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
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),
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
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
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.
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
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
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