61-Year-Old Woman of Jewish Heritage Diagnosed with Breast Cancer
A 61-year-old woman of Ashkenazi Jewish ancestry was referred for evaluation of a palatable mass that she discovered in her left breast. She has no family history of breast or ovarian cancer. Thirty years ago, she experienced a fibroadenoma in her left breast and had an excisional biopsy. Her physical exam confirmed the presence of a 3 cm mass in her left breast.
Mammography confirmed the mass, with characteristics suggestive of cancer. An ultrasound showed an irregular mass measuring 3.2 x 1.4 x 1.3 cm. The left axillary lymph nodes appeared normal.
A core-needle biopsy was obtained — results showing invasive ductal carcinoma, grade 2. There was no lymphovascular invasion or carcinoma in situ. Immunohistochemical staining showed:
Strongly positive for estrogen receptor (ER) and progesterone receptor (PR)
HER2 overexpression was equivocal with no amplification
What is the recommended course of treatment?
Should this patient be vaccinated against COVID-19 before treatment begins?