65/FCC: 1 year enlarging left breast mass

(+) New onset breast pain(+) New onset erythema

Family History:(+) Maternal aunt with breast CA

Gynecologic History:Menopause at 57 years old

Past Medical History(+) Hypertension, controlled(+) DM Type 2, controlled

Primary Impression:Left breast mass, 8x7 cm, with overlying erythema and ipsilateral axillary lymphadenopathy, suspicious for malignancy

Request Mammography, Breast UTZ, Core Needle Biopsy, Hormonal panel

Diffusely enlarged left breast mass

ER: 1%PR: 1%HER2: 2+FISH: Negative

Invasive Ductal Carcinoma of the right Breast, Basal Type (ER-, PR-, HER2-), Stage IV

Systemic therapy• if PD-L1 CPS ≥ 10: Pembrolizumab + chemotherapy (preferred)• nab-paclitaxel (paclitaxel) or gemcitabine/carboplatin• if PD-L1 negative (CPS <10): Chemotherapy alone (sequential single-agent preferred for less toxicity)options: paclitaxel, nab-paclitaxel, docetaxel, capecitabine, vinorelbine, gemcitabine, eribulin, carboplatin/cisplatin

Subsequent line/ targeted options• if germline BRCA ½ mutation• PARP inhibitors (olaparib, talazoparib)• if PD-L1 negative, progressed after chemo• Sacituzumab govitecan (TROP-2 antibody drug conjugate)

Local/ supportive management• liver metastases: systemic therapy is primary; local ablation/ resection is not standard unless oligometastatic and controlled• breast primary mass: surgery/ radiotherapy only if symptomatic (ulceration, bleeding, pain)• bone metastasis: add zoledronic acid or denosumab

Support/ Palliative care• if germline BRCA ½ mutation• PARP inhibitors (olaparib, talazoparib)

MONITORING• History & physical exam: - Every 3-6 months for the first 3 years. - Every 6-12 months for years 4-5. - Annually thereafter.• Mammography: - Annually for the contralateral breast• Laboratory & imaging studies: - Not recommended routinely in asymptomatic patients.• CEA, PET, bone scan, tumor markers (CA 15-3, CEA) are only indicated if new symptoms or exam findings suggest recurrence.

PREVENTION• Adherence to follow-up• Maintain healthy weight (target BMI &lt;25), regular exercise, strict control of DM and HTN, avoid alcohol and smoking• Encourage screening for first-degree relatives (annual mammography starting at 40, or earlier if high risk).• consider MRI if high genetic risk (BRCA carriers)• Consider BRCA mutation testing due to family history.• Emphasize adherence to follow-ups, survivorship care plans, and prompt reporting of new symptoms (bone pain, weight loss, cough, neurologic symptoms).• Psychosocial support: Breast cancer support groups, counseling for patient and family.