Author Affiliation: Dr Spiegel is Professor and Associate Chair, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.
Clinical Crossroads at Beth Israel Deaconess Medical
Center is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley,
MD, and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor. Clinical
Crossroads section editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
DR PARKER: Mrs K is a 43-year-old woman with
metastatic breast cancer. Formerly an elementary school teacher, she now stays
home with her husband and 5-year-old son. She has private insurance and has
experienced no restrictions in her complex care.
Her mother died of breast cancer at age 58 years. Therefore, Mrs K started
breast self-examinations at age 20 years and mammograms every 6 months at
age 25 years. Due to the birth of her child and breast-feeding, she had an
interval of 2 years without a mammogram. During that period in 1995, she detected
a breast lump, which was malignant. She underwent a modified radical mastectomy
followed by cyclophosphamide, methotrexate, and fluorouracil chemotherapy
for 6 months. At the time of surgery, lymph nodes were negative.
Spiegel D. A 43-Year-Old Woman Coping With Cancer. JAMA. 1999;282(4):371-378. doi:10.1001/jama.282.4.371