Breast Cancer

A 47-year-old woman who has a history of breast cancer returns to your officefor a routine examination. She has questions about what constitutes optimalfollow-up care for breast cancer survivors; she has read and heard conflictingrecommendations.

In this article, I review several interventions that have been shown or are postulated to reduce breast cancer risk in women with no history of the disease; these include chemoprevention, physical activity, weight control, diet, alcohol use, and avoidance of specific carcinogens.

Are aromatase inhibitors safe and effective as adjuvant therapy for postmenopausal women with estrogen receptor-positive breast cancer?

A 49-year-old woman, severely obese but otherwise healthy, appeared for a preemployment medical examination. She neither smoked cigarettes nor drank alcohol. She had no respiratory problems and recalled no family history of such. A baseline mammogram taken 4 years earlier showed no abnormalities, and the patient was not under care for any medical condition. Results of physical examination were normal, except for the obesity-which made it difficult to determine breast masses with confidence.

Back pain and weakness of both legs had bothered this 60-year-old woman for 1 week. Left breast cancer, stage 2, had been diagnosed 2 years before, and subsequently she underwent a lumpectomy followed by chemotherapy and radiation therapy.

A 54-year-old woman with breast cancer metastatic to the lungs had been treated with four courses of docetaxel, to which she partially responded. Following the first cycle of chemotherapy, the patient experienced arrested growth of her fingernails and toenails. Progressively worsening onycholysis then developed.

A 72-year-old woman first noticed progressive enlargement of the maxillary area of her face 18 years earlier. She denied facial trauma and significant dental caries. Her medical history consisted of breast cancer managed by a mastectomy and type 2 diabetes mellitus of 3 years’ duration.

A slightly pruritic, red, scaly rash on an 8-year-old boy’shands has been progressively worsening since it appeared4 months earlier. Nail pitting also was noted. There are noother rashes on his body. The patient is active in sports;denies any new exposure to soaps, clothing, or other contactants;and spends time in the homes of his recently divorcedparents.

An ulcerated lesion that measured approximately 2 cm in diameter had developed on an 80-year-old woman's scalp. The lesion featured a dark eschar that covered a slightly elevated, erythematous border. According to the patient's husband, a different lesion had been at the site 2 weeks earlier. He described the original as a "ball" that ulcerated, had no drainage, and formed a scab.

For 2 weeks, a 59-year-old woman had experienced weakness on the left side of her face. She described her appearance as "deviated" and complained of dribbling from the corner of her mouth and difficulty in chewing. The patient was unable to close her left eye and said that noises sounded unpleasantly loud and distorted in the left ear. She denied earache, vertigo, fever, headache, and rash.

Many of my older women patients think theyare at much higher risk for breast cancer thancoronary heart disease (CHD). How can we raise women'sawareness about their risks of CHD and therebyencourage them to take measures to prevent it?

Women often forget to perform amonthly breast self-examination.

A 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.