Seasons Magazines

Seasons Magazines

Charlotte Hungerford

Kimberly Caprio, MD

Kimberly Caprio, MD, who dabbled in both musical theater and marine biology as a student, didn’t decide right away that she wanted to pursue a career in medicine. But the Charlotte Hungerford Hospital (CHH) breast surgeon did volunteer work with abused women while minoring in women’s studies at Boston College, and knew early on that she wanted to do something in the women’s health space.

Her first foray into the health field was as a sales representative for Johnson & Johnson, in New Brunswick, New Jersey. “By the time I finished a year of sales, I realized that I stunk at it,” Dr. Caprio recalls. “I decided, ‘Okay, this isn’t for me; I’m going to medical school.’”

She initially considered obstetrics/gynecology, and also tried her hand at pediatrics and neurology. “But they didn’t fit the pace of my mind or my personality,” says Dr. Caprio. “Then I did my surgery rotation and thought, ‘OK,             this is it.’ ”

The breast surgery fellowship program was just developing when Dr. Caprio finished medical school. One of her mentors at Hackensack University Medical Center, an institution she rotated through during her surgical residency, happened to be one of the first fellowship-trained breast surgeons. “She taught me so much,” says Dr. Caprio, who soon followed in her mentor’s footsteps. “I liked the relationship she had with her patients, as well as the idea of getting back to women’s health. Being a breast surgeon is a nice way to give back to, and care for, the people who always take care of us – all the women in our lives.”

Becoming a breast surgeon – and a naval lieutenant commander

A Connecticut native, Dr. Caprio grew up in Southington and went to high school at Miss Porter’s School in Farmington. She says she enjoys mentoring students from Southington schools as well as Miss Porter’s; in fact, a Miss Porter’s senior (and prospective medical student) was shadowing Dr. Caprio on the day she spoke to Seasons magazine.

Dr. Caprio received her medical training in New Jersey, completing both medical school and a surgical residency at the University of Medicine and Dentistry of New Jersey. She joined the Navy during her residency, doing reserve duty in the Bronx (“mostly physicals, giving shots, and getting paperwork in order,” she says) while completing her surgical training. By the time she was discharged, Dr. Caprio had achieved the rank of lieutenant commander.

Lieut. Commander Caprio returned to her home state to complete a breast surgery fellowship at Yale New Haven Hospital. “The best part of the fellowship was that it was only about half surgery – the other half was learning about all the other disciplines I work with now and learning their language,” she explains. “I did rotations in radiation oncology, medical oncology, genetics and plastic surgery. You really learn how to do breast surgery in residency; in fellowship, you learn the tricks of the trade and how to communicate with your peers in these other disciplines.”

Before joining Hartford HealthCare Cancer Institute at CHH in October, Dr. Caprio spent six years directing the Hoffman Breast Health Center at Saint Francis Hospital and Medical Center in Hartford. “I saw an opportunity to take what I had built at Saint Francis and bring a version up to Torrington,” she says. “The goal is to create a more seamless experience for women by coordinating care among specialties.”

According to Dr. Caprio, while there are several surgeons in the community who are “wonderful at doing breast surgery,” Hartford HealthCare’s objective is to take women from any zip code who enter the system, because of a breast cancer diagnosis, and have their experiences be as uniform as possible. Dr. Caprio’s  goals for CHH include decreasing the wait time for study results and reducing the time period between appointments.

“These women are in a very vulnerable and scary spot,” she says. “An abnormal mammogram starts this whole cycle of worry and stress; minimizing the wait and stress not only makes a difference psychologically and socially, but also makes a difference clinically.”

Malignant or benign?

Most breast cancer patients follow a similar pathway once they enter the Hartford HealthCare system. Dr. Caprio’s first visit with a patient may occur before or after a breast biopsy. “There may be findings on a biopsy that require another surgical excision,” she explains. “Sometimes findings under the microscope don’t match the findings on a mammogram, and I’ll take out a little more tissue to break the tie.”

Other times, she says, a patient may land in her office after an abnormal mammogram, and Dr. Caprio will review the woman’s family history and imaging history to determine whether she needs a biopsy or can be followed up in six months. “When I do send a patient for a biopsy,” she says, “only about 20 percent of them come out as something cancerous – 80 percent are benign.”

Dr. Caprio points out, in fact, that she probably does more surgery for benign breast issues – to confirm they aren’t cancerous – than for breast cancer itself. Sometimes, she says, she’ll remove a benign breast mass that is getting bigger or causing discomfort. “Also, if a patient has nipple discharge but there’s nothing on imaging,” she adds, “I would choose to remove that milk duct.”

For the most common types of breast cancer, and when very small legions are detected by screening, she typically performs surgery up front, removing the tumor and a couple of lymph nodes (to see if the cancer has spread beyond the breast). The tissue is sent for staging and oncotyping, a genomic test that determines whether the cancer will respond to chemotherapy and, possibly, hormone therapy. After chemotherapy, if the patient opts for breast conservation surgery or a lumpectomy rather than a mastectomy, she will proceed to radiation.

“In the case of large tumors, maybe with lymph nodes involved, and for certain types of breast cancer, we might give chemotherapy up front,” she says. Doing so may shrink the tumor so that Dr. Caprio can do a less invasive surgery.

Removing tumors with better cosmetic results

Dr. Caprio’s special interests include hidden scar surgical techniques and oncoplastic breast conservation surgery, also known as reconstructive lumpectomy, which uses plastic surgery techniques to optimize cosmetic results. “The philosophy is to make the experience have as little impact as possible in the future,” says Dr. Caprio. “When a patient comes in and says, ‘I don’t care what my breasts look like, I just want the cancer gone,’ today that’s probably true, but in five years, she might think differently.”

Dr. Caprio tries to hide scars underneath the breast, in the armpit, or at the nipple line. “Pretty much any place in the breast can be reached from those three spots,” she says. Oncoplastics, she says, basically borrows techniques from plastic surgery to reconstruct the breast. “Instead of making the incision right over where the cancer is, we use breast reduction patterns and use flap rotation techniques – creating a flap from the breast tissue itself – so that the breast will look the same as it did before the surgery,” she explains.

Dr. Caprio notes that the chance of recurrence is the same (3-5 percent) whether patients opt for lumpectomy with radiation or mastectomy (removal of the entire breast).

Managing high-risk patients

Another one of Dr. Caprio’s special interests is managing high-risk patients – patients who, because of family history or genetic predisposition, are at higher risk of getting breast cancer. Dr. Caprio typically refers patients who have multiple female family members with breast cancer, or family members with ovarian, pancreatic, or male breast cancers, to speak with a genetic counselor. “We test for about 60 different genes now that can be related to breast cancer, and they’re not just related to  breast cancer,” she says. “That’s where the genetic counselors come in.”

Most of the time, the tests are negative. Still, if there is a lot of cancer in the family tree, patients are still considered high-risk. “I’ll offer nutritional counseling, recommending weight loss and other lifestyle changes to reduce risk, including avoiding alcohol,” says Dr. Caprio. “If they are high enough risk, I add an annual breast MRI to their mammogram, alternating them six months apart.”

Advances in imaging technology have impacted both breast cancer detection and patient experience, according to Dr. Caprio. “The 3D mammogram [which provides a 3D instead of 2D view of the breasts] cuts down on the call back rate, so you don’t get that letter saying you have to come back for another view. It has also cut down on the number of biopsies we do,” she says. Breast MRI and ultrasound have improved as well, she adds. Better imaging technology also means that breast masses are detected much earlier, when they are smaller and require less invasive surgery to remove.

Guiding the development of the breast surgery program

Dr. Caprio has been teaching students at both University of Connecticut and Quinnipiac for several years and hopes to continue her academic work at CHH. “We have residents and students working with my partners in Hartford, and they will be coming here too, eventually.” For now, Dr. Caprio is charged with guiding the development of the breast surgery program in Hartford HealthCare’s northwest region.

When she’s not working, you might find Dr. Caprio shuttling her 12-year-old to his activities, road-tripping in her new RV to various camping and hiking destinations, watching a musical at the Bushnell, or performing with a singing group. A former member of the CitySingers of Hartford and a “Doo-wop” singing group Decibelles in New York, she is contemplating joining a local choir.

“If I didn’t go to medical school,” says Dr. Caprio, who has been performing since she was eight, “I was going to go to Broadway.”

For more information about the Hartford HealthCare Cancer Institute or the Breast Surgery practice in Torrington, contact 860-496-4190.

Lori Miller Kase is a freelance writer living in Simsbury.

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