October 25, 2016 | by Letisia Marquez
Laura Kruper, M.D., head of City of Hope’s breast surgery service, thinks back to an emotional time in her childhood when she reflects on what motivated her to become a doctor.
In the early 1980s, her great Aunt Peggy – who had helped raised Kruper’s grandmother and was like a mother to her – was diagnosed with breast cancer that had spread to her bones.
“I do remember going to visit Aunt Peggy in her house … and she was in a lot of pain,” Kruper, then 15, recalled. Aunt Peggy eventually died and her grandmother “never, ever recovered from that.”
“I know just how devastating it was to her when her sister died,” Kruper said. “Breast cancer impacts many people, not only the person who has breast cancer, so I think that was one of the reasons I wanted to go into cancer surgery.”
Finding more effective treatments and diagnosis for breast cancer patients also inspired her to pursue medical school.
A few years before her sister, Kruper’s grandmother had survived breast cancer but all her lymph nodes had been removed. (Lymph node removal for breast cancer was standard treatment up until the mid-1990s. The removal of all the lymph nodes underneath the arm was routine, whether cancer was found in the nodes or not. Currently, many women diagnosed with breast cancer only have a few lymph nodes removed.)
Kruper’s grandmother had a habit of biting her nails. Kruper recalled how one time, her grandmother’s arm swelled up because she didn’t have lymph nodes to fight off even a small infection.
“Sometimes the focus is so much on treating the breast cancer that there isn’t as much emphasis on the side effects that women can have after therapy, some of which are permanent,” Kruper said. “Breast cancer treatments and surgery have changed significantly since my grandmother’s time and for the better. There is much more attention paid to long-term side effects for survivors.”
Memories of her Aunt Peggy and grandmother continue to be present in every cancer patient Kruper treats.
I talk to people who are diagnosed with breast cancer the way I would want to be talked to, or the way I would want my family or friends to understand what they’re going through,” Kruper added.
Kruper’s early life
As a child, Kruper’s family lived in various East Coast cities, but her family eventually settled in Pittsburgh. Her parents divorced at an early age, and her mother worked as an oncology nurse.
“I would go to the hospital with her and visit some of her patients, and there’s just something different about taking care of cancer patients,” Kruper said. “It’s a combination of understanding how to treat a specific cancer but also understanding that each patient’s story is unique.”
Kruper attended Brown University and started the pre-med major. She changed her major when she started taking science courses and tests “that were so far removed from the care of patients.”
“I was in these huge, huge chemistry classes with hundreds of people, and I started thinking, ‘How is this related to patient care?’” she said. “It just seemed too abstract … so I started taking classes about one of my other passions: the art and culture of ancient civilizations. I ultimately majored in Egyptology.”
After college, she moved to New York and worked in the photo department of Condé Nast Traveler.
“People ask me, ‘Did you get to go take pictures and travel?’” Kruper said. “No, we sent photographers to go do that. I worked in the office to help put it all together.
“My time at the magazine strengthened my appreciation and understanding of the visual arts,” she reflected.
But she still thought about going to medical school and decided to finally pursue that career goal at the Perleman School of Medicine at the University of Pennsylvania.
“What really made my decision was volunteering in the emergency department … just hearing people’s stories and being in that environment,” she added. “That’s when I realized, ‘OK, now I’m ready.’”
Kruper also knew she wanted to combine her passion for photography and aesthetics with her desire to care for cancer patients.
“For me, breast surgery is very aesthetic, and I think it’s very important when a woman has breast cancer to have good aesthetic results,” she explained. “Breast cancer surgery and breast surgery in general is very visual, and so it’s important to have that aesthetic attention. I think that’s why I’m so drawn to it.”
One patient’s story
“Dr. Kruper was my angel,” said Iris Barank, M.D., when asked about Kruper, who was her breast cancer surgeon earlier this year.
In early 2016, Barank was diagnosed with Stage 1 lobular invasive breast cancer, which is present in the milk-producing glands, at an Orange County hospital.
Barank, 48, wanted doctors to perform a mastectomy. They suggested a regular mastectomy, or removing the entire breasts, and inserting tissue expanders between the skin and the chest muscle, which stretches the skin to make room for implants. The procedure would require the Irvine, California, resident to return to the doctor’s office periodically over a period of six months.
Barank wasn’t sure about that type of surgery, or the expanders, and spoke to other doctors, who recommended she consult Kruper for a second opinion.
Barank preferred a bilateral skin-sparring mastectomy. That surgery would remove the breast tissue and keep her bilateral skin and nipples intact, thus helping the breasts retain their natural appearance. Breast implants would also be inserted during the surgery, cutting down on the number of clinic visits Barank would need to make, as well as pain and discomfort.
“Dr. Kruper’s kind personality, her reassurance and her endless patience made me feel safe,” said Barank, adding that she sent Kruper a long email with questions about the surgery, which were promptly answered. “I knew I was in good hands.”
“I left the hospital after two days with bilateral implants,” she added. “It makes a big difference – most women have simple mastectomy, and then a few months later another surgery to place expanders and then months of pain and discomfort as the expanders are filled with saline. Then there’s a final reconstruction surgery.”
Kruper realizes how important it is to be there for patients to give as much information and advice as she has, as well as encouragement.
“It a great joy when I get to see the patients when they get to the other side, and see what they’ve accomplished and come through,” Kruper said. “Many women realize how strong they (are), which is a really great thing.”