An Important Finding on Routine Screening

Joan K. Riley

A 53-year-old female was in excellent health when a mass was found in her right breast on an annual screening mammogram. A breast needle biopsy was performed and demonstrated the presence of an estrogen-receptor-positive ductal carcinoma in situ and an estrogen-receptor-negative invasive carcinoma on multiple margins. The mass was grade 2 out of 3 and measured 1 cm in diameter. The patient underwent a lumpectomy, and at this time the lymph nodes were negative. One month later the margin was positive on one side, and thus a right total mastectomy was performed. The patient was placed on tamoxifen (antiestrogen) and continued taking the drug for 5 years until a CT scan showed liver metastases. Subsequently the patient received chemotherapy with Taxotere (docetaxel; a mitotic inhibitor). It was later determined by immunohistochemistry (IHC) that her cancer overexpressed HER2/neu, and the patient began taking Herceptin (trastu-zumab). Two years later, a CT scan revealed progression of the disease. She was started on carboplatin (alkylating agent-platinum compound), Taxotere, and Herceptin. CA 15-3 was measured and was 24 U/mL (0-30 U/mL). One month later her CA 15-3 was 40 U/mL and 2 months later, it was 64 U/mL. A CT scan showed an increase in the size of the liver mass. Seven months later she presented for selective internal hepatic radiation therapy. Her CA 15-3 was 189 U/mL at this time. She continues to undergo chemotherapy.

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