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Clinical Crossroads
July 28, 1999

A 43-Year-Old Woman Coping With Cancer

Author Affiliations

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.

JAMA. 1999;282(4):371-378. doi:10.1001/jama.282.4.371

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.

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