BREAST CANCER: The Case of Barbara Allen
Authors:
Michael Wilkes, MD, PhD-Associate Professor of Medicine
Stuart Slavin, MD, MsEd-Associate Professor of Pediatric Medicine
Richard Usatine, MD-Associate Professor of Family Medicine
Jerome Hoffman, MD-Professor of Medicine
UCLA School Of Medicine
Standardized Patient materials written by:
Elizabeth M. O’Gara
Format:



Small group case discussion with standardized patient
Initial and follow up visit with the patient
Materials include faculty guide, student guide, small group
schedule, prep notes, and SP scripts
Description:
This is a two-part case of an initial prevention visit and subsequent
diagnosis of breast cancer. Prevention is raised in the follow-up visit
through questions about the patient’s sister. (Three additional parts of the
case are available on request for use in teaching about the management
and prognosis of metastatic breast cancer as well as dealing with end-oflife decisions and the inclusion of patients in research protocols.)
Part I: Barbara Allen is a 47 year-old female who presents for a routine
physical exam with no particular concerns. The students learn that she
has a family history of breast cancer in paternal relatives and are directed
to the NCI Risk Determination website (http://bcra.nci.nih.gov/brc/) to
determine her relative risk.
Part II: Ms. Allen is lost to follow up although a lump was found on
physical examination at the first visit. She returns 8 months later. From
mammography and biopsy, students learn she has cancer and must give
her the bad news.
Level:
Second medical students
Objectives:
Part I:
1. Develop an approach to a “well-woman” health
maintenance/screening exam
2. Analyze risk factors for breast cancer
3. Determine how to approach a breast lump (when is immediate
intervention / referral / work-up required? When is follow-up /
reexamination appropriate?)
4. Appreciate the central role of follow-up in clinical care
5. Discuss the benefits and limitations of shared decision-making
Part II:
1. Analyze the "duty" of the physician with patients who fail to followup or fail to comply with recommended treatment
2. Give bad news effectively, including ways of managing patient
emotions
3. Assess ways of discussing treatment options in the face of personal
uncertainty
4. Understand implications of differences in insurance coverage for
various procedures and treatments
5. Develop an approach to preventive measures for high risk patients
Cost: Free