Millie


Date: Sat, 02 Oct 2004 23:39:54 -0700

08 02 04 61 04100201




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...
  1. Original diagnosis February 2002 lump under the arm and in the breast, with "out of capsule" condition.
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  2. IBC diagnosed in April 2004, symptoms begin in December 2002.
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Please call *** *** **** to schedule a meeting, or respond by email.

Thanks.

Sincerely,



Millie

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Copy to:
  1. Stanford Medical Center

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