Dear Doctor,

Georgina Whetton has had breast imaging in September 2026. The left breast is graded 5, with one axillary node graded 3, and a biopsy result is awaited. Surgery is likely to follow soon. I am writing ahead of that to flag six points that have been reviewed by Dr Gemma Lewis MRCS MRCGP, a family contact who is a GP and surgeon, so that they can be considered at Georgina's own GP appointment.

The assessment clinic was at Royal Stoke Hospital, University Hospitals of North Midlands NHS Trust (NHS number 454 282 0556). The breast care nurse, Sarah, can be reached on 01782 674077 if you wish to liaise directly.

1. Antihypertensive therapy, bisoprolol 2.5mg and candesartan 8mg, was stopped on 22 August 2026. Off treatment, home blood pressure has averaged 149/64 over 21 readings, with a peak of 176/70 on 5 September. [Dr Lewis's recommendation: pending]
2. Simvastatin 40mg was stopped on 22 August 2026 as a patient-led trial. QRISK3 is 10.5% and a lipid recheck is due. [Dr Lewis's recommendation: pending]
3. Georgina is taking vaginal estradiol pessaries and is asking whether to continue these given the breast findings. [Dr Lewis's recommendation: pending]
4. Metformin was stopped on 22 August 2026. HbA1c is 36, with a repeat due in three months. This is for information. [Dr Lewis's recommendation: pending]
5. Haemoglobin has fallen from 143 in May to about 132 in August, with red cell count, haematocrit and platelets falling in parallel. All values remain within range and ferritin is 142. [Dr Lewis's recommendation: pending]
6. Wearable data over five months suggests sleep-disordered breathing, with 10 to 15 breathing disturbances an hour and overnight oxygen dips to the low 70s. There has been no formal sleep study. [Dr Lewis's recommendation: pending]

Given the likely short timeframe to surgery, I would be grateful if these points could be reviewed ahead of pre-operative assessment. I am happy to provide the full evidence pack behind these six points if that would be useful.