Scribe BC - Adjuvant breast consult

"Patient: Jane Doe, Date of Birth: 01/01/1970, Age: 54, Gender: Female Date and Time of Consultation: 01 November 2024, 10:00 AM Reason for Consultation: Consultation for adjuvant breast cancer treatment. History of Present Illness: Patient diagnosed with invasive ductal carcinoma of the right breast. Underwent lumpectomy and sentinel lymph node biopsy. Pathology revealed pT2N1MX, grade 2, ER 90%, PR 70%, HER2-negative. Patient is now being evaluated for adjuvant therapy. Past Medical History: Hypertension, controlled with medication. Medication Lisinopril 10 mg daily Allergies No known drug allergies. Social History Non-smoker. Drinks alcohol occasionally. Employed as a teacher. Lives with her husband and two children. Good social support system. Family History Mother had breast cancer diagnosed at age 65. Father has history of prostate cancer. Physical Exam Alert, attentive, and in no distress. There is no evidence of peripheral lymphadenopathy. Cardiovascular and respiratory exams are unremarkable. No tenderness on palpation of the spine. Abdominal is soft and nontender, with no palpable masses. No hepatosplenomegaly. No peripheral edema. Bilateral breast exam was unremarkable with no worrisome masses or skin changes. Investigations Pathology report from lumpectomy and sentinel lymph node biopsy. Assessment/Plan Jane is a 54-year-old female with a pT2(3.5cm) N1(1/3) MX, grade 2, ER+ (90%) PR(70%) HER2-negative, invasive ductal carcinoma of the right breast. Overall, Jane has a stage II breast cancer. I have estimated her 10-year risk of recurrence with no further treatment to be approximately 25%. This can be reduced to 12% with a combination of letrozole. Since Jane's breast cancer is estrogen receptor positive, hormone therapy is strongly recommended. I have recommended 5 years of letrozole. I discussed the side effects which include, but are not limited to, myalgias, arthralgias, hot flashes, fatigue, and a risk of osteopenia and osteoporosis over time. 5 years of letrozole would be expected to reduce her relative risk of recurrence by 50%. Finally, we discussed chemotherapy. Given her high risk breast cancer, I have recommended the chemotherapy regimen BRAJACTG which is expected to decrease her relative risk of recurrence by 1/3. This is an 8 cycle regimen with doxorubicin and cyclophosphamide given every 2 weeks for 4 cycles, followed by paclitaxel given every 2 weeks for another 4 cycles. The side effects include, but are not limited to, myelosuppression and a risk of febrile neutropenia, chemotherapy associated alopecia, fatigue, nausea, vomiting, diarrhea, mucositis, peripheral neuropathy, myalgias and arthralgias, hypersensitivity reactions, and a small risk of cardiotoxicity. I have recommended G-CSF support given the myelosuppressive nature of this chemotherapy and have arranged this today. I have also given her a prescription for antinausea medications. She has consented to starting chemotherapy and I will arrange for her first cycle to start in the next few weeks. I will see her prior to cycle #2. Thank you, it has been a pleasure to be involved in the care of Jane. Medical Oncology This document was created using AI Ambient Scribe and Front-End Speech Recognition software and may include incorrect spelling/words. Consent for usage of AI was obtained by patient/guardian.