Vera (37 years old)

Vera, 37 years old, works fulltime in a magazine store. During the weekend, she often loses track of time while she is reading the latest gossip of celebrities. She was diagnosed with luminal B-like cT2N1M0 breast cancer after reporting a palpable lump in her right axilla.

Assessment summary

• No relevant medical history
• Premenopausal. Nulliparous (G0P0)
• Genetic counselling + testing (positive family history): no BRCA1/2 germline mutations
• Tumour biology (core biopsy from breast): G2, invasive carcinoma of no special type, ER 100%, PgR 10%, HER2 negative (IHC 2+, SISH negative), Ki67 50%
• Lymph node core biopsy: positive for macrometastases

Treatment & follow-up

• Fertility counselling: cryopreservation of oocytes
• Echocardiogram: no structural or functional cardiac abnormalities
• Pretreatment staging with breast MRI and localisation of tumour
• Neoadjuvant chemotherapy: dose-dense EC-100 q2w with G-CSF support followed by dose-dense paclitaxel q2w
• Breast MRI at post-neoadjuvant therapy:
  • Partial response in breast (19 mm nodule) and complete response in axilla (ycT1cN0)
• 3 weeks later: breast conserving surgery with minor reconstructive techniques and limited ALND
  • 19 mm foci, G2, invasive carcinoma no special type
  • Lymphovascular invasion
  • R0 resection
  • 1 macrometastasis and 1 micrometastasis (2/6 lymph nodes)
  • ypT1cN1a