Breast self-awareness was key to detecting breast cancer

While some may think breast self-examinations are optional, Pam Herber of Yorkville, Illinois, would say that her story is proof that breast self-exams are still an important component of your wellness checklist.

In November 2020, while visiting her son in Oklahoma, 60-year-old Herber reached across her chest and felt something funny. There was a lump in her right breast. With a family history of breast cancer, Herber used to get a mammogram every six months but in the last five years, she would get mammograms yearly and performed self-exams regularly - often enough to immediately recognized something was wrong. When she came back home, she immediately scheduled an appointment with her doctor who sent her for a mammogram.

A mammogram uses low-dose radiation X-rays to detect changes in breast tissue. Because X-rays don’t easily go through breast tissue, the mammography unit uses two plates to flatten the breast to spread the tissue apart. This mechanism creates a better picture and allows radiologists to use less radiation. When symptoms are present, like in Herber’s case, radiologists use a diagnostic mammogram that includes additional images of the breast that are not typically part of a screening mammogram.

Herber’s initial mammogram didn’t show a mass.

Her doctor decided to run a breast ultrasound. Unfortunately, her local hospital didn’t have the breast ultrasound technology available so she had to visit another nearby facility.

A breast ultrasound uses sound waves to draw computer pictures of the inside of the breast. This enables doctors to see any changes in the breast that are difficult to identify with a mammogram. During an ultrasound mammogram, gel is put on the skin of the breast, and a wand, called a transducer, is moved over the skin. The transducer sends out safe sound waves and picks up the echoes as they bounce off body tissues, which are put together to draw a picture of the breast. Breast ultrasounds can tell the difference between fluid-filled cysts, which are usually noncancerous, and solid masses, which may require further testing.

When I told the doctor that I was willing to travel, he told me to go see Dr. Jaskowiak at UChicago Medicine.

Herber’s breast ultrasound showed a mass. The doctors decided to conduct an ultrasound-guided breast biopsy, which uses sound waves to help locate a lump and remove a tissue sample for examination under a microscope.

“It was 2:30 p.m. on New Year’s Eve when my doctor called me and told me that I had breast cancer,” Herber said. “Happy New Year, 2020 sucked.”

Herber’s brother connected her with a doctor that he trusted.

“When I told the doctor that I was willing to travel, he told me to go see Dr. Jaskowiak at UChicago Medicine.”

Once Herber established care with Nora Jaskowiak, MD, at UChicago Medicine about 50 miles away from her home, it was like a “well-oiled machine.” With choosing UChicago Medicine for her cancer care, she was able to get another breast ultrasound right at the academic medical center to confirm the findings. She was also connected with plastic and reconstructive surgeon Rebecca Garza, MD, who specializes in breast cancer reconstruction and would be part of her care team.

“At first, I was concerned because I didn’t want to have to travel all over town to see doctors at different locations who may not be in connected when determining the best outcome for me,” Herber said. “But when I found out that Dr. Garza was just a few floors above us and we met, I was relieved that she was nearby and in my corner.”

Together, Jaskowiak, Garza and Herber met to create a treatment plan.

“When you’re with Dr. Jaskowiak, you don’t need to take notes. As she’s explaining everything that’s happening from the diagnosis to the treatment, she’s writing it down to help me understand,” Herber said. “She gave me a toolbox. I had the ability to answer all of my questions at any time by going over the notes she wrote down for me.”

Because there wasn’t any evidence that the cancer had spread distantly, Herber was a candidate for surgery. She chose to undergo a mastectomy and immediate reconstruction. She also underwent a sentinel node biopsy. The sentinel nodes are the first lymph nodes which receive drainage from the breast and to which cancer cells are most likely to spread from a primary tumor. The biopsy identifies, removes and examines those nodes to see if any cancerous cells have spread.

“Fortunately, her case was pretty straightforward,” Jaskowiak said. “I encourage everyone to be breast self-aware and because she was conducting self-exams and was aware, she was able to spot a change early, which in the long run, made her treatment easier.”

After surgery when Herber felt another lump, Jaskowiak got her into the office the same day. “She stopped what she was doing and got me in,” Herber said, “That was a sign that she cares about her patients and the outcomes.” Turns out the lump was from the drain tube that is used to collect fluids during healing.

It was only one month between diagnosis and treatment for Herber. Now that she’s on the other side of surgery, she’s feeling great and is just driving to the Hyde Park campus for follow-up appointments to ensure all is well.

“I couldn’t have planned for a better scenario, Herber said. “I feel like the doctors cared, which is exactly how you’re supposed to feel.”