EPI204 Forum

Greetings, students!  Welcome to the Epi 204 forum!

To find what small group you are in you need to go the the Epi 204 TICR (not CLE) website and click on Roster (and wait a little):

http://ticr.ucsf.edu/courses/schedule/clinical_epi.html

Problem 1.4 in the text has gotten out of date, so I wrote a new one.  I also made slight edits to the other problems, just to make them easier to for folks with less medical background, like explaining what a thoracentesis is.  The revised problem set is posted on the CLE site under required reading for today's section.

I'm also pasting it below for your convenience: 

Cheers!

Tom

PS don't be so shy in lecture!

NEW PROBLEM 1.4

4.    (Real case!) A 56-year-old woman had a prophylactic mastectomy because she had tested positive for BRCA-2, a gene that greatly predisposes to breast cancer.  The preoperative mammogram and MRI were negative, but the removed specimen shows multifocal low-grade (estrogen- and progesterone-receptor positive) lobular breast cancer (largest tumor diameter 1.1 cm).  Her two oncologists and the tumor board all say an axillary lymph node dissection to determine whether the axillary nodes are involved is essential for staging.  The staging will be used to determine whether she should receive chemotherapy in addition to hormone therapy, which is standard for estrogen-receptor positive breast cancers.  However, a commercial genetic test panel (OncoType DX), run on her tumor tissue at the suggestion of her cousin, gives a result of 7; anything < 18 is considered low risk of recurrence.  The OncoType DX report provides the following risks if she were to be treated with tamoxiphen (an estrogen antagonist) therapy alone or tamoxiphen + chemotherapy:

Recurrence or mortality risk for OncoTypeDx score =7 (95% CI) by treatment and nodal involvement

Do you agree with her treating clinicians that the axillary node dissection is essential?  What would be some reasons to do it or not do it?