Breast cancer

On 7 January 1948, a meeting was held at the Royal Society of Medicine in London. Its purpose was to settle a controversy. Robert McWhirter, an Edinburgh-based radiotherapist, had been invited to defend the scandalous position advocated by Geoffrey Keynes ten years previously: that radical mastectomy offered no survival advantage when compared to simple mastectomy plus local radiotherapy. The negative publicity surrounding the meeting proved overwhelming for Keynes and he abandoned his research.

Breast cancer is now the most common cancer of women in the UK and incidence is increasing. Because of major treatment advances and earlier diagnosis over the past 40 years, survival rates have been improving gradually and women diagnosed with breast cancer today are almost twice as likely to survive for 10 years or longer as women 40 years ago. However, breast cancer remains a major contributor to cancer morbidity and mortality in the UK. The majority of patients present with potentially curative disease and surgery is the mainstay of treatment.

We present the case of a female patient with a subacute paraneoplastic brainstem neurological syndrome associated with breast cancer and the development of anti-Ri antineuronal antibodies (ANNAs). It is an important syndrome to identify because of the need for urgent investigation and management to reduce progressive and irreversible neurological deterioration and to recognise the associated risks of bulbar and central respiratory failure. Diagnosis can be confounded if the anticipated normality of imaging and cerebrospinal fluid (CSF) studies is not appreciated.