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The Teacher / Coach

This lifelong educator finds that her own experience with Breast Cancer is inspiring her to teach others.

As a Health and Physical Education teacher at Trumbull High School, Jane Kluspes has always taught the girls in her health classes about the importance of monthly breast self exams (BSEs) and, when they get older, regular mammograms. When Jane´s own mother died of breast cancer in 1992, Jane realized that this family history put her at increased risk of the disease, and she became even more vigilant.

And still, when she received the news from her radiologist, Donald Butler, MD, she could hardly believe it: her annual mammogram in July, 2001, showed an area of suspicious calcifications: small white spots that might-or might not-indicate cancer. Dr. Butler wanted to do a more detailed X-ray.

Stunned, Jane immediately asked her primary care physician, Myl Rama, MD, for the name of a surgeon to go over the mammogram results. Dr. Rama thought that Jane would be comfortable with Mary Pronovost, MD, as her surgeon. He also recommended that Jane call The Norma F. Pfriem Breast Care Center to help her deal with the phone calls, tests, arrangements, appointments, decisions, and other details that were about to become a part of her life.

"I was a wreck," Jane says. "I needed to talk to someone. Sally Cascella, the nurse case manager at the Breast Care Center, immediately stepped in to help. She arranged for an appointment with Dr. Pronovost the very next day."

After seeing the more detailed mammogram, Dr. Pronovost felt that Jane should have a stereotactic breast core biopsy. Again, the Breast Care Center made all the needed arrangements. During the core biopsy, Dr. Pronovost removed some small cores of breast tissue through a needle, using a computerized mammogram to direct the needle to the exact location of the calcifications. This test is often done by a radiologist or surgeon when an abnormal area is visible on a mammogram, but no lump can be felt in the breast on examination. A pathologist (a specialist in microscopic analysis of tissue samples) can then evaluate the tissue to see if there are any cancer cells.

Within 48 hours of the core biopsy, Dr Pronovost called Jane with the bad-news/good-news: It was cancer, but because they had caught it early, it seemed to be in situ-confined to the milk ducts of the breast, not invading surrounding tissue.

Early the next morning, Dr. Pronovost sat down with Jane and began discussing treatment options (see box, below). Dr. Pronovost also explained that with mastectomy, breast reconstruction could be done at the same as the mastectomy, to shape a new breast.

Jane´s choice: mastectomy. "I knew with any other option I´d be worrying for the rest of my life: Did they get it all?" And it was Jane herself who brought up the idea of bilateral mastectomy-removal of both breasts, to prevent cancer from ever occurring in the right breast. "I did know about all the other options, but they weren´t right for me. I just wanted that cancer out of my body, never to come back," she says firmly.

This was a major decision, and Sally Cascella, in the Breast Care Center, wanted to make sure Jane really thought it through. "She called me and asked, ´Are you sure?´" Jane says. "She helped me to consider all of my options very care-fully. I was so grateful for Sally´s concern. I did take the time to re-think, and talk it over with the people I love most. In the end I was sure bilateral mastectomy was the right choice for me."

"This is not a common decision," says Dr. Pronovost. , "but for Jane it was the right one. She had watched her mother die of breast cancer, and she didn´t want that to be her experience."

Jane is more pithy. "I want to be sure I´m around to watch my nephews, Ricky, Collin, and Tyler, grow up," she says bluntly. Jane was fortunate that her surgeon was one of those who have met the American College of Surgeons standards for Sentinel Lymphectomy. The sentinel lymph node is the first in a linked network of nodes that collects and drains wastes and fluids from the cancerous area. (The dictionary defines a sentinel as one who keeps guard. That´s what the sentinel lymph node does- it keeps guard over that area of the breast.) In Sentinel Lymphectomy, the surgeon determines which lymph node is the sentinel node, and removes only that node or nodes. If laboratory examination of the node shows that it is free of cancerous cells, all of the lymph system beyond it can also be judged cancer free with 95% accuracy, so no other nodes need to be removed.

It meant an extra step in Jane´s surgery. Under the direction of Ian Karol, MD, radiologist Fernando Rivera, MD, injected a harmless radioactive dye near the tumor, then massaged the area to encourage the dye to spread out to the lymph system. Several X-rays were taken, and in about 45 minutes, it was possible to see which lymph node was the first to take up the dye. Dr. Pronovost then performed the double mastectomy, including removal of the sentinel node and just a few other nodes on the side of the breast with the tumor. The nodes were sent to pathology, where microscopic examination showed that they were free of cancer. No further nodes required removal. This was good, because when many lymph nodes are removed, the chances increase that the patient will develop lymphedema. In this painful condition, the tissues of the whole arm swell; and this situation can go on for long periods of time-not good for an active health and physical education teacher!

While Jane recovered from her surgery at the home of her closest friends, Ginny and Richard, Dr. Pronovost took Jane´s case to The Norma F. Pfriem Breast Care Center´s Multidisciplinary Team-a group of surgeons, oncologists, nurses, pathologists, radiologists, and therapists-to discuss whether any further treatment would be required. Their decision: Jane would receive no extra benefit from radiation or chemotherapy. Except for physical therapy to strengthen the muscles of her arm, her treatment was over.

"My doctors were all wonderful, and the Breast Care Center helped me to think through each step of my treatment, so I knew I was making the right choices for me," Jane says.

Jane is completely satisfied that she made the right decisions. She doesn´t feel that she has "lost" part of herself. Instead, "I see my scars as my lifeline," she says.

Knowing that her two sisters, Margaret and Laura, are also at risk, Jane encourages them to be diligent in breast self exams and mammograms. Her goal is to keep others from going through what her mother went through.

"I will use my own experience in my teaching," she adds. "I´ve always known that breast health was important. Now I´ll be able to share this with the girls in my health classes, and tell them that I´m fine because I was diligent. And from now on, when I teach them about the importance of breast self-exams and regular mammograms, I´ll add, ´Go home and tell your mothers."

Jane Kluspes has been a teacher in the Trumbull school system for 25 years and has coached girls field hockey at Trumbull High School for 19 years. Her team knows about her cancer, and has been 100% supportive, she says.

A Note from Glen Reznikoff, MD

Medical Director, Norma F. Pfriem Breast Care Center

Jane Kluspes´ story illustrates the many treatment options that are available to a woman with breast cancer. Although Jane´s choice was to have modified radical mastectomy, the majority of patients choose breast conservation (lumpectomy or partial mastectomy) plus radiation therapy. Both choices are reasonable; studies show that there is no statistical significant difference in survival between patients treated with radical mastectomy and those who choose breast conservation.