A 48 years old African American female with a history of hypertension, dyslipidemia, twenty years history of smoking cigarettes; the patient’s mother, ex-smoker, was diagnosed with lung cancer two years ago. The patient notices a discharge from her right breast after a self-breast exam. However, she does not feel anything different about her breast.
Smoking cigarettes is a predisposing factor in the development of breast cancer. Moreover, the patient’s mother has been diagnosed with lung cancer, which queries biological predisposition to cancer. On the other hand, hypertension and dyslipidemia acts as precipitating factors to malignancy (Gøtzsche & Jørgensen, 2013).
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The patient’s family history is that she has been a widow for twelve years, she has four children, the eldest son is in college, and the second and third sons are in high school while her last born daughter is in elementary school. On the past medical treatment, the patient has been on Onglyza medication twice a day for the last three months and Varenicline once a day. The patient has also been admitted to a rehabilitation center for three months because of her cigarette addiction. Some of the subjective illnesses include diabetes, hypertension, abnormal heart rhythms, and panic attacks. The patient reported that she experiences difficulty breathing; sometimes back, she had convulsive seizures before quitting cigarette smoking and now the relevant painless discharge from her right breast (Macacu et al., 2015). It is non-relevant that she has not done a mammogram before.
A physical examination is done. The patient’s BP is 165/111 mmHg, Pulse 98. Random blood sugar test reads 230mg/dl. The patient is diabetic and hypertensive. The breast exam and the mammogram test reveal a tumor in the breast. A biopsy test reveals a breast carcinoma (Maskarinec et al., 2017; Welch et al., 2016). The final diagnosis is ductal carcinoma in situ. Prioritized differential diagnosis includes hypertension and diabetes mellitus.
References
Gøtzsche PC, Jørgensen KJ. (2013). Screening for breast cancer with mammography. Cochrane Database Syst Rev .;6:CD001877
Macacu A, Autier P, Boniol M, Boyle P. (2015). Active and passive smoking and risk of breast cancer: a meta-analysis. Breast Cancer Res Treat . 213-224.
Maskarinec G, Jacobs S, Park SY, et al. (2017). Type II Diabetes, Obesity, and Breast Cancer Risk: The Multiethnic Cohort. Cancer Epidemiol Biomarkers Prev . 854-861.
Welch, H. G., Prorok, P. C., O’Malley, A. J., & Kramer, B. S. (2016). Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. New England Journal of Medicine , 375 (15), 1438-1447.
