title: Bone metastases from breast cancer: guidelines for diagnosis.
abstract: OBJECTIVE
  To discuss the case of a 62-year-old woman with prior history of breast cancer who later sought chiropractic care, and to present an overview of appropriate imaging procedures in such cases.
  
  
  METHODS
  The patient had a 6-month history of mild left-sided sacroiliac pain, which radiated into the left lateral thigh and leg. There was additional pain over the left upper ribs and left posterior arm, which had started insidiously. One year prior, she had undergone a lumpectomy. Current radiographs were negative for carcinoma.
  
  
  RESULTS
  Cautious spinal manipulation and soft tissue procedures were used to treat her sacroiliac joints. The thoracic pain was left untreated. The patient improved over the first 7 visits but had pain return after swimming. After ceasing therapy, she still suffered from similar pain.
  
  
  CONCLUSIONS
  It is important to assess patients who present with new bone pain after they already have a history of breast malignancy. Chiropractic physicians should take appropriate diagnostic steps to rule out suspected malignancy when there is no plain film evidence and biopsy is negative.
authors.affiliation: annekeverbeeck@hotmail.com
authors.forename: Anneke
authors.initials: A
authors.lastname: Verbeeck
mesh_terms: D001859:Bone Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology*; D002983:Clinical Competence; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D026882:Manipulation, Chiropractic / Q000379:methods; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012446:Sacroiliac Joint / Q000503:physiopathology*; D013997:Time Factors