A 47-year-old womanwith a history of breast cancer comes to the office for the first time to request bilateral mastectomy

A 47-year-old womanwith a history of breast cancer comes to the office for the first
time to request bilateral mastectomy. She recently changedmedical insurance
providers, and her previous physician is not in her n1anagedcareorganization’s
network. She saysthat 2 yearsago she underwent lumpectomy and radiation for
cancer in her left breast Routine follow-up examinations have disclosed no
recurrence of cancer. She saysthat between follow-up examinations, she
experiences severeanxiety that significantly affectsher home life and\Vork. She
says, “I can’t endure’waiting for the ax to fall’ any longer. I’d be happier having both
breasts ren1oved and undergoing breast reconstructionthan Iwould be having to
face the uncertainty of recurrence.” Which of the followingis the most appropriate
response to the patient?

  • A) Ask her to discuss her previous medical historyand cancer with you
  • B) Explain that mastectomy is too aggressivefor her stageof disease
  • C) Reassure her that continued routine 6-month examinations are the most
  • appropriate managen1ent
  • D) Recommend startinganxiolytictherapy before proceedingwith her
  • decision
  • E) Support the patient’s decision and recommend a plastic surgeon

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