Skill Checkup: A 56-Year-Old Woman With a History of Breast Cancer and Pain in Her Ribs and Spine

Pavani Chalasani, MD, MPH


January 14, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 56-year-old Black woman presents for follow-up 2 years after definitive treatment for localized hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative cancer in her left breast. She underwent left mastectomy with sentinel node biopsy. In addition, given her family history of breast cancer (an aunt and a cousin), she underwent genetic testing and was negative for BRCA mutations. She received adjuvant chemotherapy and then started on an aromatase inhibitor. Owing to side effects, she switched to tamoxifen within 2 months.

The patient has two grown children, does not smoke, is 5' 6" tall, and weighs 150 lb (BMI, 24.2). Her vitals in clinic are a temperature of 98.1 °F, pulse of 50 beats/min, respiratory rate of 20 breaths/min, and blood pressure of 139/75 mm Hg.

She now reports a palpable lump in her right breast and recent pain in her spine and ribs that has become increasingly bothersome. On workup, a complete blood count and complete metabolic profile were essentially unremarkable, except for an alkaline phosphatase level that was elevated at 620 U/L (upper limit of normal in laboratory, 140 U/L). She underwent right-sided mammography, which was negative.


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