As reported by the Boston Globe, December 27, 2004.

Doctors Say Rell's Prognosis Looks Good

By Noreen Gillespie, Associated Press

HARTFORD, Conn. -- Gov. M. Jodi Rell did everything right.

A longtime advocate of breast cancer awareness, she got regular mammograms. But her cancer was so tiny that it escaped detection by technology, and it was discovered only during a biopsy for non-cancerous calcium deposits.

Rell underwent surgery Monday at Danbury Hospital. Doctors performed what many believe is the most drastic course of treatment: a mastectomy.

While the treatment sounds severe, experts said it does not mean that it is a signal the governor has an aggressive form of the disease. Details about Rell's particular type of cancer and surgery were not released, but breast cancer experts said the operation may have been the best way to treat her particular case.

"This does not necessarily mean she has advanced disease," said Dr. Kristen Zarfos, medical director of UConn Health Center Women's Specialty Health program. "But there are circumstances where mastectomies are done when there is not advanced disease."

Rell's cancer was diagnosed last week after a routine mammogram. It was so tiny that even the advanced imaging technology could not detect it. Her doctor performed a biopsy on non-cancerous calcium deposits known as atypia, and during the procedure found two other deposits and removed them. One was cancerous.

The good news, doctors said, was that the cancer was caught early, and that tests revealed it had not spread to the lymph nodes. And though outside doctors did not know the specifics of her case, they said the fact that she is not expected to need chemotherapy after the surgery is a good sign.

"The fact that she doesn't need chemo means that it probably wasn't invasive, or the invasive part was very small," said Dr. Donald Lannin, a professor of surgery and executive director of the Yale-New Haven Breast Center. "That would be a good sign, and means she would have a very good outcome."

During a mastectomy, doctors remove part or all of the breast tissue while the patient is under general anesthesia. The governor's staff said she spent most of Monday afternoon in surgery for a mastectomy and breast reconstruction.

When deciding if a patient is a candidate for a mastectomy, doctors evaluate several things, including the size and type of the tumor. They also consider if the cancer is in multiple places in the breast, and if it has the potential to spread.

"One reason might be that the cancer is located in many different areas of the breast. If you don't get it all out, it comes back in gangbusters," said Dr. Scott Kurtzman, a professor of surgery at the University of Connecticut.

But for individual reasons, women may also opt for a mastectomy. In non-invasive cases, the other option is a lumpectomy and radiation. A mastectomy completely takes care of the problem in one procedure.

"It's over, it's done with," Kurtzman said. "Some women find that very attractive."

To reconstruct the breast, plastic surgeons have two procedural options. They can take tissue from the abdomen or other areas of the body and create a new breast. Or, they can use a tissue stretcher, gradually filling it with saline for a period of weeks before putting in a permanent prosthesis.

Rell has said that despite the surgery, she plans to give the State of the State address when the General Assembly convenes next week. She was expected to be in the hospital for three days, and though she will likely experience pain and fatigue, doctors said that it is possible she can return in time.

Zarfos said she tells her patients to take it one day at a time, and that each patient recovers from procedures differently.

"I think she's going to be in a good situation," she said. "This should not impair her ability to govern the state."