacco/Alcohol/Substance Use

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Past history of smoking for 6 years. Uses alcohol; 4–6 hard alcoholic drinks/wk. No illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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No known drug allergies

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Medications (Current)

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Fluoxetine 40 mg PO q 24 h

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HCTZ 12.5 mg PO q 24 h

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Lisinopril 10 mg PO q 24 h

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MVI 1 tablet PO daily

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Review of Systems

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Slightly distressed female with new-onset painless breast lump. No complaints of pain, soreness, or fatigue at this time

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Physical Examination

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General
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Slightly overweight woman in no acute distress

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Vital Signs
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BP 152/96 mm Hg, P 78, RR 12, T 36.3°C

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Weight 182 lb (82.7 kg)

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Height 66 in. (168 cm)

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Denies pain (pain 0/10)

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Skin
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No suspicious lesions

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HEENT
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PERRLA, EOMI

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Lymph Nodes
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