Last fall, Allison Ziering Walmark and husband Michael Walmark of Westport, Conn., had a lot going on at home. Besides making sure their two children got to school, music lessons, and gymnastics competitions prepared and on time, they were also coping with the unexpected deaths of Michael’s mother and Allison’s parents.
On top of that, the Walmarks were busy advocating for their now 13-year-old son, Ethan, a prodigy pianist, who is on the autism spectrum.
Then, they learned there was something else that needed their immediate attention. Allison’s annual screening mammogram and ultrasound detected a small tumor in her right breast. (Allison opted to have both screening tests because she has dense breasts—50 percent of women do—which make it harder to detect breast cancer.)
Not one to mince words, the former New York City consumer magazine marketing executive saw the breast lump as just another challenge.
“I wasn’t asking, ‘Why me?’” says Walmark. “I thought, ‘Why not me?’ One in eight women will get diagnosed with breast cancer in their lifetime. You play the cards you’re dealt. I’m not the kind of person to sit and crawl into a ball. It doesn’t help me. It doesn’t help anyone.”
Next, she needed to have a breast biopsy. Both her Ob/Gyn and the radiologist, who found the breast lump, recommended she have this done right away. It would determine whether the tumor was cancerous.
Finding her breast cancer treatment ‘dream team’
Since her day-to-day life was so hectic, Allison Walmark wanted to see a doctor close to home.
“My mind went directly to Yale,” she says. “I have two kids. I couldn’t go into New York City all the time.” But it turned out that she didn’t need to go even as far as New Haven. By tapping into the family’s social network in the Fairfield County community, a friend (herself a breast cancer survivor) recommended Mary Pronovost, MD, who has an office in nearby Trumbull—a 15-minute drive from the family’s home.
“If my friend was comfortable there, I knew I would be, too,” Walmark says.
Dr. Pronovost, a Yale Medicine oncologic breast surgeon, sees patients at the Smilow Cancer Hospital Care Center at Trumbull, located at Park Avenue Medical Center (PAMC) and at Bridgeport Hospital. Dr. Pronovost is part of a team that includes Danielle Bertoni, MD, an oncologic breast surgeon, Tomer Avraham, MD, a plastic and reconstructive breast surgeon, and medical oncologists, radiologists, and radiation oncologists.
Providing excellent, accessible care to the community is important to Dr. Pronovost and her team.
“I have lived here for 20 years,” Dr. Pronovost says. “I practice in my community. There are people that I've known or our kids have gone to school together who come here, and I feel very privileged to be able to help them.”
Walmark was relieved to find that all the pre- and post-surgical care she needed was available at PAMC. There she could access everything from radiologic imaging to radiation therapy to chemotherapy infusions, if needed. The facility also offers complimentary integrative medicine therapies such as yoga, Reiki, and massage therapy to cancer patients receiving care there.
The best choice for her
During Walmark’s initial appointment, Dr. Pronovost performed a core needle breast biopsy to determine if the tumor detected on the mammogram was benign or malignant. The in-office procedure took about a half hour.
Her biopsy sample was sent to a pathologist for evaluation. When the results came back, Dr. Pronovost explained to the Walmarks during a follow-up visit that the breast lump was malignant. It was a Stage I tumor, a highly treatable type of breast cancer that usually requires immediate surgery.
Walmark listened as Dr. Pronovost carefully explained treatment options. There were a variety of surgical choices to weigh. One was to have a single or double mastectomy with breast reconstruction. Or she could choose what’s known as breast conservation surgery (a lumpectomy), which allows a woman to keep most of her breast.
“New surgical techniques allow us to do more breast-conserving surgeries,” Dr. Pronovost says. “We leave the natural breast contour and appearance as best we can. With the latest oncoplastic techniques, once the cancer is removed, the woman's own tissues can be rearranged in her breast to fill the space of the tumor.”
Survival rates are the same whether a woman chooses to have breast-conserving surgery or a double or single mastectomy and breast reconstruction, as long as radiation follows the lumpectomy, explains Dr. Pronovost.
Which option a woman ultimately chooses is a highly personal choice. “Often there’s anxiety and worry about future cancers,” says Dr. Pronovost, “so we need to guide patients in what we think is going to be their best decision.”
It’s an educated choice that takes into consideration the kind of tumor, the stage of cancer, if there is a family history of cancer, and how a woman feels about her natural breasts.
“There’s a lot more to a person when she walks in the door than just her diagnosis on paper,” says Dr. Bertoni. “Our team knows it's important to talk to patients about their personal values and beliefs. We form an individualized treatment plan that will work best for them.”
For Walmark, a double mastectomy and breast reconstruction were the right choices for her. “I always knew that if I got breast cancer, I would opt for a double mastectomy,” says Walmark.
Walmark had her surgery at Bridgeport Hospital, part of the Yale New Haven Health System. The double mastectomy and breast reconstruction surgeries were performed back-to-back and took a total of about two hours.
The surgeons found a second tumor directly behind the first that was undetectable with mammography. Due to the small size of the tumors and because the cancer had not spread, neither radiation therapy nor chemotherapy was recommended. Instead, she was prescribed daily hormonal therapy with a medication called Tamoxifen. Her breast tumor was estrogen-sensitive, meaning that estrogen helps it grow. So, controlling Walmark’s estrogen levels on an ongoing basis is important to prevent cancer recurrence.
Not missing a beat
“They really are the pros,” says Walmark of Dr. Pronovost and her team. Up and walking the hallways that afternoon, Walmark was released from the hospital the day after her surgery.
On her way home, she made good on a promise to her daughter, now 11, stopping by school to give her a hug and reassure her that mom really was okay.
“My son and daughter are the joys of my life,” says Walmark. She was relieved to learn that her lymph nodes all tested negative, and genetic testing showed that she does not have a genetic predisposition to cancer or a so-called “cancer gene.” So, her children are not at increased risk for developing cancer.
“If Eliza or Ethan got the cancer gene from me—,” says Walmark, attempting to hold back tears. “I’m sorry,” she says, trying to wave away her emotions with her hands. “I didn’t cry about the cancer or diagnosis. But, the idea of passing this gene onto my kids…” she says, unable to finish her sentence, her words trailing off.
She smooths out her sleeveless, summer-white sweater and regains her composure. “I’m very lucky,” she says, “and hopefully, the cancer won’t ever come back.”