Dr. Kristen Zarfos, Dr. Andrea Malon, Dr. Chia-Chi Wang

Breast surgeon Kristen Zarfos joined the Middlesex Hospital Surgical Alliance only a few months ago, but she is no stranger to the institution.

Back in 1987, after completing her general surgery residency at Yale-New Haven Hospital and Baystate Medical Center, she became the first female general surgeon at Middlesex Hospital. She moved on after a couple of years, joining the faculty of University of Connecticut Health Center, where she worked under a renowned breast surgeon and developed expertise in breast surgery. She went on to lead breast cancer programs at Saint Francis Hospital and Medical Center and The Hospital of Central Connecticut.

Dr. Zarfos returned to Middlesex in March, and she and her colleagues are in the process of creating a clinical model of care for women who warrant greater surveillance for breast disease. This opportunity, combined with the robust diagnostic services already offered, will offer women a comprehensive breast program.

Not only does the addition of a nationally recognized breast surgeon like Dr. Zarfos to the Middlesex staff reflect the institution’s commitment to expanding its breast cancer program, but the appointment has allowed Dr. Zarfos, who lives in Deep River, to come full circle.

“It’s been exciting for me career-wise to head up a program and expand it at Saint Francis, develop a similar program at Central Connecticut, and now to return to what is, in effect, my professional home at Middlesex, and develop the same kind of care here that women request, appreciate and deserve,” she says.

EXPANDING THE PROGRAM

Dr. Zarfos, who will see patients at the hospital’s Cancer Center location in Westbrook, points out that she is joining what she refers to as “an already strong, 25-year-old breast program,” established by Dr. Andrea Malon, medical director of the Middlesex Hospital Cancer Center, and enhanced a year ago by surgical oncologist Dr. Chia-Chi Wang, both of whom see patients primarily at the hospital and its cancer center in Middletown.

“Adding Dr. Zarfos – a well-known, experienced breast surgeon – will help us to offer these services to more women throughout the area, especially along the shoreline,” says Dr. Malon. “It’s great that patients can get a full complement of cancer care in their own community, that they don’t have to travel far for medical care when they are sick.”

The goal, they point out, is to lessen the fear surrounding a breast cancer diagnosis, and they hope to work together to find ways to improve the experience.

“What I’ve learned from my patients,” says Dr. Zarfos, “is that it’s frightening to be told you have an abnormal mammogram or ultrasound, and it’s the unknown that makes a woman fearful. If we can provide reports the same day as well as a breast exam to complete the patient’s evaluation, we are helping to eliminate the unknown.”

AN AGGRESSIVE DIAGNOSTIC PROGRAM

More than 250,000 women are diagnosed with breast cancer nationwide each year, and more than 40,000 die from the disease annually. Because early detection can improve the chances of survival – and catching cancer before it spreads makes it easier to treat – detection technology is at the forefront of Middlesex’s breast program.

“We have a very aggressive diagnostic program,” says Dr. Malon.

Like most medical centers in the United States, Middlesex offers digital mammography (which uses computer-based cameras for breast imaging, rather than film-based cameras).

But they also offer 3D mammography, which detects 47% more invasive cancers than traditional 2D mammograms and can eliminate unnecessary biopsies, Dr. Malon says. In fact, there are 31 percent fewer false positives when doctors use 3D mammography.
Other types of breast imaging like ultrasound and breast MRI may be used in patients with dense breasts, those with abnormalities on mammograms, or those at high risk for the disease.

Middlesex also offers molecular breast imaging (MBI) which, according to Dr. Zarfos, is an important tool in patients who have several nodules in the breast, and can reduce the need for multiple biopsies. MBI is like a PET scan of the breasts – radioactive dye is injected into the bloodstream and accumulates in areas of malignancy, where cells are actively dividing, so that they “light up” on an image.

Cancers detected early are less likely to require total mastectomy, or removal of the breast; in fact, surgeons are performing fewer mastectomies each year because new technologies enable them to find cancers while they are still small, Dr. Zarfos says. Instead, the majority of breast cancers can be treated with a partial mastectomy, or lumpectomy.

PILLARS OF BREAST CANCER TREATMENT

The four pillars of breast cancer treatment, according to Dr. Wang, are surgery, chemotherapy, endocrine therapy and radiation therapy. Not every patient requires every modality of treatment.

“For example,” she says, “if a woman wants to have conservative breast surgery – that is, they don’t want a mastectomy – most of the time they will require radiation, because without radiation, you have a higher chance of local recurrence.”
Studies have shown that women who have a lumpectomy, along with radiation, have the same survival rate as those who have a total mastectomy.

Depending on the size and type of the breast tumor, and whether cancerous cells have spread to the lymph nodes surrounding the breast, some patients will need chemotherapy after surgery; others will not. Exciting advances in genetics enable doctors to analyze the genomic makeup of a tumor and determine whether a cancer is likely to recur and how it might respond to treatment. The doctors at Middlesex use this kind of testing to help them determine whether or not chemotherapy is the appropriate course of treatment for a particular patient. Some cancers are dependent on hormones to grow; endocrine or hormone therapy can slow or stop the growth of hormone receptor-positive breast cancer tumors.

“No two breast cancers are the same,” says Dr. Wang. “We are learning more and more about the subtle differences between one cancer and the other, and these differences affect the treatment plan. Breast cancer treatment today is more targeted and personalized than ever before.”

GUIDING PATIENTS THROUGH THE PROCESS

Doctors Malon, Wang and Zarfos all say that an important part of their jobs is helping to guide patients through the treatment process.
“Once you tell patients what they have to cope with, that’s the first step to dealing with the diagnosis and getting on with the process of being treated and healing,” says Dr. Zarfos.

One unique feature of the Middlesex breast program, according to Dr. Malon, is that the institution has “nurse navigators” who help steer patients through treatment.

“They make sure the patients make all the appointments that they need, and help them with transportation, referrals to social workers, stress management professionals, integrative medicine programs, physical therapists – whatever they need,” says Dr. Malon.

The other thing that sets Middlesex apart, she adds, is that it is truly a community program.

“Our providers live here, our family and friends live here – we are dedicated to our community,” says Dr. Malon.

At the same time, the doctors say, the breast program offers state-of-the-art care, not to mention that Middlesex’s affiliation with Mayo Clinic means experts at that renowned institution are also accessible for consultation on complex cases.

Most importantly, says Dr. Zarfos, “this program is going to offer patients our time and complete, undivided attention – along with science-based care – so that they will feel that we value who they are as women. When I was teaching medical students, my message was that you should treat people the way you would want to be treated, giving them attention and answering their questions. We are going to do our best to give patients excellent care that is kind and compassionate.”

Lori Miller Kase is a freelance writer living in Simsbury.