Question: My 60-year-old sister was recently diagnosed with stage IV metastatic breast cancer. She underwent a lumpectomy 11 years ago with radiation and a five-year course of tamoxifen for a marginal stage one tumor (DCIS with minimal invasion and negative lymph nodes). In March of 2008, she began noticing skin changes on both breasts (dryness, reddening, and hardening of the tissue). She went to her plastic surgeon who assumed it was an infection and prescribed Keflex. After a mammogram and biopsy a month later, the diagnosis was made.
Given the botched diagnosing I am very fearful the doctors may not be pursuing the most aggressive/effective course of care. Any advice would be greatly appreciated.

Dr. Hibberd's Answer:

Thank you for your note, but I'm afraid the response goes beyond what I can detail here. Sometimes, even in the best of hands, malignancy can masquerade and disguise itself. Stage IV is an advanced stage that makes it necessary for all parties involved to evaluate the risk to benefit ratios of various treatments and their toxicity.

Treatment options will vary depending upon the location and extent of this devastating disease. If you wish an alternate opinion, consider calling your personal doctor or your nearest teaching medical center for a referral to an oncologist with an interest in advanced disease treatment. There are numerous national cancer centers of excellence that may also provide you with options on referral from your personal physician.

This is no time for Internet consultation and the guesswork. Though our government and the American Cancer Society describe treatment options on their websites, this should be used as an aid to your personalized consultation with an oncologist. Above all, treasure your sister now and try to minimize her stress. I find that patients with advanced malignancy do best when their family and friends provide emotional support and enjoy the present instead of stretching for the future.