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Skill Checkup: A 50-Year-Old Premenopausal Woman With Treated HR–Negative, HER2–Positive Metastatic Breast Cancer Presents With Progressive Back Pain

Elwyn C. Cabebe, MD

Disclosures

December 12, 2024

A 50-year-old premenopausal woman in the United States with a history of stage III hormone receptor (HR)–negative, human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer (mBC) was diagnosed and began treatment approximately 2 years ago with surgery followed by adjuvant therapy. Her adjuvant therapy was completed 10 months ago, but she presents today with progressive back pain. She was in remission when she finished her adjuvant treatment; however, she has not been visiting her physician for follow-up appointments owing to insurance and transportation issues. She describes the pain as dull and persistent, localized to the mid-thoracic region, with occasional radiation to the flanks. The pain is worse at night and is not relieved by over-the-counter analgesics. It has been getting progressively worse over the past few months. Laboratory studies show mildly elevated tumor markers, including cancer antigen (CA) 15-3 at 45 U/mL (normal < 30 U/mL). Liver and renal function tests are within normal limits. Imaging and further diagnostic evaluation are underway to determine the etiology of her symptoms and guide further management.

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