University of California San Francisco
Medical Center
Carol Franc Buck Breast Care Center
Admissions
1600 Divisadero, Second Floor
San Francisco, CA 94115
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Subject:
2nd Opinion Breast Cancer IBC
I need a 2nd opinion on my condition and treatment options. I am currently
being treated at Kaiser for breast cancer, originally diagnosed OA Feb 8,
2002. In April of this year, I was diagnosed with IBC.
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I have completed 6 cycles on the Avastin protocol, and need to make a
decision on whether to continue, stop and have a mastectomy, or simply to
stop treatment altogether on the grounds that diagnostics using CT scans
have not identified distant metastasis, and show that all tumors have been
significantly reduced or been eliminated. A complicating factor seems to
be that if I opt for surgery, then I can no longer get treatment with
Avastin, even if the evidence shows the treatment is effective. So, there
is a dilemma, and I need guidance on resolving it.
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CA 15-3 has declined from about 80 down to about 42, and lately went up
slightly, then came down again, possibly indicating continuing cancer
activity, or even failed treatment. I am not sure from discussions with
the attending physician what criteria establish success or failure of
treatment.
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Redness has largely, but not fully, been eliminated from the breast
infected with IBC; I am not sure from discussions with the doctor about
criteria for knowing when to decide about having surgery, which seems to be
the standard treatment for IBC.
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I would like a physician to review the case history to see if anything has
been overlooked that might indicate distant metastasis. Kaiser had the
case reviewed by a "Tumor Board" in April. Their report did not seem
comprehensive nor offer helpful guidance. The Tumor Board made no finding
on distant metastasis; the attending physician feels that lumps in the
neck, which are symptoms of IBC, establish metastasis. I want a 2nd
opinion.
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If you need authorization to get the medical chart, please let me know.
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I would like to know if you can work through Kaiser for payment, or if you
will be billing me directly, and in that case I need an estimate of the
approximate cost for a 2nd opinion.
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Two case studies assembled following diagnosis of IBC in April, may facilitate
your review...