Breast Cancer Patient Case Studies

 Diana was pregnant, and after five months, shestill couldn't really believe it. At age 40, she and her husband had beentrying for a long time and had just about given up hope. Now here she was,thinking more and more about her family, and her place in its cycle. Inaddition, she was also having a hard time choosing baby's names and thought itwould be useful and fun to get to know the names of her distant family members.She decided that it was time to finally put together that family tree she'dbeen putting off for years.

She knew all the detailsabout her immediate family, but as she started putting the tree together, sherealized how little she knew beyond that. Her father wasn't reliable atremembering that kind of stuff, and her mother, Julia, had died 20 years beforefrom breast cancer. Diana decided to call her favorite aunt to see if she couldfill in the missing pieces. At 74, her mother's sister Gretta was one of herfavorite people in the world. When Diana called, Gretta was delighted to hearfrom her and they arranged for a visit to go climbing through the family tree.When Diana got back from the visit, the family tree was filling in -- butsomething was starting to bother her. Many of her relatives had died of cancer.She was getting a little scared that there might be something in the family towatch out for.

Besides Diana's motherJulia, Gretta had two siblings, Johnny and Helen. Helen had died at 71 from aheart attack, but Johnny was still as feisty as ever. According to Gretta, herfather, John, had 6 brothers and sisters. While she couldn't be sure, Grettathought that two of the girls, Jane and Rose, had died of breast cancer. Theyoungest boy, Charlie had died very recently of heart disease but had also beendiagnosed with prostate cancer five years ago. After Gretta talked about Janeand Rose's breast cancer, she lowered her voice and revealed that her sisterHelen had actually had breast cancer at 40, and had had a mastectomy. "I'mso sorry I didn't talk about it more with your mother when she was sick"said Gretta regretfully, "but we just didn't talk about those kinds ofthings back then when I was younger." Gretta also explained that sinceHelen had been diagnosed with breast cancer and had done so well, everyoneassumed that Julia would be fine too. She said, "we were all in shock whenJulia got so ill and died."

Later, after filling inas much as she could on her father's side of the family, Diana phoned her uncleJohnny try make sure she wasn't missing any other information that her mother'sonly brother might know. As Diana shared what she had learned about the familytree and talked about the number of women with breast cancer, Uncle Johnny saidhe could understand Julia's concerns. As their conversation progressed, Johnnytold Diana that his daughter, Annabella, had gone though breast cancertreatments 11 years ago. Though all of her tests had been clear since herdiagnosis, Johnny said it continued to concern him. Diana asked if it would beOK to give Annabella a call and talk to her about it.

Diana and Annabellaspent a Saturday morning talking on the phone for several hours. As theytalked, Diana learned that as a physician, Annabella, had done a great deal ofresearch on breast cancer and the chance that her breast cancer and her twoaunts' breast cancer could in part be inherited. She told Diana that she hadbeen considering having tests for two genes - called BRCA1 and BRCA2 - that canincrease the likelihood of getting breast and ovarian cancer and possibly othercancers as well. Diana found herself feeling a bit overwhelmed by all this newinformation but she felt she needed to see this through.

Diana and Annabellaspent a Saturday morning talking on the phone for several hours. As theytalked, Diana learned that as a physician, Annabella, had done a great deal ofresearch on breast cancer and the chance that her breast cancer and her twoaunts' breast cancer could in part be inherited. She told Diana that she hadbeen considering having tests for two genes - called BRCA1 and BRCA2 - that canincrease the likelihood of getting breast and ovarian cancer and possibly othercancers as well. Diana found herself feeling a bit overwhelmed by all this newinformation but she felt she needed to see this through.

Annabella explained thatthe genetic counselor would meet with anyone else in the family who wantedinformation about his or her own risks for cancer. Diana decided that she wouldschedule an appointment for herself. Annabella also told Diana that the geneticcounselor had discussed cancer screening that would be recommended for someonewho carried a BRCA1 mutation or who are from a high-risk family. The geneticcounselor also discussed various research studies that might be of interest toAnnabella and some of her relatives. They had discussed who else in the familywas at risk and decided that between Annabella and Diana, they would try andlet the relevant family members know the information they had discovered.

Diana was unsure whether testing for the BRCA1 mutation was the rightthing for her. However, she felt she wanted to at least get the necessaryinformation to help with the decision. She also wanted to get accurateinformation about what she should be doing to vigilantly protect her health forher own sake and for Heather's. She was glad that she had started the familyhistory project. Like Annabella, she hoped that the information they hadgathered together might help protect their family members' health as much aspossible.















Breast Cancer Patient Case Studies: Snapshots of Risk – FEMARA®

1.What is your early breast cancer patients' risk of developing distant metastases?
In postmenopausal patients with hormone-receptor–positive (HR+) early breast cancer, distant metastases are associated with the lowest survival rates compared with other recurrences.1 And the risk of distant metastases initially peaks just 2 years after surgery.

2.But just how great is the risk of distant metastases for patients based on their distinct clinical profiles and breast cancer characteristics?
Here, you will read about 4 cases that are representative of those you may see in your practice. Please review the background information on each patient. Then, click on the link following her profile to:

    Answer questions about her case
    Get more information regarding her specific risk of distant metastases and an effective treatment approach

FEMARA® patient case study #1: Michelle







Clinical profile
    Age 68
    Stage IIIA
    Postmenopausal
    Comorbidity: Type 2 diabetes
Breast cancer characteristics
    ER+/PR-
    T2 (4 cm)
    Grade 2
    4 positive nodes
    HER-2/neu+
    Modified radical mastectomy
    Radiation
Click here for an interactive Q&A about Michelle's case.

FEMARA® patient case study #2: Emma




Clinical profile
    Age 55
    Stage IIB
    Postmenopausal
    Comorbidity: Osteoporosis
Breast cancer characteristics
    ER+/PR+
    T3 (1.5 cm)
    Grade 1
    2 positive nodes
    HER-2/neu-
    Modified radical mastectomy
    Radiation

interactive Q&A about Emma's case.

FEMARA® patient case study #3: Annette


Clinical profile
    Age 75
    Stage 1
    Postmenopausal
    Comorbidities:
    Type 2 diabetes
    Osteoarthritis

Breast cancer characteristics
    ER+/PR-
    T1 (1 cm)
    Grade 1
    No nodal involvement
    HER-2/neu-
    Lumpectomy
    Radiation

 interactive Q&A about Annette's case.

FEMARA® patient case study #4: Astrid



Clinical profile
    Age 55
    Stage I
    Postmenopausal
    Comorbidity: Hypertension

Breast cancer characteristics
    ER+/PR-
    T1 (0.5 cm)
    Grade I
    No nodal involvement
    HER-2/neu-
    Lumpectomy
    Radiation 

interactive Q&A about Astrid's case.

FEMARA® is indicated for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer.
Click here for Important Safety Information for FEMARA®.

References 1. Rugo H, Rourke M, Dranitsaris G, Kaura S. Letrozole or anastrozole for the prevention of early recurrences in post menopausal women with early stage breast cancer: using number needed to treat (NNT) to compare benefit (abstract). EJC Supplements. 2008;6(7):118 (Abstract 236). 2. Mansell J, Monypenny IJ, Skene AI, et al. Distant metastasis-the most common type of early recurrence with adjuvant tamoxifen therapy. Poster presented at: 30th Annual San Antonio Breast Cancer Symposium; December 13-16, 2007; San Antonio, Texas.