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
"I noticed a lump on my breast. It doesn't hurt, but I am worried it might be cancer."
History of Present Illness
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.
Depression diagnosed 14 years ago
HTN diagnosed 12 years ago
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.
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.
Past history of smoking for 6 years. Uses alcohol; 4–6 hard alcoholic drinks/wk. No illicit drug use
Allergies/Intolerances/Adverse Drug Events
Fluoxetine 40 mg PO q 24 h
Lisinopril 10 mg PO q 24 h
Slightly distressed female with new-onset painless breast lump. No complaints of pain, soreness, or fatigue at this time
Slightly overweight woman in no acute distress
BP 152/96 mm Hg, P 78, RR 12, T 36.3°C