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62 yr old Female was found to have a right breast abnormality on a screening mammogram. This mammogram was repeated which revealed an abnormality measuring 1.5 cm suspicious of malignancy in the upper outer quadrant of the right breast. She underwent a needle localization biopsy of this abnormality revealing infiltrating ductal carcinoma and DCIS. PMHx: History of benign disease in left breast. PSHx: Excision of breast lumps in left breast. Benign. Meds: Vit E and calcium Allergies: Amoxocillin Social: She is a widow. Attained menarche at 14 yrs of age and menopause at age 55. She is grii, pii. (No hx of tobacco or alcohol consumption.) (On Birth Control Pill x 2 yrs. No hx of Estrogen Replacement Therapy.) Family Hx: No family history of any type of cancer. Review of Systems: Negative. PEx: Was within normal limits except for mild echymosis and vague palpable abnormality at the biopsy site. Assessment: Infiltrating ductal carcinoma of right breast along with Ductal Carcinoma In Situ History of fibrocystic disease of left breast. Recommendation: She was advised lumpectomy and sentinel node biopsy pending further recommendations after sentinel node biopsy and ER, PgR data. Pathology: Infiltrating ductal carcinoma long with DCIS. T 1 C, N 1 , M x . Margins of resection clear. Estrogen Receptor status: 90% positive Progesterone Receptor: Negative Her-2Neu: Positive Final Recommendation: Adjuvant chemotherapy followed by Adjuvant Radiotherapy and Tamoxifen. Follow-up: Eight years later, the patient presents with metastases to liver, bones and brain. Patient and family decided to go into hospice. 1 Describe the epidemiology of Breast Cancer. ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 2 What are the known risk factors for developing breast cancer? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 3 What is BRCA 1 and BRCA 2? What is its clinical significance? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 4 What are the usual presenting signs and symptoms of breast cancer? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 5 What is the differential diagnosis of a breast mass? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 6 What are estrogen and progesterone receptors and their clinical significance? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 7 What are important Prognostic factors in early breast cancer? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 8 What are predictive factors in Breast Cancer? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 9 What is adjuvant chemotherapy and the principles involved? ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ 10 What are the side effects of systemic chemo chemotherapy? ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________