by Debra Bradley Ruder
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.
Courtesy of Dana-Farber Cancer Institute