Case 1: Margaret (45 years old)

Margaret, a 45-year-old woman, enjoys working in her own little vineyard. She has been complaining for the last 4-5 weeks of a severe lumbar back pain; she has overlooked it for some time, thinking it was due to the physical work in her vineyard. However, due to the persistence of the pain after some days of rest, she has decided to go to her doctor who prescribed her an X-ray. The X-ray showed a suspicious lesion in the spine. A further diagnostic workup was performed which showed metastatic breast cancer.

Assessment summary:

• Premenopausal
• No relevant medical history
• ECOG PS: 0
• No family history of breast cancer
• Imaging:
  • 2 cm tumour in the left breast, 1 suspicious axillary lymph node
  • Multiple suspicious lesions in the spine compatible with breast cancer metastasis
• Biopsy of the breast lesion: breast cancer, NST, ER 90%, PgR 60%, HER2 IHC 0, G2
• Haematology and biochemistry: all values normal
• Germline BRCA-status: wild type