BREAST CANCER SCREENINGS SHOULD BEGIN BY AGE 40

It’s the advice we've heard for years: Begin scheduling annual mammograms at age 50. But in May, the U.S. Preventive Services Task Force, an independent volunteer panel of national experts in disease prevention and evidence-based medicine, changed its guidelines. It now recommends “all women get screened for breast cancer every other year starting at age 40.”

The reason is simple, says Cleveland Clinic breast surgery specialist

Dr. Zahraa AlHilli, “Starting screening at the age of 40 saves the most lives” — a message she says organizations such as the American Cancer Society, American Society of Breast Surgeons, American College of Radiology and Society of Breast Imaging have endorsed for years. She adds that the clinic actually recommends beginning annual mammography at age 40 and continuing for as long as good health permits, advice echoed by University Hospitals, says Dr. Holly Marshall, division chief of breast imaging at University Hospitals.

“When you do a screening mammogram, you can detect a large percentage of cancers before they can be felt,” Dr. AlHilli says. “Because of that, we’re able to provide women with treatments that can really allow them to be cured of their cancer.” and a 2.6% chance of developing it in the next 10 years. She explained that while dense breast tissue is common and normal, it can make it more difficult to detect cancer on a mammogram. For that reason, she suggested Herbick alternate scheduling mammograms with MRIs at six-month intervals. The news was frightening but empowering.

Dr. AlHilli urges people to initiate a conversation with their doctors about any risk factors they might have that indicate a need for earlier screenings: previous radiation treatments, dense breast tissue, abnormal mammograms that detect high-risk lesions, multiple family members diagnosed with breast and ovarian as well as other cancers. She explains that the risk of developing breast and ovarian cancers is increased most commonly by a mutation of the BRCA1 and BRCA2 genes.

“[But] other cancers such as pancreatic cancer, prostate cancer can be related to the BRCA gene as well,” she says. And other genes have been discovered that, if mutated, increase the risk of developing breast cancer and other cancers, such as colorectal, endometrial/ uterine, melanoma thyroid cancers and others.

“Some people that can be identified as … having a gene mutation may benefit from being referred for genetic counseling and genetic testing,” she says.

“I didn’t know I could be more proactive about it,” she says.

Herbick confirmed her health insurance paid for the biannual screenings, then scheduled an MRI in January, when she normally got her annual mammogram. On Jan. 18, she got a call from a nurse that the MRI indicated “an area of suspicious enhancement” in her right breast. She went in the next day for an ultrasound.

“The ultrasound looked normal,” she says. “At that point in time, I sat there, crying on a table, thinking, I’m worrying about nothing. This is such a relief!”

Then, after undergoing an MRIguided biopsy to confirm the findings, she got that dreaded call.

Herbick spoke to Dr. Anna Chichura, Cleveland Clinic breast surgical oncologist and benign gynecologist, within the hour. She explained that she’d been diagnosed with ductal carcinoma in situ, cancer that starts in the cells lining the milk ducts that typically doesn’t spread beyond the ducts. It is also called Stage 0 breast cancer. Herbick recalls Dr. Chichura reassuring her that because the tumor had been discovered in its earliest stage and appeared to be noninvasive in nature, her prognosis was excellent.

“I thought, OK, I hopefully have a good shot at taking care of this and living a normal life,” she says.

The tumor Herbick subsequently saw on her MRI showed up not as a lump but a spidery growth that covered a large portion of the outer side of her right breast — a threat she may not have felt during a routine self-exam until it was more advanced. Further testing, including a mammogram, revealed the tumor was very close to the skin as well as around the nipple. After several conversations with her doctors, Herbick opted for a double mastectomy. Surgery to remove such a large tumor, she reasoned, would leave her right breast misshapen anyway. And she was determined to do everything in her power to make sure she never faced a breast cancer diagnosis again. The memory of her mother’s battle with ovarian cancer still haunted her.

“Watching someone you love go through what she went through for years was horrific to witness,” Herbick says, her voice breaking as she fights back tears. “It was just so hard to see someone you love go through that.”

She also remembered how valiantly her mother fought through surgeries, chemo and radiation. That memory filled her with determination.

“She took it like such a fighter, such a warrior. I never in my life have seen someone so strong,” Herbick says. “I said, She showed me how to get through it — I’m going to get through this. I went into fighter mode.”

Concerns about how she would look after surgery — or what others might think about it — didn’t enter her mind. She was prepared to go through life flat-chested, dependent on prosthetics to fill out bras and clothes, if for some reason she wasn’t a candidate for reconstruction. She hoped a partner would love her exactly as she was.

“I just wanted to be healthy and alive,” she says. The decision represented a leap in personal growth. “I’m always asking others in my life, ‘What do you think I should do?’ But when it came time to make this decision, I, for the first time in my life, did not listen to anybody but myself. I realized, This is me taking control of my life right now.” surgery specialist Dr. Zahraa AlHilli performed Herbick’s double mastectomy at the clinic’s main campus on Feb. 8, Herbick came out of the anesthesia with one question clearly on her mind: “Did you get everything?”

Removing the tumor required taking so much skin, along with the nipple, that it precluded direct-to-implant surgery. Instead, plastic surgeon Dr. Risal Djohan inserted saline-filled tissue expanders above the muscle that would be replaced once the skin had stretched enough to accommodate silicone implants appropriate for Herbick’s body type.

The final pathology report revealed the presence of lobular carcinoma in situ and atypical lobular hyperplasia, which Dr. AlHilli defines as “high-risk lesions” in Herbick’s left breast. “Basically, if somebody has these findings on biopsy, they make somebody have an elevated risk for breast cancer,” she says. Herbick considered it a confirmation that getting a double mastectomy was the right decision for her.

“I know for every woman, it’s different,” she stresses. “And they should do, once they speak with their doctors, what they feel is best for them.”

The report also stated that two of three lymph nodes, removed to confirm cancer had not spread, had isolated cancer cells on them. AlHilli confirms that patients diagnosed with ductal carcinoma in situ who choose to have a double mastectomy typically require no further treatment. But those isolated cancer cells, even though few in number, made Herbick’s case more complex. Doctors couldn’t conclude whether the cells represented a microinvasion of the tumor or an inadvertent transfer during biopsy and/or surgery.

For that reason, Herbick will be taking Tamoxifen for the next five years. The drug blocks the effects of estrogen on hormone-receptor-positive cells in estrogen-positive cancers such as Herbick’s. If Tamoxifen is in the receptor, estrogen can’t attach to the cancer cell; therefore, the cell can’t receive estrogen’s signals to grow and multiply.

Herbick can stop taking Tamoxifen in two to three years to conceive and carry a child, then start taking it again. (AlHilli explains that, like many drugs, it should not be taken during pregnancy because it can affect the developing fetus.)

But Herbick does not want to interrupt treatment. And she realizes age may become a factor in her ability to become pregnant. So she chose to have eggs retrieved from her ovaries and frozen before she started taking the medication in March to preserve her option of having a child via in vitro fertilization and surrogacy.

The morning after the mastectomy, a nurse suggested Herbick take a quick look at her chest before she left the hospital that afternoon. Herbick lifted the tops of the sports bra and hospital gown nurses had dressed her in after surgery and saw two horizontal incisions, identical in length and location under the surgical tape, that ran from the center of where her breasts, now replaced by the aforementioned expanders, had been to the sides of her chest.

“I was shocked,” she says. “My lines were so thin they were basically nonexistent.” She was jarred not by the physical change but by what it represented: “Wow, I just went through that.”

HERBICK WAS BACK ON the air 2½ weeks later, despite her doctors’ advice to take four weeks off work to recover. She’d been able to manage the post-op pain by taking Tylenol and Advil rather than the prescribed painkillers — in fact, she says nausea from the anesthesia was worse than what she describes as “soreness,” and now she could drive.

“I needed to feel normalcy,” she says. “I needed to feel that I didn’t have cancer anymore. It was out of my body, and I wasn’t sick in some way. I wanted to just get back to my day-to-day living.”

The surgical tape covering her incisions adhered so well that she was given the OK to shower without anything else covering them on the second day after surgery. Lifting her arms to perform the repetitive motions involved in wielding a blow-dryer and brush, however, prevented her from drying and styling her hair. A friend came into the station to do it that first day back at work. Herbick concedes that she “cheated a little bit” and started drying her hair during the third-week post-op instead of waiting until the fourth.

“I was still not lifting anything over 10 pounds,” she says. “But I felt very good at that point.”

There were a couple of emotional breakdowns. The most notable occurred at least three weeks after the mastectomy in Dillard’s department store at Beachwood Place, where Herbick was looking for bras to augment the two Masthead-brand surgical ones her younger sister Lauren had found for her.

“I was still sore, and I’m trying on things, and nothing was fitting me, and I was just getting frustrated,” she says. “I started sobbing by myself in the dressing room.”

The others resulted from those moments when she wondered if cancer would return, even though she understands the odds are in her favor that it won’t.

“If I have a child and then something comes back, or I’m not there for that child — I don’t ever want to do that to a kid,” she says. “But I can’t let that fear stop me.”

Herbick was amazed to see her incisions had healed completely when Dr. Djohan removed the surgical tape four weeks after surgery. But a month later she began to see a discharge from an incision on the left side of her chest, evidence that the sutures weren’t dissolving properly. The complication kept her from resuming full workouts until well after her implant procedure. It also prevented filling the tissue expanders with more saline, a process that involves inserting a needle through the skin into each device, as Dr. Djohan had done twice after her mastectomy. Herbick discounts the effect on the final result.

“I was never very, very small,” she says. “It wasn’t a huge difference, even from before surgery.”

Herbick will complete breast reconstruction when she gets around to it. An oncologist friend suggests she wait until the year anniversary of her implant surgery, when “everything is settled, where it’s supposed to be.” Dr. Djohan left small portions of her areolas, which he’ll use to fashion nipples. (Although her left nipple and areola initially were left intact during the mastectomy to give her some sense of normalcy, she had them removed during implant surgery. “I just want them to match,” she says.) She found an out-of-state artist who specializes in “nipple tattoos” to create areolas once she recovers from that last procedure.

“His work is incredible,” she says. “I took pictures of what I looked like before so I can just say, ‘Here’s about what size they looked like. Maybe we can match them.’”

Herbick’s work to drive home the importance of cancer screenings is just beginning. She’s received messages from women stating they got a mammogram simply after hearing her tell her story on Fox 8. One man sent a card in which he thanked her for sharing her journey. It motivated his daughter, whom he’d been nagging for years to get a mammogram, to schedule one finally. Men even told her they got a colonoscopy because of it.

Current projects include working with the New Day Cleveland team on an hour-long show on breast cancer awareness. She'll tell stories on other people who have battled the disease and promote the station’s Fox Trot run/walk on Aug. 13 at Cleveland Metroparks Zoo. This year's annual event benefits the Breast Cancer Research Foundation.

Her biggest goal is to work with legislators to ensure that all people in the state of Ohio can access the same tools she had to catch breast cancer in its earliest stages. While she acknowledges that every breast-cancer diagnosis is as individual as the patient, she is proof that it does not have to be life-ending, particularly for those who are proactive in protecting their health.

“I hope to show women that [my outcome] could be the outcome for [them], and it’s not so scary,” she says. “If your life is going to be saved, you can handle it.”