Robert A. Buckman, M.D., Ph.D.
Adjunct professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center
Okay, so let's start by describing our patient's situation. Mrs. Simpson is a woman of 55 who was diagnosed with primary breast cancer just over 10 years ago at another hospital. The primary was node positive and also estrogen and progesterone receptor positive, ER-positive, PR-positive. So, Mrs. Simpson had adjuvant chemotherapy then she had 5 years of hormone therapy. She moved into your geographic area about a year ago and transferred to your care for routine follow up. She remained completely well for just about 5 years after completing her endocrine therapy until about 3 weeks ago. Then she suddenly developed low back pain which her physician told her was probably muscular in origin. She telephoned your office, and by your primary care nurse, you arranged a bone scan to be done this morning and for her to be seen by you this afternoon, okay? The bone scan shows multiple boney metastases.
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