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Joyce A. O'Shaughnessy, MD; Kenneth H. Cowan, MD, PhD

JAMA. 1993;270(17):2089-2092.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

SELECTED CASE

In 1988, a 38-year-old woman noticed progressive, symmetrical hardening of both breasts. Mammograms showed dense tissue bilaterally with no discrete masses and biopsies were unfortunately not recommended. In 1989, she developed lumbar back pain, and a complete blood cell count showed a hemoglobin level of 90 mg/L, a white blood cell count of 3.4x10⁹/L, and a platelet count of 90x10⁹/L. Her breast examination showed bilateral, diffuse denseness without skin involvement. Breast and bone marrow biopsies showed estrogen receptor-positive infiltrating ductal breast carcinoma metastatic to the bone marrow. She was treated with dose-intensive fluorouracil, leucovorin calcium, doxorubicin, and cyclophosphamide (FLAC) in combination with the hematopoietic growth factor, granulocyte-macrophage colony-stimulating factor (GMCSF). After two cycles of therapy, her back pain had disappeared and her blood cell counts normalized. After 10 cycles, her breast examination was normal, but repeat bone marrow examination showed a residual microscopic focus . . . [Full Text PDF of this Article]

Author Affiliations
From the Medical Breast Cancer Section, Medicine Branch, National Cancer Institute, Bethesda, Md.

Footnotes
Reprint requests to the Medical Breast Cancer Section, Medicine Branch, National Cancer Institute, Bldg 10, Room 12N226, National Institutes of Health, Bethesda, MD 20892 (Dr O'Shaughnessy).

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