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SU25.1-5 | Breast Surgery — Assignment
CLINICAL SCENARIO
A 52-year-old postmenopausal woman attends the breast clinic after noticing a painless, hard lump in the upper outer quadrant of her right breast three weeks ago. On examination the lump is approximately 2.5 cm, irregular, and slightly tethered to the overlying skin, with no palpable axillary nodes. She is understandably frightened and has read conflicting information online about whether she will lose her breast. She asks you to explain how the diagnosis will be made and what her treatment choices might be.
Instructions
Write a structured clinical response that takes this patient from first presentation through diagnosis to a counselling discussion about treatment. Demonstrate that your recommendations follow the evidence and the principles of triple assessment, and that you can translate the science into language suitable for counselling a patient. Use clear headings and clinical reasoning throughout.
Length: 900-1200 words
What to Submit
1. Establishing the diagnosis: triple assessment
Describe how you would evaluate this lump using triple assessment. State which imaging modality is appropriate for her age and why, and how the result is communicated. Explain which biopsy technique you would use and what information it provides.
Guidance: Cover clinical assessment + imaging (mammography preferred over 35-40, with the BI-RADS reporting concept) + core biopsy for histology and receptor status.
2. Characterising the tumour and its biology
Explain the histological types of invasive breast cancer she might have and the meaning of ER, PR and HER2 status. Describe what 'triple-negative' would mean and why receptor status matters for treatment.
Guidance: Address invasive ductal vs lobular carcinoma, DCIS as the in-situ precursor, and how ER/PR/HER2 (and triple-negative) drive systemic therapy choices.
3. Surgical options and the survival evidence
Outline the surgical choices (breast-conserving surgery with radiotherapy versus mastectomy) and the evidence on survival. Explain how the axilla would be staged with minimal morbidity.
Guidance: State clearly that BCS + radiotherapy gives equivalent survival to mastectomy in suitable cases, and that sentinel lymph node biopsy stages the clinically node-negative axilla.
4. Counselling the patient
Draft how you would counsel this anxious patient. Address her fear of losing her breast, summarise adjuvant systemic options by receptor status (endocrine therapy, trastuzumab, chemotherapy), and describe a patient-centred, multidisciplinary approach.
Guidance: Be empathetic and accurate: link endocrine therapy (aromatase inhibitor / tamoxifen) to hormone-positive disease, trastuzumab to HER2-positive, and chemotherapy to triple-negative; emphasise shared decision-making.
Grading Rubric — Breast Cancer Case Study — 40 points
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Triple assessment and diagnostic plan | 10 pts | Accurately describes all three arms, selects age-appropriate imaging with rationale, and explains core biopsy and reporting (BI-RADS). |
| Tumour biology and receptor status | 10 pts | Correctly explains histological types, in-situ vs invasive disease, and the clinical meaning of ER/PR/HER2 and triple-negative status. |
| Surgical options and survival evidence | 10 pts | Clearly states equivalence of BCS + radiotherapy and mastectomy for survival, and correctly describes SLNB for axillary staging. |
| Patient-centred counselling and adjuvant therapy | 10 pts | Empathetic, accurate counselling that links each systemic therapy to receptor status and emphasises shared, multidisciplinary decision-making. |