A 50-Year-Old Woman Comes to the Physician for a Routine

question 544

Multiple Choice

A 50-year-old woman comes to the physician for a routine screening mammogram.  An asymmetric 1.5-cm mass with calcifications is found in the upper outer quadrant of her left breast.  She has no weight loss, headaches, or bone pain.  She has no other medical problems and takes no medications.  There is no family history of ovarian or breast cancer.
The patient's vital signs are normal.  BMI is 24 kg/m².  Examination reveals a palpable mass in the left upper quadrant of the left breast.  She has no nipple or skin abnormalities.
A core needle biopsy of the mass confirms invasive ductal carcinoma with focal necrosis.  Staining for hormone receptors (estrogen/progesterone) and HER2 is negative.  She undergoes a wide-margin lumpectomy with surgical axillary lymph node staging.  The tumor is 1.8 cm in diameter.  She has 4 positive lymph nodes in the axilla.  Imaging reveals no evidence of other metastatic disease.
Which of the following is the most appropriate next step in managing this patient?

• A)Chemotherapy, radiation, and aromatase inhibitor
• B)Chemotherapy, radiation, and tamoxifen
• C)Chemotherapy alone
• D)Chemotherapy followed by radiation
• E)Close follow-up without further therapy

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