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Late Summer 2002
Breast Cancer: We'll Get Through It Together

The Norma F. Pfriem Breast Care Center is helping one young woman, her family, and her friends to handle breast cancer with a swift diagnosis, comprehensive treatment, and plenty of support.

At age 39, Fairfield resident Annette Serniak had never given much thought to breast cancer. She hadn't yet had her first mammogram, and didn't perform regular breast self-exams. But she knew something was wrong when she accidentally found a lump. "It felt like a small kiwifruit."

That's how she describes the lump (a bit less than one inch wide, but surrounded by some swelling) that she felt at the outer edge of her right breast on Monday, February 18.

Diagnosis
Startled and frightened, she immediately called her gynecologists, OB/GYN of Fairfield County, who saw her that same day. They were concerned at what they found, and scheduled her for a mammogram at Advanced Radiology Consultants on the 19th. The results looked suspicious. The next step: an immediate appointment, that same day, at The Norma F. Pfriem Breast Care Center at Bridgeport Hospital. There, Annette and her husband, Jay, met Sally Cascella, RN, clinical coordinator at the Center, and surgeon Subhash Shah, MD. Dr. Shah, after examining Annette and reviewing the mammogram report, also believed the lump was highly suspicious and called for an ultrasound.

Bridgeport Hospital-affiliated radiologist Pamela Reeser, MD, agreed that Annette's situation called for swift answers. She immediately performed the ultrasound. What she saw persuaded her to perform a core needle biopsy. Guided by the ultrasound image, Dr. Reeser carefully placed a needle into the lump. She removed several small samples of tissue, leaving only a small incision behind. The tissue sample went to the laboratory for tests.

Throughout that day, "All I'm thinking is, 'My girls are going to grow up without me,'" says Annette, whose daughters are 7 ½ and 4 years old.

In fact, "Annette was so upset," says Sally Cascella, "that after the biopsy we agreed that she should go to the Breast Care Center's Fairfield office to meet our executive director, Lee Ann Riley, who is a breast cancer patient herself. I wanted Annette to see that women with a diagnosis of cancer can and do go on."

"Lee Ann was an inspiration to me," Annette says. "She was soothing and calming and she told me what would be happening in the days ahead.

"The next day, Wednesday, I got my hair cut and colored. I figured I was going to go ahead and live my life. Wednesday evening I learned that the core needle biopsy I had the day before was positive for cancer," Annette says.

On Thursday, Annette and Jay met with Dr. Shah to discuss possible treatments. Dr. Shah told the Serniaks he thought the best course would involve up to four components:

  1. First would come lumpectomy (removal of the lump).
  2. At the same time as the lumpectomy, he would perform a sentinel node biopsy to see if her lymph nodes showed signs of the disease. (See box.)
  3. If the nodes were positive for cancer, he would want her to have chemotherapy to target roaming cancer cells.
  4. Finally, radiation would make sure there were no cells left at the site of the lump.
The Lymph System
The lymph system, part of the body's disease fighting process, carries away waste from the body. It's made up of lymph vessels and lymph glands, or nodes. A sentinel lymph node is the first node to show signs of cancer from a given area of the body. If it tests positive for cancer, more lymph nodes must be removed. The presence of cancer in the lymph nodes means that the disease has spread beyond the breast.

Second Opinions
Annette and Jay had a lot of thinking to do. Wanting to be very sure that they had all the input they could get, they asked for second opinions from two world-famous cancer centers: Memorial Sloan-Kettering Cancer Center in New York City and the Dana-Farber Cancer Institute in Boston. Everything they heard confirmed Dr. Shah's expertise—so they came back home to The Norma F. Pfriem Breast Care Center.

Treatment
On February 27th, just a week and a day after her first visit to the Breast Care Center, Dr. Shah performed surgery to remove the lump and the sentinel lymph node. That node did test positive for cancer, so he then removed ten more nodes.

Several of these lymph nodes were positive, meaning Annette's cancer had spread. So chemotherapy was the next step. Now Annette needed a medical oncologist—a physician specializing in chemotherapy and other non-surgical treatments for cancer. Again, the Serniaks did their research, and chose Glen Reznikoff, MD, medical director of The Norma F. Pfriem Breast Care Center.

Dr. Reznikoff and Dr. Shah brought Annette's records before the Breast Care Center's Multidisciplinary Cancer Committee, a group of surgeons, radiologists, medical oncologists, radiation medicine specialists, pathologists, nurses, rehabilitation therapists, and others. As they conferred, each contributed his or her expertise and advice to create a total plan of care for Annette.

Annette's attitude: "Whatever I have to do to survive this, I will do." Her priority was to make sure that her little girls, Allyson and Caroline, did not grow up without a mother.

The Norma F. Pfriem Breast Care Center Support
Warned in advance by her doctors, Annette knew that one side effect of chemotherapy is hair loss. "The minute I saw my hair coming out, my best friend took me out to our garage and we shaved my head," Annette says. She went to The Norma F. Pfriem Breast Care Center to purchase a wig, courtesy of "b.wëll" (a division of Noëlle Spa for Beauty and Wellness).

The Serniaks had told their children that Mommy had a lump that didn't belong in her body, and that the lump would have to come out. And that Mommy would be tired and feel sick for a while. "It will be hard, but we'll get through it together," they said. And it was hard, especially for Annette's younger daughter, Caroline, "Caroline was frightened by the thought of Mommy in a wig" says Lee Ann Riley. "There were several women in the Breast Care Center when Annette came in for her wig. With Annette's approval, I asked Caroline, 'Can you tell which lady here is wearing a wig?' Caroline looked around and said, 'No one is wearing a wig!'

"I told her, 'I'm wearing a wig,'" Lee Ann says. "Caroline said, 'Take it off!' So I did.'"

After feeling Lee Ann's head and trying the wig on herself, Caroline was much more comfortable with the idea of her mother in a wig.

This level of understanding and support from the Breast Care Center has been available for Annette and her family throughout her treatment. "Whatever you need, we'll help you and your family get through this," was the Breast Care Center's promise to the Serniaks.

"Just Listen"
"Friends and families of cancer patients often ask me, 'What can I say? How can I help?'" says Lee Ann Riley, executive director of The Norma F. Pfriem Breast Care Center and a breast cancer patient herself. "Here's what I tell them:

"Don't say 'I know what you must be going th


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