CM is a 43-year-old female who presents with concerns
regarding two painless right-breast lumps that she detected four
months ago. She missed an appointment for evaluation by her
primary-care provider at that time and presents today with
reportedly no change in these findings since that time. There has
been no breast discharge, bleeding, overlying skin changes,
lymphadenopathy, or fevers; she denies recent or past breast
trauma. She did, however, undergo a stereostatic breast biopsy
three years ago that demonstrated atypical lobular hyperplasia, and
there is a known family history of breast cancer (mother, diagnosis
at age 48). Current review is significant for a 10-pound weight
loss due to diminished appetite over the last two months.
Amenorrheic x three years; no current hormonal-replacement therapy
or previous oral-contraceptive use; had levonorgestrel implantation
at age 28, removed at age 33 and has only used condoms since, but
nothing now as she is not sexually active.
This case is meant to highlight indications for
breast-cancer screening and to outline the standard evaluation of a
female who presents with a breast mass.
Learning objectives for the case:
• Distinguish between the common types of breast
masses.
• Know the guidelines for breast-cancer screening.
• Explain the reasoning behind the standard diagnostic
approach to a patient with a breast mass.
Also review with following in order to adequately answer the questions in regard to the case above:
• Epidemiology: what is the latest information regarding
Breast Cancer?
• Clinical considerations: what are the considerations you
should explore in regard to this disorder (e.g. most common
presenting symptom, less common symptoms, physical exame findings,
testig to order (with rationale) – which is most recommended in
regard to this case and why.
• Review the TMN classification system.
• Review the SEER staging system as an alternative rating
system for epidemiology reporting.
• Explain the Risk factors for developing breast cancer.
What risk factors does this patient have for breast
cancer?
After completing your Case Studi and reviewing the guidelines for breast-cancer screening, answer the following Discussion Board questions using the latest evidenced based guidelines:
• Discuss the questions that would be important to include
when interviewing a patient with this issue, including any risk
factors she may have.
• Describe the clinical findings that may be present in a
patient with this issue.
• Are there any diagnostic studis that should be ordered on
this patient? Why?
• List the primary diagnosis and three differential
diagnoses for this patient. Explain your reasoning for
each.
• Discuss your management plan for this patient, including
pharmacologic therapies, tess, patient education, referrals, and
follow-ups.
please use references in apa style and can not use reference no later than five years ago.
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