Management of Breast Cancer Case Leads to Untimely Death

This case involves a fifty-six-year-old woman who presented to her Ob/Gyn after discovering a large lump in her breast. The patient was sent for several tests, including a needle biopsy that confirmed an invasive ductal breast cancer that was HER2 positive. The patient also underwent imaging tests that demonstrated distant liver and pulmonary masses. Shortly after receiving the prognosis, surgery was recommended to remove the primary breast mass without explaining the risks or other therapeutic options. The surgery was met with great complication, as the mass was highly invasive. The patient suffered unsustainable bleeding and went into cardiac arrest on the operating table. CPR was performed but a normal heart rate could not be returned, and she was pronounced dead after thirty minutes of resuscitation.

Question(s) For Expert Witness

1. Should surgical resection have been the first step in this patient's management of the cancer?

Expert Witness Response E-000029

The current standard of care in such a case would focus on reducing metastatic disease in the liver, which is more likely to directly affect overall survival than is the tumor in the breast. Although surgery might be used to reduce the local tumor burden, and thereby ameliorate local symptoms, first-line treatment for a patient with newly diagnosed advanced breast cancer should focus on systemic control of the metastatic disease.