Browsing by Author "Wells, Lindsey"

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    Adherence Barriers to Breast Cancer Treatment: Fragmentation of Care, Mood Disorders, and Substance Use Disorder
    (2021-03) Wells, Lindsey; Brown, Lucy; Heitz, Adaline; Newton, Erin
    Case: The patient is a premenopausal, recently divorced 40-year-old female with a history of alcohol use disorder, anxiety, and depression. She presented with a 3-month history of a palpable right sided breast mass and was found to have Stage IIB/IIIA ER+ PR+ invasive ductal carcinoma of her right breast. She successfully completed preoperative therapy followed by a right mastectomy. She subsequently had a relapse in her alcohol use disorder and since then has had inconsistent and incomplete radiation treatment. Her substance use led to the loss of her job, custody of her children, and social support. Conclusions: We identified four primary barriers to adherence to cancer treatment: fragmentation of care, major depressive disorder, generalized anxiety disorder, and substance use disorder. As a result of these mental health and systemic communication challenges, her treatment was discontinued and her care team lost her in follow-up. Clinical Significance: As many as 28% of breast cancer patients do not complete their recommended treatment, which increases risk for recurrent breast cancers. Discontinuation of and non-adherence to therapy for breast cancers are associated with increased mortality. Among breast cancer patients who have difficulty adhering to chemotherapy treatment, a common barrier is fragmentation of care. Studies have also indicated that anxiety and depression may play explanatory roles in non-adherence to breast cancer treatment. Prevalence of depression is as high as 24% among breast cancer patients. Furthermore, rates of co-occurrence of substance use disorders in cancer patients can reach up to 35%. Substance use disorders, including alcoholism, have been associated with increased rates of non-adherence and discontinuation of hormonal treatment in individuals with ER+ breast cancer diagnoses. Interventions addressing the occurrence of mental illness and fragmented cancer care are important steps in increasing adherence among these patients.
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    Phyllodes Tumor vs Fibroadenoma: Diagnosis and Management
    (2020-03) Huang, Christina; Kathryn, Snyder; Wells, Lindsey; Brown, Lucy; Kem, Danielle; Ludwig, Kandice
    Case: The patient is a 71 year-old woman who presented with enlarging painful breast mass. She had history of previous excision of a fibroadenoma in her left breast in 1993. She underwent menopause at 52 and does not take estrogen. Diagnostic imaging revealed 4.7cm breast mass, which had increased from prior measurement of 2.8cm to 4.7cm. Core biopsy demonstrated a fibroepithelial neoplasm areas of hypercellular stroma and occasional stromal mitotic figures most consistent with phyllodes tumor. Lumpectomy was performed. Final pathology showed a 4.8cm well-demarcated tumor with mildly pleomorphic spindled cells in the stroma and up to 1 per 10 mitoses per high powered field, consistent with benign phyllodes. The patient was followed every 6 months with imaging for 2 years without recurrence. Conclusions: Phyllodes tumors are rare fibroepithelial tumors of varying metastatic potential that can be mistaken for benign fibroadenomas. Phyllodes tumors should be surgically excised with wide margins, needing radiation or chemotherapy only if recurrent or large (>10cm), whereas fibroadenomas can be managed expectantly if asymptomatic (Gnerlich, 2014). Phyllodes tumors are often diagnosed in women ages 35-55. The patient in this case was diagnosed at a more advanced age with benign disease, although older age is more often associated with increased histologic grade (Mishra, 2013) (Karim, 2009). Borderline and malignant tumors are more likely to recur within two years of resection; there is less data on recurrence rates of benign tumors. Clinical Significance: Phyllodes tumors should be suspected with rapid growth of a known fibroadenoma. Core biopsy should be performed rather than fine needle aspiration for accurate diagnosis. Although phyllodes tumors comprise less than 1% of all breast neoplasms, it is crucial that uncommon pathologies are diagnosed correctly so that patients receive appropriate treatment.