CONTACTS 

SUBJECTS
Meeting with Doctor at Kaiser Review Rising CA 15-3 Cancer Marker Di
CA 15-3 46 Rises from 37 Reversing Prior Trend Reported Last Month

0604 -
0604 -    ..
0605 - Summary/Objective
0606 -
060601 - Follow up ref SDS 48 0000. ref SDS 46 0000.
060602 -
060603 - CA 15-3 has risen from 45 to 54, ref SDS 0 SM6M, and CT scan reports 2
060604 - new 1 CM lymph nodes have developed, but significance is uncertain.
060605 - ref SDS 0 SP5S  The doctor noted that ASCO patient guide says CA 15-3
060606 - test is effective for determining when treatment fails. ref SDS 0 M28G
060607 - Millie reported evident increase in size and discomfort of a new lump
060608 - where the surgery was performed on 020312; the doctor examined this
060609 - area and did not feel a lump. ref SDS 0 7C84  Patient asks about
060610 - taking another biopsy to assess relapse. ref SDS 0 7C98  The doctor
060611 - scheduled another CT test for July that will be assessed in the next
060612 - meeting. ref SDS 0 GK65
060613 -
060614 -     [On 030606 meeting with the doctor resulted in analysis that
060615 -     continued growth of new lump under the arm is scar tissue, and not
060616 -     new metastasis. ref SDS 50 7C6W
060617 -
060618 -
060619 -
060620 -
060622 -  ..
0607 -
0608 -
0609 - Discussion
0610 -
061001 - Recovery Progress CA 15-3 Cancer Marker Rises 20% from 45 to 54
061002 - CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 20%
061003 -
061004 - Follow up ref SDS 48 SM6M, ref SDS 46 SM6M.
061005 -
061006 - The doctor submitted results of the latest blood test on 030503
061007 - showing the CA 15-3 cancer marker has increased from 45 to 54,
061008 - continuing the rise reported on 030220.  Millie did a test a month
061009 - earlier test on 030403 that showed a drop from 46 to 45, so in 4
061010 - weeks, there was a 20% rise....
061012 -           ..
061013 -          030503......... 54 H............. 030508, ref SDS 0 SM6M
061014 -          030403......... 45 H............. 030508, ref SDS 0 SM6M
061015 -          030220......... 46 H............. 030220, ref SDS 48 5E6L
061016 -          030106......... 37 H............. 030109, ref SDS 46 SM6M
061017 -          021202......... 41 H?............ 021204, ref SDS 42 SP5G
061018 -          021102......... 36 H?............ 021113, ref SDS 41 Y65I
061019 -          021023......... 33 H?............ 021023, ref SDS 40 SQ5I
061020 -          020930......... 33 H?..29........ 021002, ref SDS 39 SQ5I
061021 -          020917......... 36 H?............ 020924, ref SDS 38 SQ5I
061022 -          020717......... 59 H?............ 020726, ref SDS 37 YN5K
061023 -          020629......... 75 H ............ 020705, ref SDS 35 UX6I
061024 -          020608........  67 H ............ 020614, ref SDS 31 0001
061025 -          020603........ 108 H ............ 020607, ref SDS 29 X67F
061026 -          020511........ 117 H ............ 020603, ref SDS 28 PJ4J
061027 -          020419......... 81 H ............ 020430, ref SDS 24 7N5H
061028 -          020321......... 85 H ............ 020405, ref SDS 14 6T8K
061029 -
061031 -  ..
0611 -
0612 -
0613 - Analysis
0614 -
061401 - 20% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
061402 -
061403 - Follow up ref SDS 48 GJ5M
061404 -
061405 - The doctor indicated that a 20% rise in CA 15-3 from 45 to 54 over the
061406 - past four (4) weeks, per above, ref SDS 0 SM6M, and which extends a
061407 - 25% rise reported on 030220. ref SDS 48 SM6M, is not necessarily a
061408 - cause for concern at this time in relation to carcinoma and distant
061409 - metastasis, explained during the meeting on 020321. ref SDS 12 6R5X
061411 -  ..
061412 - Today, we asked about ASCO guidance saying several investigators
061413 - describe 25% change in CA 15-3 as significant. ref SDS 48 I56K  Lack
061414 - of concern about 25% rise in CA 15-3 appears conflicting with The
061415 - doctor's assessment on 030109 that a 10% drop shows favorable effects
061416 - of treatment. ref SDS 46 GJ5M  If a 10% drop was significant, then why
061417 - isn't a compound 20% rise very significant today?
061419 -  ..
061420 - The doctor discussed CA 15-3 testing in relation to results of the CT
061421 - scan test below. ref SDS 0 VN3Y
061423 -  ..
061424 - Will continue blood tests, per planning below for next visit in May.
061425 - ref SDS 48 M28G
061426 -
061427 -
061428 -
061429 -
061430 -
061431 -
061432 -
0615 -

SUBJECTS
PET Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
Distant Metastasis New Nonspecific May be Post Treatment Trauma Infla
CT Scan Performed for Comparison with PET Scan to Evaluate New Metast
CT Scan Findings Show Previous Metastatic Lymphadenopathy No Longer A
2 New 1 CM Masses in Area of Prior Surgery for Lymph Nodes CT Scan Fi
Distant Metastasis Not Reported in CT Test on 030508
Fibrotic Densities Referenced CT Report 030428 Received on 030508 Sa

1309 -
131001 -  ..
131002 - Fibrotic Densities Referenced to Prior CT Report Unsupported
131003 - CT Scan Shows No Evidence of Carcinoma Activity
131004 -
131005 - Follow up ref SDS 48 LK5L, ref SDS 46 LK5L.
131006 -
131007 - The doctor submitted results of the CT scan test ordered on
131008 - 030220, ref SDS 48 GK65, and performed on 030428....
131010 -      ..
131011 -     Patient
131014 -      ..
131015 -     CT of the Chest
131019 -      ..
131020 -     History
131022 -      ..
131023 -     Follow up.  History of breast cancer.
131025 -      ..
131026 -     Findings
131028 -      ..
131029 -     Comparison:  030128
131030 -
131031 -         Reported in the record on 030220. ref SDS 48 LK5L
131032 -
131033 -            [On 030710 compare CT scan on 030626. ref SDS 51 AL6N
131035 -      ..
131036 -     A spiral CT of the chest was performed with the use of intravenous
131037 -     contrast.  Signed informed consent was obtained.
131039 -      ..
131040 -     There are some fibrotic densities seen in the chest, primarily in
131041 -     the left apex and also paralleling in the inferior mediastinum.
131042 -     These have decreased since the prior study.  There are no
131043 -     pulminary nodules.  There is no significant mediastinal or hilar
131044 -     adenopathy.
131045 -
131046 -         Where are "fibrotic densities" discussed in the prior report
131047 -         date 030128 and submitted by The Doctor on 030220?
131048 -         ref SDS 48 GJ4S
131050 -      ..
131051 -     There are irregular densities located medially deep to the left
131052 -     breast.  There may be some calcifications and surgical clips in
131053 -     this area.  There may be a well circumscribed 1 CM fluid density
131054 -     located superiorly.  There is some subcutaneous or skin deflect
131055 -     seen in the upper part of the breast.  This may be the region of
131056 -     the patient's previous surgery in the left breast.  There are some
131057 -     small lymph nodes measuring less than 1 CM in size located in the
131058 -     left axilla on the current study.  These were not present on the
131059 -     prior examination.
131060 -
131061 -         [On 030710 CT scan shows 2 swelled lymph nodes in left axilla
131062 -         increased in size from less than 1 CM to 1.5 CM. ref SDS 51
131063 -         VM7I
131065 -          ..
131066 -         [On 030710 CT test "Impression" does not discuss lymph nodes
131067 -         that grew from less than 1 to 1.5 CM. ref SDS 51 GJ69
131069 -      ..
131070 -     Impression
131071 -
131072 -     1.  Decreasing presumed post-inflammatory or therapeutic changes
131073 -         in the left lung.
131075 -          ..
131076 -     2.  There are two small less than 1 CM lymph nodes in the left
131077 -         axilla. These were not present on the prior examination of
131078 -         030128, and there significance is uncertain.
131079 -
131080 -                    [On 030710 CT test does not remark on lymph nodes
131081 -                    that grew from 1 to 1.5 CM. ref SDS 51 SP5S
131083 -              ..
131084 -             How does this report correlate to the report submitted on
131085 -             030220 saying in part...
131087 -                  ..
131088 -                 A few small lymph nodes in the mediastinum which do
131089 -                 not meet the criteria for malignancy.
131091 -                  ..
131092 -                 No evidence of axilary lymphadenopathy. ref SDS 48
131093 -                 SP5S
131095 -          ..
131096 -     3.  Postsurgical changes in the left breast.
131097 -
131099 -      ..
131100 -     Signed informed consent was obtained.
131105 -      ..
131106 -     RAD.REP
131107 -     MTZRAJ  030508 1727
131108 -
131109 -
131111 -  ..
1312 -
1313 -
1314 - Analysis
1315 -
131501 - The doctor advised that the CT scan report, per above, ref SDS 0
131502 - SP5S, shows possible new cancer activity in the area where lymph nodes
131503 - were removed through surgery on 020312. ref SDS 9 7V61
131505 -  ..
131506 - He indicated the mass discovered that is less than a centimeter, per
131507 - report results, ref SDS 0 SP5S, is too small for a determination that
131508 - new cancer has in fact formed.  The doctor said another PET scan could
131509 - be performed.
131510 -
131511 -            [...below doctor says CT and PET scan testing more reliable
131512 -            than CA 15-3 cancer biomarker tests for determining
131513 -            recurrent disease. ref SDS 0 7C7K
131515 -             ..
131516 -            [On 030710 CT test reports lymph nodes grew from 1 to 1.5
131517 -            CM. ref SDS 51 SP5S
131519 -  ..
131520 - There is no evident finding of distant metastasis, which aligns with
131521 - understandings from the CT scan test reported on 030220, ref SDS 48
131522 - GK51, and the prior PET test reported on 030109. ref SDS 46 GK61
131523 -
131524 -
131525 -
131526 -
1316 -

SUBJECTS
CA 15-3 54 50% Increase from 33 Doctor No Concern Cancer Recurrence

1903 -
190401 -  ..
190402 - CA 15-3 Not Recognized by ASCO for Diagnosis Identifies Relapse
190403 -
190404 - The doctor advised that 20% rise over 4-weeks in CA 15-3 should not
190405 - cause patient concern, reported today per above, ref SDS 0 GJ5M,
190406 - because this test is not recognized for diagnosis of cancer by the
190407 - American Society of Clinical Oncology (ASCO).
190408 -
190409 -     [On 041018 seems to align with practice at UCSF Cancer Center;
190410 -     Doctor Benz indicated CA 15-3 cancer biomarker is not used to
190411 -     assess patient status at UCSF. ref SDS 59 KX5L
190413 -      ..
190414 -     [On 041019 Doctor Guardino indicated that CA 15-3 is not used for
190415 -     cancer marker at Stanford Cancer Center. ref SDS 60 Y15N
190417 -  ..
190418 - The doctor submitted a document with the title...
190420 -          ..
190421 -         "Patient's Guide, Follow-up Care for Breast Cancer."
190423 -  ..
190424 - The Doctor pointed to the heading on page eight (8) that says....
190425 -
190426 -       Tests Not Recommended by ASCO for Routine Follow-up Care
190428 -  ..
190429 - He read the entry on page eight (8), which says....
190430 -
190431 -       Breast Cancer Tumor Markers CA 15-3, CA 27.29, and CEA --
190432 -       increases in these markers are measured as a method of detecting
190433 -       recurrence.
190435 -  ..
190436 - The basis was not clear from this language for the doctor's indication
190437 - today that ASCO does not "recognize" CA 15-3. ref SDS 0 M28G
190438 -
190439 -        [On 030710 doctor restates that ASCO does not recognize CA 15-3
190440 -        to evaluate breast cancer. ref SDS 51 WS42
190442 -  ..
190443 - The doctor seemed to relate that ASCO guidance he cited in the manual
190444 - suggests that continued rise in CA 15-3 from 33 on 021023, ref SDS 40
190445 - SQ5I, to 46 on 030220, ref SDS 48 5E6L, and then further rise to 54 in
190446 - the report today, per above, ref SDS 0 SM6M, does not suggest relapse
190447 - that requires treatment, following completion of adjuvant treatment on
190448 - 021204, ref SDS 42 0001, and as reported by the doctor on 021206.
190449 - ref SDS 43 SM6M
190451 -         ..
190452 -        [On 040517 rise of CA 15-3 was discussed in the document
190453 -        submitted on the Tumor Board "minutes" as indicating failed
190454 -        treatment. ref SDS 57 4R59
190456 -         ..
190457 -        [On 041018 Doctor Benz indicated that UCSF Cancer Center does
190458 -        not rely on CA 15-3 testing to evaluate breast cancer patients;
190459 -        dramatic changes in CA 15-3 can be meaningful. ref SDS 59 KX5L
190461 -         ..
190462 -        [On 041019 Doctor Guardino indicated that CA 15-3 is not used
190463 -        for cancer marker at Stanford Cancer Center. ref SDS 60 Y15N
190465 -  ..
190466 - There was discussion of ASCO research on 030220, ref SDS 48 ZL4X,
190467 - showing that rise in CA 15-3 cancer marker can point to relapse,
190468 - ref SDS 48 YV92, and should be interpreted by the physician in
190469 - conjunction with other clinical data. ref SDS 48 SZ4G
190471 -  ..
190472 - The doctor seemed familiar with ASCO standards on CA 15-3, in addition
190473 - to Kaiser documentation presented during the meeting, per above.
190474 - ref SDS 0 M28G  The doctor related that clinical assessment from
190475 - examination, together with CT scan and PET scan testing provide data
190476 - for evaluating progression of disease along with CA 15-3 tests
190477 - results.  The doctor advised that results of the CT test on 030428,
190478 - shown above, ref SDS 0 LK5L, indicate there is no evidence of
190479 - recurrent disease at this time, per above. ref SDS 0 GK51
190480 -
190481 -     [On 030606 meeting with the doctor reported that CA 15-3
190482 -     test results deserve attention. ref SDS 50 VY7G
190484 -      ..
190485 -     [On 030710 testing has not established recurrence; CA 15-3 test
190486 -     continues rising to 68, ref SDS 51 XX4G; doctor relates CA 15-3 80
190487 -     signaled need for action by the medical team to treat another
190488 -     patient; doctor cites ASCO guidance again for support that rising
190489 -     CA 15-3 should not alarm patient. ref SDS 51 WS42
190491 -      ..
190492 -     [On 040812 the doctor advised that side effects of weekly
190493 -     cancer treatments that reduce energy levels and cause bleeding
190494 -     nose, coughing, heaviness in the chest, and difficulty breathing
190495 -     beginning on 040517, ref SDS 57 RZ4I, must be endured in order to
190496 -     reach a stable condition where CA 15-3 is consistently below 39.
190497 -     ref SDS 58 GJ5M
190499 -      ..
190500 -     [On 071023 Doctor Rugo at UCSF explains cancer marker increase
190501 -     from 56 in May to 74 in October guides looking more carefully and
190502 -     does not suggest cut off of 80 for consideration of treatment
190503 -     regimen. ref SDS 62 V65R
190504 -
190505 -
190506 -
190507 -
190508 -
1906 -

SUBJECTS
Discomfort Swelling Increase Under Left Arm Tired Low Energy Clinica
Patient Symptoms Guide Kaiser for Performing Treatment of Cancer Rel
Quality of Life Treatment Objective Metastatic Cancer Not Cure Prolo
Symptom New Lump Under Arms where Cancer Surgery Performed on 020312
Biopsy Unnecessary and CT Test Deferred another Month

2407 -
240801 -  ..
240802 - Kaiser Relies on Patient Clinical Symptoms to Treat for Relapse
240803 -
240804 - Millie asked the doctor what indications Kaiser relies on to
240805 - identify relapse that supports further treatment?
240807 -  ..
240808 - The doctor said that Kaiser goes by how the patient is feeling.
240809 - He said a lot of testing can be performed, but the best indicator of
240810 - problems is when the patient begins to suffer symptoms that impact
240811 - life-style.
240812 -
240813 -
240815 -  ..
240816 - Lump Under Left Arm Getting Bigger
240817 -
240818 - Millie related that she generally feels strong and healthy.  She
240819 - continues to work out regularly and her vital signs are normally
240820 - pretty good in the range of 125 75 55, except when she visits the
240821 - doctor, and then things seem to elevate.
240823 -  ..
240824 - The doctor said that elevated blood pressure is pretty normal for
240825 - people visiting the hospital.
240827 -  ..
240828 - Millie advised that a lump seems to be getting bigger under her arm
240829 - where the prior surgery was performed, and where the CT scan test
240830 - reports finding 2 new less than 1 CM masses that were not present in
240831 - the prior exam, per above. ref SDS 0 VM8N  She placed her fingers on
240832 - the area, and asked The Doctor to check this area.   She recalled that
240833 - on 020208 she reported a lump in this same location, ref SDS 7 0001,
240834 - and this led to a biopsy and then surgery on 020312. ref SDS 9 7V61
240835 -
240836 -        [On 030606 lump bigger, more discomfort under left arm.
240837 -        ref SDS 50 Y45M
240839 -  ..
240840 - The doctor placed his fingers on the area Millie identified, and
240841 - said he does not feel anything.  He said that often scar tissue can
240842 - form from surgery and/or reaction to radiation, and noted this may be
240843 - what is reported in the CT scan today, ref SDS 0 VM8N, but noted it is
240844 - too soon to make a determination, because the material is too small
240845 - for testing.
240846 -
240847 -
240849 -  ..
240850 - Biopsy Unnecessary and CT Test Deferred another Month
240851 - Discover Treat Cancer Before Relapse Gets Out of Control
240852 - Quality of Life Treatment Objective During Eventual Decline
240853 -
240854 - Millie asked about taking a biopsy to see if discomfort caused by
240855 - lumps uner the left arm is cancerous in light of the prior record on
240856 - 020208 when lumps under the arm were reported and a biopsy was ordered
240857 - at that time? ref SDS 7 0001
240859 -  ..
240860 - The doctor commented today that Kaiser practices strive to maintain
240861 - quality of life through the period of treatment and in the event of
240862 - eventual decline.
240864 -  ..
240865 - Millie asked if a biopsy could assist in discovering and treating
240866 - cancer before problems get out of control?
240868 -  ..
240869 - The doctor advised that a biopsy is not needed, and suggested
240870 - doing another CT scan in July, 2003 for follow up, as was done during
240871 - the prior visit on 030220. ref SDS 48 GK65
240873 -  ..
240874 - Why was biopsy and surgery scheduled immediately when lumps were
240875 - reported on 020208, but there is no urgency today when new lumps
240876 - appear in the same area?
240878 -      ..
240879 -     [On 030606 doctor noticed lumps under left arm have grown to
240880 -     become definitely noticable; and determined lumps most likely are
240881 -     not cancer, so biopsy not ordered. ref SDS 50 Y45M
240883 -      ..
240884 -     [On 030606 doctor discloses that patient likely candidate to
240885 -     relapse due to metastatic disease. ref SDS 50 589J
240887 -      ..
240888 -     [On 030710 report on CT test performed 030626 shows lymph nodes
240889 -     grew from 1 to 1.5 CM. ref SDS 51 AL6N
240891 -      ..
240892 -     [On 031010 article reports breast cancer relapses in 50% of cases
240893 -     within 2 years. ref SDS 52 IM6N
240895 -      ..
240896 -     [On 040227 biopsy ordered for lumps in the neck. ref SDS 53 0001
240898 -      ..
240899 -     [On 040318 biopsy showed cancer relapse that requires immediate
240900 -     treatment. ref SDS 54 8R6M
240902 -      ..
240903 -     [On 040504 doctor normally orders biopsy to evaluate inflammed,
240904 -     red coloration on breast cancer patients, but invariably tests are
240905 -     negative, so biopsy was not ordered in this case. ref SDS 56 WI8F
240907 -      ..
240908 -     [On 040419 biopsy performed after examination by surgeon.
240909 -     ref SDS 55 1572
240911 -      ..
240912 -     [On 040517 biopsy disclosed patient suffers rare disease
240913 -     inflammatory breast cancer (IBC). ref SDS 57 6T5G
240915 -      ..
240916 -     [On 040710 CT scan shows 2 swelled lymph nodes had increased in
240917 -     size from 1 CM to 1.5 CM. ref SDS 51 VM7I
240919 -      ..
240920 -     [On 041210 patient's daughter asks why her mom's cancer cannot be
240921 -     cured; doctor explains treatment goals for quality of life.
240922 -     ref SDS 61 9Q7H
240924 -  ..
240925 - Schedule next meeting with The Doctor in July and will have CA 15-3
240926 - blood test a week prior.
240928 -  ..
240929 - Following the meeting with The Doctor, we went to the medical imaging
240930 - department, and scheduled the CT scan for April.
240932 -  ..
240933 - Kaiser will submit notice of the date set for the CT scan test.
240934 -
240935 -
240936 -
240937 -
240938 -
240939 -
240940 -
240941 -
2410 -