Breast Cancer Recurring 18 Years After Mastectomy

What happened, in summary

A 70-year-old woman had been treated for an early right-breast cancer with mastectomy. Because her recurrence risk was considered low, she did not receive chemotherapy or radiation. She completed 5 years of tamoxifen.

Eighteen years later, the breast cancer returned in the sternum and lungs, with right pleural and chest-wall involvement. Letrozole and denosumab did not control the disease, so she entered a clinical trial of everolimus and fulvestrant. Everolimus was stopped when breathlessness and lung changes were attributed to drug-related pneumonitis, which improved with corticosteroids. While off everolimus, the cancer progressed. She completed 6 cycles of fluorouracil, epirubicin, and cyclophosphamide, followed by exemestane and later tamoxifen. A recurrent right pleural effusion was managed with pleurodesis.

She was later admitted with worsening breathlessness and cough. Despite treatment for suspected inflammation and infection, she deteriorated and died. Postmortem examination found diffuse metastatic breast adenocarcinoma throughout the right lung. It also identified a separate bronchoalveolar lung carcinoma in the left lung, and both cancers contributed to her respiratory decline.