Initial oncology consultation

Dear DR Chen

Thank you for asking me to meet with this patient for further management of stage IIA invasive ductal carcinoma of the left breast

As you know, Margaret Vance is a 62-year-old female

She initially detected a painless lump in the upper outer quadrant of her left breast during self-examination in early 02/2026. She denies any nipple discharge, skin dimpling, bone pain, SOB, or constitutional symptoms such as fever, night sweats, or unintentional weight loss. She underwent a left breast lumpectomy and sentinel lymph node biopsy on 18/03/2026 and has recovered well post-operatively with minimal incisional discomfort.

Investigations done so far: Bilateral diagnostic mammogram and targeted US on 14/02/2026 demonstrated a 2.3 cm spiculated mass in the left breast at the 2 o'clock position with no suspicious axillary lymphadenopathy. Ultrasound-guided core needle biopsy on 20/02/2026 confirmed grade 2 invasive ductal carcinoma. Final surgical pathology from the lumpectomy on 18/03/2026 revealed a 2.4 cm grade 2 invasive ductal carcinoma with negative surgical margins and negative lymphovascular invasion. Zero of 2 sentinel lymph nodes were involved (pT2 N0 M0). Immunohistochemistry showed the tumour is ER positive (95 %), PR positive (80 %), and HER2 negative (IHC 1+). Baseline staging bloodwork including CBC, renal function, liver enzymes, and alkaline phosphatase on 25/03/2026 was entirely within normal limits. Oncotype DX recurrence score is currently pending.

Past Medical History

Her past medical history is significant for essential HTN, dyslipidemia, and osteopenia. Her past surgical history includes a laparoscopic cholecystectomy in 2014 and her recent left lumpectomy and sentinel node biopsy. She is post-menopausal, having undergone natural menopause at age 51, and has never used hormone replacement therapy.

Medications

Her current medications include amlodipine (Norvasc®) 5 mg PO daily, rosuvastatin (Crestor®) 10 mg PO daily, cholecalciferol (vitamin D3) 1,000 IU PO daily, and calcium carbonate 500 mg PO daily.

Drug allergies: Penicillin (maculopapular rash)

Social History

She is a lifetime non-smoker and consumes 1 to 2 glasses of wine per week. She works full-time as an elementary school librarian. She is married and lives in a single-story house in Toronto with her husband. They have two adult children who live locally and are very supportive.

Physical Examination

On physical examination today, she is alert, oriented, and in NAD with an ECOG performance status of 0. Vital signs show a BP of 128/76 mmHg, HR of 72 bpm, RR of 14 breaths/min, temperature of 36.7 °C, weight of 68 kg, and height of 165 cm. There is no palpable cervical, supraclavicular, or bilateral axillary lymphadenopathy. Breast examination reveals a well-healing left upper outer quadrant lumpectomy scar and left axillary sentinel node biopsy incision without erythema, warmth, or significant seroma; the right breast exam is unremarkable. Heart sounds are normal with no murmurs, and lungs are clear to auscultation bilaterally. The abdomen is soft and non-tender with no hepatosplenomegaly.

Impression

Margaret is a 62-year-old post-menopausal female with completely resected stage IIA (pT2 N0 M0), hormone receptor-positive, HER2-negative invasive ductal carcinoma of the left breast. We discussed the role of adjuvant systemic therapy to reduce the risk of distant recurrence. Final recommendations regarding adjuvant chemotherapy will be guided by the pending Oncotype DX recurrence score; if the score is low, she will proceed directly to adjuvant radiation therapy followed by 5 years of adjuvant endocrine therapy with an aromatase inhibitor such as anastrozole 1 mg PO daily. Given her history of osteopenia, I have ordered a baseline BMD scan prior to initiating an aromatase inhibitor. I have also placed a referral to Radiation Oncology for consideration of adjuvant whole-breast irradiation, and I will review her in clinic in 3 weeks once the genomic assay results are available.

Once again, thank you for involving me in her care. if you have any questions or concerns, please do not hesitate to contact me.