Multiple primary malignancies (MPM) are an increasing trend seen in oncology due to factors of increased survival time of patients, environmental exposures and hereditary risk factors. The increase of diagnoses is also seen with more screenings as well as longer life expectancies. We present a 70 year old female who initially presented with trouble swallowing. It was revealed she had squamous cell carcinoma (SCC) of her epiglottis. PET scan work up revealed uptake in her left breast. Bilateral mammogram, ultrasound and biopsy revealed her left breast had invasive ductal carcinoma (IDC) and her right had invasive lobular carcinoma (ILC). With her smoking history and strong family history of cancer, she was highly susceptible to developing multiple primary malignancies She did not continue routine health screenings including mammogram and low dose CT chest which may have prevented or discovered her malignancies at an early stage. This is an emphasis on the importance of routine health surveillance and screening especially in the primary care setting.

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BackgroundLung cancer is one of the most diagnosed malignancies and the leading cause of death worldwide. In the United States, over 150,000 deaths occur annually; the 5-year survival rate is 16% due to late diagnosis and non-resectable tumors. 1 There are two major groups of lung cancer: Small Cell Lung Cancer (SCLC) and Non-small Cell Lung Cancer (NSCLC). NSCLC makes up the majority of lung cancer at 75%. 2 NSCLC is categorized into three subtypes: squamous cell carcinoma (SCC), adenocarcinoma, and large cell carcinoma. 3 Smoke exposure has been a dominant risk factor but risk will vary in different ethnicities and genders. 4 Statistics indicate that they are highest among men and especially in the Micronesian/Polynesian, Eastern Asian and Eastern European population. Additionally, 10-25% of lung cancers occur in those who never smoke. 3 There are cases of those who may have smoke exposure or other environmental risk factors. These include exposure to carcinogenic chemicals, ionizing radiation, asbestos and alcohol consumption. 3 There are also familial risk factors and genetics play a role in acquiring NSCLC. Familial clustering of cancer is seen when the same type of cancer is presented in two or more first degree relatives. This can be seen with shared environments, inherited mutations and high penetrance genes. 5 Genome wide association studies (GWAS) have been used to detect common alleles for inherited malignancies. 5