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

Pavani Chalasani, MD, MPH

Disclosures

October 21, 2021

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. Given her family history of breast cancer (an aunt and a cousin), the patient underwent genetic testing and was negative for BRCA mutations. In addition, she underwent left mastectomy with sentinel node biopsy. 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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