October 2000
Right in Our Own Back Yard

When this Stratford woman developed breast cancer, she and her family needed more than the best of care. They also needed help understanding their options, choosing physicians and treatments, and coordinating the many appointments and services available for them. They were grateful to find both the care and the help in The Norma F. Pfriem Breast Care Center at Bridgeport Hospital.

If there's one thing Sandra Bruno never puts off, it's her annual mammogram. Twelve years ago, her mother was diagnosed with breast cancer, and Sandra knows that this disease can be hereditary. She also knows that for a cure, early detection is crucial. So every month she does her self-exam, and every January she goes for her mammogram—a little more nervous than most women, perhaps, hoping each year that she'll leave the radiologist's office feeling relieved.

This year, there was no relief for Sandra. Her radiologist found an abnormality on her mammogram—a mass in her left breast. More tests were needed to determine whether it was, or was not, cancer. "I always look on the bright side. I was concerned," Sandra says, "but I was sure there was nothing to worry about." When she told her husband..."I immediately thought the worst," Ken Bruno says.

Two days later Sandra went for an ultrasound exam, again hoping for good news. Unfortunately, results from the ultrasound still were not conclusive. There was a mass, but what type of mass was still uncertain. For a firm diagnosis, Sandra needed a biopsy to remove and study a small sample of the tissue.

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Even more nervous now, Sandra wasn't sure where to turn. Then her gynecologist, Joanne Wible-Kant, MD, recommended that Sandra call The Norma F. Pfriem Breast Care Center at Bridgeport Hospital. Dr. Wible-Kant knew of the Breast Care Center's reputation for swift diagnosis and coordination of care for breast cancer patients.

Sally Cascella, RN, nurse case manager at the Breast Care Center, saw Sandra and Ken that very day. And from then on, though fear was always with the Brunos, there was no more wondering, "What do we do now?" The Breast Care Center organized and coordinated Sandra's appointments and care, and explained each step to the Brunos.

"We want our patients to feel free to ask any questions and know that, if we don't have the answers, we'll get them as soon as we can," says Lee Ann Riley, executive director of the Norma F. Pfriem Breast Care Center, who has had breast cancer herself. "In fact, I give our patients my home phone number so they can reach me at any time. Having breast cancer is such a deeply felt, mind-numbing thing; we want to make this confusing and frightening time as stress-free as possible."

The first step for the Brunos was to meet with a surgeon. The Breast Care Center provided them with the names and credentials of surgeons with experience in breast surgery. In making their decision, Ken and Sandra consulted their primary care physician, Germano Guadagnoli, MD, who has known and cared for the whole Bruno family for many years. They chose Mary Pronovost, MD, to be Sandra's surgeon.

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Dr. Pronovost met with the Brunos at the Breast Care Center, examined Sandra, reviewed her X-rays, and discussed various options for a biopsy:

  • Fine-needle aspiration of cells, in which the lump is located by physical examination and a needle is inserted to withdraw cells (not appropriate for Sandra since her lump could not be felt upon physical examination).
  • Ultrasound-guided core needle biopsy, done with the patient on her back while the radiologist guides a needle into the mass and takes samples.
  • Stereotactic biopsy, in which the breast is compressed and two x-rays are taken. A computer uses these images to calculate the location of the suspected growth and a needle is inserted into the area to take tissue samples.
  • Surgery, in which an incision is made and tissue is removed.

"I think Dr. Pronovost would have sat with us forever, discussing these options," Sandra says. "It was very calming." It was also good to know that Sandra's uncertainty would not last much longer. The Norma F. Pfriem Breast Care Center promises a diagnosis within 48 hours of a biopsy, and delivers on that promise.

Sandra decided on ultrasound-guided core needle biopsy. The procedure was done the next day by radiologist Pamela Reeser, MD, in Bridgeport Hospital's Radiology department. "Ultrasound guided breast biopsy is the best procedure for many women: The patient lies comfortably on her back and tissue from masses as small as 5 millimeters can be sampled," says Dr. Reeser.

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Sandra, a reading consultant at David Wooster Middle School in Stratford, was at work 48 hours later when Dr. Pronovost called to give her the diagnosis. "She was concerned that I was not at home when she spoke with me," Sandra says, "but it was OK, because my friends at work knew what was going on and were there for me when Dr. Pronovost gave me the news." The suspicious mass was a cancerous tumor.

"I was very upset," Sandra says, and then laughs at the understatement. "I was in a fog—this couldn't be happening to me." But within an hour she and Ken were meeting with Dr. Pronovost in the Breast Care Center, getting all the details and information that they could soak up. Dr. Pronovost discussed the surgical options: lumpectomy (involving removal of the tumor and lymph nodes, followed by radiation therapy) or mastectomy (removal of the breast). Survival rates are the same for both courses of treatment. Sandra's decision: a lumpectomy.

On the morning of her procedure, Sandra was admitted through the Breast Care Center. Then she was taken to the Nuclear Medicine department where she received an injection of a substance that can be traced as it travels through the lymph system. The object was to discover which was the first lymph node to drain lymph from that area of the breast. That node and a few of those connected to it could then be removed for biopsy, helping to determine if the cancer may possibly have spread. Dr. Pronovost performed the lumpectomy and removed ten lymph nodes in Bridgeport Hospital's operating room.

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When Sandra woke up after the surgery, Sally Cascella was there to tell her that the surgery had gone well.

From her first visit to the Norma F. Pfriem Breast Care Center to the removal of the tumor, only a week had passed.

After the surgery, Dr. Pronovost also discussed Sandra's situation at the weekly meeting of the Breast Care Center's Multidisciplinary Breast Cancer Team. There, more than 20 healthcare professionals—oncologists, diagnostic radiologists, radiation oncologists, pathologists (see "Diagnosing Cancer"), physical therapists (see "What is Physical Therapy?"), surgeons, oncology nurses and social workers, and experts in integrative therapies (such as dietary supplements, massage, and relaxation techniques)—discussed the further treatment options that would be possible. They came up with a recommendation that they felt would give Sandra Bruno the best chance for long-term survival.

"There were two things in my favor," Sandra says. "First, the lump was only 8 millimeters. And second, when the pathologist examined the lymph nodes, they were all cancer-free." This meant the cancer had probably been caught before it could spread. "If I hadn't had that mammogram, I might not have known about the cancer until it was too late," Sandra says.