Skill Checkup: New-Onset Upper Chest Pain in 61-Year-Old Breast Cancer Survivor

Tanya Gupta, MD


April 26, 2023

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

A 61-year-old White woman living in the United States presents to her oncologist at a follow-up appointment with a dull pain in her upper chest and some breathing difficulty. Five years ago, she was diagnosed with hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative stage IIB invasive lobular breast cancer. She was treated with lumpectomy and sentinel lymph node biopsy, radiation to the breast and axilla, and has been taking a nonsteroidal aromatase inhibitor (AI) ever since. The oncologist suspects disease recurrence. The oncologist orders PET imaging, which reveals a large tumor mass in the midline of her chest, encroaching on the lungs and esophagus. She undergoes a lung biopsy that demonstrates involvement by breast cancer. She is diagnosed with HR-positive/HER2-negative advanced metastatic breast cancer. There is no family history of breast cancer.


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