2009 Turning Point

Survivor Spotlight

A doctor faces breast cancer – and her fears
by Debra Bradley Ruder

Physician, researcher, mom … and cancer survivor, Karen Puopolo, MD, PhD. 

Toward the end of her fourth pregnancy, Karen Puopolo, MD, PhD, realized something was not normal with her left breast. There was a lump, but Puopolo figured it was a blocked duct or something else related to her pregnancy. Both her breast-feeding consultant and OB/GYN assured her not to worry, and Puopolo – herself a physician and researcher – opted to "wait and see."

But when her daughter Elizabeth Chloe was about nine months old and Puopolo began to wean her off breast feeding, the lump became more prominent. Puopolo, who specializes in newborn medicine at Brigham and Women's Hospital, booked an evaluation at her hospital's Comprehensive Breast Health Center. The ultrasound, mammogram, and two biopsies that followed revealed she had stage IIA invasive ductal carcinoma, a cancer that arises from cells lining the milk ducts. The disease had not spread to her lymph nodes.

At age 42, with four children and a full-time career, Puopolo was shocked, afraid, and mad. "I thought, ‘Oh, lord, I have an infant.' I knew I had a small chance of having breast cancer, but I wasn't expecting it," she recalled recently in her Longwood Avenue office. "My husband told me I had to stay around and help him raise our children."

Puopolo's experience with a delayed diagnosis is not unique. Breast cancer is the most common cancer in pregnant and postpartum women, affecting roughly one in 3,000 pregnant women, according to the National Cancer Institute. The natural breast fullness and tenderness during this life stage can interfere with early detection and diagnosis of these cancers.

Once her disease was found, Puopolo had four months of chemotherapy at Dana-Farber, taking doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and paclitaxel (Taxol) every two weeks. A mastectomy and reconstructive surgery followed, along with some additional anticancer medicines. The chemotherapy caused debilitating fatigue, nausea, and weight loss, but Puopolo's cancer responded well to the drugs.

This winter, Puopolo got discouraging news that she had a new nodule suspicious for breast cancer in her chest wall. A biopsy and then surgery to remove it revealed invasive ductal carcinoma. Although this cancer had not spread, a genetic test called Oncotype DX suggested that it had a higher-thannormal risk of recurrence. Puopolo's doctors recommended radiation therapy and six more months of chemotherapy. In addition, she opted for surgery to remove her ovaries and plans to take an aromatase inhibitor to help reduce the chance of recurrence through estrogen suppression.

She's also doing her best to stay in shape and remain healthy by routinely using the stairs and taking long walks around her Newton, Mass., neighborhood with her husband, Steve Melly.

"Dana-Farber is a wonderful place," Puopolo says. "Everyone is kind, respectful, and professional. My oncologist Ann Partridge and her nurse practitioner Anne Kelly are great, and my oncology nurse Deb DiPrete is a godsend."

Those strolls, along with support from her husband and kids – now ages 3 to 16 – have helped her through the ordeal, along with several other factors. Among them are her caregivers at Dana-Farber/Brigham and Women's Cancer Center. "Dana-Farber is a wonderful place," Puopolo says. "Everyone is kind, respectful, and professional. My oncologist Ann Partridge and her nurse practitioner Anne Kelly are great, and my oncology nurse Deb DiPrete is a godsend. I have the same medical team as before, and it now includes Dr. Jay Harris of Radiation Oncology."

Being a physician and researcher (she runs a small lab that investigates neonatal infectious diseases) has also made it easier to sort through the scientific literature and weigh various options for treatment. "I'm a very informed consumer," Puopolo says. "I want to believe everything is going to be fine, but I can't fool myself about my medical situation. However, I had a 100-percent risk of death if I didn't get treated."

Facing her fears has also helped Puopolo as a patient, physician, and mom. At a professional conference in Washington, D.C., last summer, she crossed paths with other women in academic medicine who were there to review their skills and career goals. During the three-day event, Puopolo realized that her breast cancer had kept her from crafting a five-year academic plan. She thought to herself, "I'm done being afraid. I can't stand around ignoring my life."

Puopolo urges women who are pregnant or breast feeding to pay attention to their bodies, despite the hormonal and other changes they're experiencing. "If something just doesn't seem right after a few months," she advises, "have it checked out." Good advice from a doctor who's been there.

By her side: Facing cancer together
by Christine Cleary

In their 44 years of marriage, Mary and Jim Kenn have gone through a lot side by side … including Mary's battles with cancer. 

Mary Kenn sits at home in Bridgewater, Mass., surrounded by familiar comforts. Framed photos of her three grown children and their families hang on her wall; the scent of fresh home-baked blueberry muffins fills the air; and, most reassuring of all, her companion of the last 44 years, her husband, Jim, is at her side.

There's a soothing harmony between the Kenns, one in which their sentences and stories blend into one voice, even when they're describing Mary's three bouts with women's cancers. "I get very involved," Jim says, using the word "we" when talking about his wife's treatments.

Mary Kenn became a patient at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) in spring 2008, when she was diagnosed with a rare cancer of the uterus and chose an experimental treatment. But her saga with women's cancers goes back to 1997, when she underwent a lumpectomy for breast cancer; a year later she learned she had a different type in her other breast.

"The second cancer required the whole works – mastectomy, chemotherapy, and radiation," recalls Kenn, who received her care at a local hospital. "Each time something came up we'd say, 'we'll get this fixed,'" adds Jim.

Mary enjoyed good health while taking several medications to help prevent a recurrence. Nearly 10 years later, however, she noticed some mild vaginal bleeding. Her local gynecologist recommended a hysterectomy, and the lab report after that procedure showed carcinosarcoma of the uterus, an unusual type of cancer that grows in the muscle and lining of the uterus.

A second surgery was scheduled to fully stage the cancer, and although biopsies showed no sign of cancer beyond the uterus, Kenn elected to enroll in a clinical trial to give herself the best chances that the cancer would not return. "I thought this would be like an insurance policy," she explains. "It would also help doctors find treatments for other women."

The trial is testing a combination of radiation therapy with the chemotherapy drugs oxaliplatin and gemcitabine, a protocol used for other aggressive cancers, says Kenn's Dana-Farber oncologist Susana Campos, MD, MPH. "We shared with the Kenns what we knew, and what we didn't know about this very rare type of uterine cancer," explains Dr. Campos. "For example, we do know there is a high risk of spread to the abdomen. But because the cancer is uncommon, there really is no standard of care, so an experimental approach made sense."

Kenn, 65, finished treatment in December 2008 and returns for scans and check-ups. She and her husband sing the praises of DF/BWCC and especially their devoted nurse, Christin Whalen, RN. "I was nervous coming into Boston, and Christin put me at ease," Kenn recalls. "She hugged us when we arrived, and often called us at home to see how I was."

Today, the Kenns relish their roles as "Mima" and "Bampa" for their five grandchildren. Oldest daughter Alicia and her own daughter, Amanda, 22, live with them, and their other two children and families are nearby. A college student studying to be a nurse, Amanda says, "I love my Mima and Bampa more than oxygen."

Thanks to her renewed health, Kenn can continue with one of her favorite hobbies: embroidering blankets and other gifts. After buying a computerized sewing machine she attended an embroidery class. As usual, her husband, Jim, was at her side.

2009 Turning Point