Roundtable Talk with UChicago Medicine: The Importance of Screening for Breast Cancer

KATHLEEN HUMPHRIES: If you go down, we all go down. You know, and she said, and do you really think I want to live without my baby? Oh, don't get me started. So I did. I went to the-- I went to have my mammogram, and there it was. There was something suspicious.

KIRTI KULKARNI: My name is Rirti Kulkarni. I'm a breast radiologist at University of Chicago, Medicine.

TARA LATTA: My name is Tara Latta, and I am a breast cancer survivor.

KATHLEEN HUMPHRIES: My name is Kathleen Humphries, I'm a breast cancer survivor.

SARAH SHUBECK: My name is Sarah Shubeck, I'm a breast cancer surgeon at the University of Chicago Medicine.

TARA LATTA: My first experience with breast cancer was actually through my mom. She was first diagnosed in 2013, and it was stage III. And it later did progress to be metastatic, and I decided to take a break from my career and care for her. And so I spent the last year and a half of her life caring for her when it became terminal. About a year later, though, I was seeing a specialist at the University of Chicago for a different condition, and incidentally there was a finding of a suspicious area in my breast on another scan, a diagnostic scan.
I was a bit taken back and surprised by that finding, because my mammogram three weeks prior to this was clear, normal. And so of course I wanted to have a referral to the Breast Center, and my surgeon at the time, breast surgeon, was assigned to me, and she went ahead and ordered a biopsy. And that biopsy did come back positive for breast cancer, which I guess in some ways I was expecting to get breast cancer at some point in my life. But I thought much later in life, and not in my early 40s.
And so I was a bit surprised. I wished my mom was still there that I could talk to her about it. But unfortunately she wasn't. And so I went on my own journey, and navigated the breast cancer landscape.

KIRTI KULKARNI: Tara, thanks for sharing your story. A couple of things that you mentioned here was that you had a mammogram, but it was not seen on the mammogram. I really want to share with you that there are different types of breast densities, and sometimes if patients have dense breasts, which is category C or D. there are four types of breast densities, A, B, C, or D, A being very fatty, and D being very dense. And if it's C or D breast density, sometimes mammographer's job gets really hard. You can't find small cancers that might be hidden behind the dense breast tissue.
And we do find sometimes that, like you mentioned, there was another test when it was found. And then there was a mammogram that was done. So sometimes a patient might get a CT scan of the chest, and there might be a lesion in the breast that is seen, and they might recommend the patient to get a mammogram. Sometimes it could be a PET scan for some other reason that the patient is getting, and they might find something which is lighting up on the PET, and might then recommend the patient to get a mammogram. So there are various routes, but eventually we start off with a mammogram. And an ultrasound after that.

TARA LATTA: Yeah, I mean just to kind of add to that, my breast density was C. And additionally I had what I later found out is innumerable cysts, which also made it more complicated or more complex breast tissue. And so we think that's why it was missed.
My original mammogram was actually done at another institution. And so when I was referred to University of Chicago to the breast surgeon, she went ahead and had that mammogram reread. And it was seen at the time.
And I reread the mammogram report. It did mention that my mom had metastatic breast cancer. And it also had mentioned that I had breast density of C, which is C of D, right? The third of the four.
And I had-- I did know a bit about breast density. I knew that it made it a little difficult to read. But I guess there was a part of me that thought that if they couldn't see very well, they might refer me to different imaging, especially with the risk that I had. And so Doctor J actually explained to me that a risk assessment probably should have been done on my case, and she explained what some of those calculators are, and given my mom's history. Plus the density that I had. I probably would have been referred to an MRI or ultrasound at the very least.

KIRTI KULKARNI: So almost 40% of women have dense breasts, and we definitely have a challenge when we're looking at mammograms in these patients. We do something known as 3D mammography, which is basically a set of images that I look at. Not just a single image. So we have four images. But in each image, there is a cine. So there are multiple images that make up a stack for me. And it's sometimes really hard, in spite of doing the 3D mammogram, to find the cancer hiding behind.
The adjunct screening tools such as automated whole breast ultrasound, or a breast MRI. So the automated whole breast ultrasound is when you're basically getting an ultrasound done. The images get post processed, and then the radiologists look at the images, either on the same day or the next day. And the breast MRI is a magnetic resonance imaging, where the patient is laying typically on the belly, and it almost it takes around 15 minutes, and you get an injection, a contrast injection during that time.

SARAH SHUBECK: I think it's important, though, too, that we're starting from a conversation the next level of breast screening, when we know so many of our sisters, our friends, our community members aren't even getting to that first access point. Right? We know that screening mammography works to make breast cancer outcomes better. We know that we can do it more precisely. But a lot of what I think about, and what we talk about is, how do we get people even through that first set of doors, right? How do we empower women with enough information, and those people around us to get that first piece of this puzzle, so that we can at least assess their density, or understand their risk, or empower them with their own information?
And I think it's something I really that sticks with me too. I'm a breast cancer surgeon. I'm sure there are women in my social circle that I'm not reminded about their mammogram. So I think even if you start at that point, you are getting your mammograms religiously, and maybe it wasn't enough for you, but at least it was getting through the door to someone who could help you define your risk, and helping you learn about your body in a really important way.

TARA LATTA: Right.

KIRTI KULKARNI: But a lot of women don't even know what age to start with a screening mammogram. A lot of people don't know where to go for a screening mammogram. So there's definitely a lot more work that has to be done to talk about the myths and misconceptions about it, right? Some women think there's a lot of compression that happens, it takes a long time. The reports-- who gets the reports-- another question, right?
Because we the radiologists who actually interpret the mammograms, seldom get to meet the patients. Most of the times we're sitting in the dark room and reading those exams afterwards. So yeah, there are definitely a lot more work, like you said Dr. Shubeck, to be done in the community.

KATHLEEN HUMPHRIES: One of the questions I was going to ask based on your experience is, what constitutes a genetic predisposition?
You know? How far are those relationships, like it was your mom, but is that your grandma too? Is it-- how far does that go?
The only person in my family who had dealt with breast cancer was a great aunt, my grandmother's sister. And so there was no real predisposition, I guess, for me. My mom didn't have it, sisters or. But it had been years since I had gone for a mammogram. Just years. And for no reason other than life, you know? Life steps in and changes your trajectory, and you're doing different things.
And my dad was diagnosed with leukemia in 2010. My sister-in-law had come to live with me in 2008. After my dad had leukemia, and I was trying to make sure that my mom, who was his caregiver, I'm trying to take care of her from long distance. I mean, we lived in the same city, but I'm working, and doing this, doing that. And in the interim my sister-in-law, who was living with me, was diagnosed with pancreatic cancer. So my dad died first, and that was despite all of my protests. Like, no, no, no, you know? Despite that, then my sister-in-law who was given three months to live actually lived for two more years. So and then the-- my mom had a benign brain tumor. I'm making this way too long, but the point I'm trying to make is that I'm fine. I don't have a problem. So let me just make sure everybody else is OK, let me do what I need to do, then I'll take care of myself.
Well, during this time my brother, who was also came to live with me at my insistence, because he had some medical issues. He said, you are doing this for everybody else. I haven't seen you go to one doctor's appointment. I'm like, well, I don't have to. I'm not sick. I don't have any problems, you know?
But he became insistent. And so it was really because of that. And my mom said to me, she said, honey, you have got to take care of yourself. She said.

KIRTI KULKARNI: Absolutely.

KATHLEEN HUMPHRIES: If you go down, we all go down. You know? And she said, and do you really think I want to live without my baby? Oh, don't get me started. So I did. I went to the-- I went to have my mammogram, and there it was. There was something suspicious. And thereafter it was the ultrasound, and then the biopsy.
And the thing that I think helped with me was that when it was confirmed and checked, that this was stage two breast cancer, I thought, I got to get rid of this. I can't do this. You know? I don't have time. I cannot let this be a problem in my life. I can't.
And so not that it wouldn't have been, or that it couldn't have been, but it was just my attitude was, I don't have time to be sick. I can't. And so my focus shifted. And I just felt like, I got to get on, come on, we got to get this over with. We got to. And I met my surgeon, and she was just so incredibly-- I mean, literally, I felt my spirit connect. My spirit just got up off the table and went and hugged her.
Because it was that I felt like this was a human being, and a woman who had an expertise that I don't have. And so I didn't feel like I was a case, or someone to be examined as part of a clinical something. I was a human being, being related to by another human being, who had the expertise I needed.

KIRTI KULKARNI: You felt the connection. The way you said it.

KATHLEEN HUMPHRIES: Instantly. Yeah.

SARAH SHUBECK: I was just going to say, I remember when we met, you had no time for cancer. And I'm 100% supportive of that. But what I was so thankful for is that you did make time for yourself in this storm of being your family's matriarch, right? And I see it a lot, is that finally an individual gets around to thinking about her own health risks.
But only after they've cleared so many things off of their docket, such that it becomes guilt. And I remember talking to you, too. You have this social circle of friends who've been affected by breast cancer very directly, and I love how it was tackled as a team sport. And it was this like deep sisterhood that I felt very privileged to get to see and get to know. And I was relieved, because I worry a lot of times for patients, myself included, that we are busy putting ourselves in the back seat to let everyone else around us get what they need.
I definitely see it in a lot of my patients, and in myself, too. We often will put ourselves in the back seat and take care of everyone else's needs before our own, right? Your parents, your siblings, your children, whatever it may be. But we have to leave a little space for ourselves to look out for our health, and breast cancer screening is something that we have to remember to do. And we have to take ownership of, because we know it works. It's uncomfortable, it's scary, but it's definitely one way where we can prioritize our health. And maybe by doing that, other things will follow.

KATHLEEN HUMPHRIES: I think you're so right that we do put ourselves on the back burner. And when we're not mindful of the fact that we have not taken care of ourselves.

KIRTI KULKARNI: Yeah. And screening mammograms do work. They're easy, quick, it's available through the University of Chicago Medicine at multiple locations now. And I think, you go in without when you don't have any symptoms. So you could make it into like a lunch with your girlfriends, or make it into an event where you're taking some time off to take care of yourself and celebrate that, in some way or the other.

KATHLEEN HUMPHRIES: Now that's the truth, and in fact Dr. Shubeck mentioned my village of friends. They, out of the group, and it's about it's my high school and college friends. And out of our group, I'm the fourth person to have this. So they were already, OK, let's suit up. Here we go. And they went with me for everything that I had to do.
And it was, you need an advocate. You're dealing with your own emotions and whatever else you're going through. It's like, I don't know what to ask. I don't know what I feel. But luckily there's-- you've got people there who, they know what to ask. Even if you don't, even if your story is not their story, say it. Get it out. Don't be afraid of what-- I mean, what could be worse? You've already been diagnosed with cancer. So what? Now let's get to what needs to happen.

KIRTI KULKARNI: And I can see that stress and anxiety when the patient-- when we're going to do the biopsy on the patient. And most of the patients are worried about, what is the outcome of the biopsy than the actual procedure. And we're always trying to give them support and share with them that we're here for you. It's a great team of doctors at the UChicago Medicine, and answer some of the questions.
But until we get that diagnosis, we can't really move forward with additional discussions. There are some patients who really want to be, like, let's talk to the surgeon ahead of time. I want to meet. But we try to tell them one step at a time.

TARA LATTA: I know that. I can remember the exact moment I was diagnosed was when I was walking my dog, and it was a Friday at after 5:00, and I got a call from the surgeon. And I'm sitting here thinking it's Friday night. When I first heard the words that I had cancer, I guess I was slightly prepared that it was going to happen. There was a bit of some difficulty having the biopsy done, because it was difficult to see with the ultrasound.
And so and then once I could kind of tell that we had found it, I personally could tell, I was preparing myself mentally that this was going to be cancer. So when I actually heard the news, probably a bit different of a reaction than normal, but I said I knew it. And so I think that there's probably some women who feel very similarly that there may, may feel that way as well.
And then I definitely had like the first 24 hours was just like a, oh my goodness, moment. And before I moved into action. And but there was that first definite 24 hours of like, there's no turning back. Right?

KATHLEEN HUMPHRIES: Who did you tell? Who did you share that with?

TARA LATTA: Well, I initially reached out to my brother-in-law and sister-in-law. They're both in the medical field. They're doctors, surgeon. And just said, do you know anybody? Where should I start?
I will say, I didn't know anybody my age with breast cancer. I know my mom had breast cancer. And so I didn't even have anybody to call to say, hey, what was this like? And so that was a moment of like, holy cow, who am I supposed to talk to about this?
And so I started reading online, and joining some support groups online. That's because you can do that pretty quickly. But I realized I really wanted to talk to people. So I had to reach out while I was waiting to talk to the surgeon. I reached out to mentors that were older than me, and said, do you know anybody with breast cancer?
And so that's what got me on the trail of finding people who were older than me that had breast cancer.
And then I did finally reach one person who was around my age, and she recommended a young woman's support group. And so that was very helpful, to speak with women who are closer to my age, dealing with similar experiences. And that was very helpful.
But I think there's a multitude of emotions that you go through, and there's comfort in talking to people who have been through it, and can kind of help you navigate that. The breast cancer landscape.

KATHLEEN HUMPHRIES:
When I heard the news that it was breast cancer, the thought was, at first, I don't know. I don't know if it's like the stages of grief or what I was, like, no. Denial, or as I said, I don't have time for this. Or just whatever those changes are that you go through, it's like what-- again, where am I going to come out?
But the thought that I kept in my head was, not only where does my story end. Where does this chapter? Where does the cancer chapter end? But what do I need to do to make it end in my favor? What do I need to do? And I think, as I try to empower myself, the one thing I did do was I stayed offline. And not freak myself out, and just kind of rely on the professionals. That I felt that I did-- I felt them. So I thought, well, let me do what I need to do, and to help her help me. And that became my goal. I got to get through this, and I've got to be OK. And I'm going to do everything I can to make sure that-- to help ensure that happens.

TARA LATTA: I will say one other thing. When I was-- this was before I had met my breast surgeon, but I was just asking, I was like how do you decide who to go with? And she's like, you will know. You will know when you are with your surgeon.

KATHLEEN HUMPHRIES: That is so interesting.

TARA LATTA: And she was right.

KATHLEEN HUMPHRIES: She was right.

TARA LATTA: She was right. So there is a connection that can't be described. When you meet your oncology team. And there's a connection.

KATHLEEN HUMPHRIES: Let me tell you, interestingly I had to go to a different facility to have the first follow up biopsy, or ultrasound.
And so it was with a different surgeon, and she was really lovely. Just, you know. But she wasn't my savior. She was just a really lovely person, and I said, OK, thank you so much. So I had to go get my surgeon. And really, I didn't even-- I hadn't even met Dr. Shubeck yet. Had not even met you yet, but it was, yeah, no, it's not my surgeon. This one is.

KIRTI KULKARNI: So did you have a list of questions prepared when you met Dr. Shubeck, or?

SARAH SHUBECK: There were questions.

KATHLEEN HUMPHRIES: There were.

SARAH SHUBECK: They were ready for me.

KATHLEEN HUMPHRIES: Yeah.

KIRTI KULKARNI: Because some women get so emotional, and probably lost in this, what to do next step, that someone-- like you had your sisterhood, like Dr. Shubeck said, with you. To support you and get you ready for the day when you were going to meet Dr. Shubeck, and ask those questions, because that would guide you to the next step.

KATHLEEN HUMPHRIES: Yeah. I think too, I probably had the questions that most people have when they find out they have breast cancer. And it's like, well, what next? What are my chances? And what will I have to do? Will I have to have a mastectomy? Will I have to-- it's just all those life changing questions that you have.

KIRTI KULKARNI: Both of you have such compelling stories, and such, moving stories. But it takes a village to get to the point where you are, but it also takes courage to share your story. Not everyone is ready to share. So.

TARA LATTA: I think that's so important to share those stories. I mean, I don't know-- I remember the days when cancer was sort of hush hush. And even with employers, right? Like we've got-- I've got to hide that I have cancer, or that I'm going through treatments. And I knew women that were doing that. And I'm just glad that we're even at this table together right now, having this conversation. And giving the ability for us to tell our stories. So.

KATHLEEN HUMPHRIES: Yeah, I am too, Tara. I think if one person sees this and says, I haven't checked either, just one person.

SARAH SHUBECK: Absolutely. And I think to your point, like breast cancer is a whole collection of diseases. It's not one size fits all.
Everyone's journey is unique. Every person, we need to figure out where we're meeting a person in their life, how cancer is only going to delay or impact that story as much as we can allow it to. And then how do we set you back on path.
I tell a lot of my patients, and maybe I think we had some similar conversation, I always try to picture who someone would be if I saw them at the grocery store. Right? Because when we're talking, it often makes people who are normally the pillars kind of a puddle, right? It's such scary, scary news.
And so I'm always thinking to myself, how would Kathleen be if I saw her at the grocery store? Just walking through her day, dealing with her to do list, everything else in her life. And often that's what I lean on the people around you to show me, is like there in a different phase of the fight often than the person who's right directly in front of me. And I always look forward to that six month, 12 month post visit, because that's really you, right.

KATHLEEN HUMPHRIES: Yeah.

TARA LATTA: Yeah.

SARAH SHUBECK: That's really when you break through, when you're like, how are you? And you don't lead with, oh my cancer. You lead with my family, or my friends, or myself.

KIRTI KULKARNI: But to your point, Dr. Shubeck, I totally understand how everyone's journey is different, and how the type of cancer, and how it's treated is different, right? So the goal is to get that a little more personalized treatment, and also same with screening mammography. We think one size fits all, but then there are patients who have dense breast, and we might not find the cancer at the right time, or patients in which the cancer is so aggressive that it comes really fast in spite of patient getting a screening mammogram every year.

SARAH SHUBECK: I think the example I tell patients about managing their breast cancer is that at different seasons of treatment, there's a different quarterback. The patient's kind of still the coach, right? So I work with-- I send a lot of my patients to Dr. Chen, we work together a lot. And so I use her as an example a lot of the time, where depending on your cancer, sometimes I'm your starting quarterback, and sometimes Dr. Chen is, because some patients need medicines first to make their cancer kind of more ready for surgery, or because that's really the most important thing in the modern era, is a lot of these medicines that are now available that weren't before.
But still everybody does need a surgery. And the idea is to get the right amount of surgery for the right patient.
And so it depends on the season. A lot of patients will still come to me as the surgeon with their new diagnosis, and the end of that conversation will be me saying, hey, actually you need a medical doctor first. And that's because you need the right person at the right time.
And so we work together. This is-- surgery is, very humbly, no longer the most important show in breast cancer care. And I'm thrilled for that. Because that means we're getting better by doing it differently. And as we lean on each other to provide that best care and work together with true multidisciplinary spirit, right?
I speak to my colleagues all the time about patients, and how maybe we need to navigate a life event, and modify the timing of everything so that he or she can do what they need to do. But it really is-- we are nothing alone. Right? Surgeons against breast cancer did not work, in history. We lean on our colleagues, we learn on, we lean on the innovations of radiation, of medical therapies, of our imaging modalities so that we can get patients to have the best cancer outcome possibly.

KIRTI KULKARNI: But also that means that the time it takes to treat is long. Right? Because sometimes patients need, like you said, medicines before, and then would need surgery, and trying to navigate them through this process is important.

SARAH SHUBECK: And it's like mini medical school, right? I talk to patients about that too a lot. It's like, well, you're going to get an honorary degree you never wanted. Right? So let's talk about what breast cancer is. Know the enemy, right? And have-- own your information. I don't want to keep a secret, right? Everything that we learn about your body is ultimately yours. So we need you to be able to be a partner in that, because we're not going to keep anything behind closed doors.
I want you to be empowered with your results, right? Because it's a team. It's a team sport, and ultimately the decider is you.

KATHLEEN HUMPHRIES: I always felt that too.

KIRTI KULKARNI: I think starting at the age of 40 getting a screening mammogram is something that could be a beautiful birthday gift for yourself when you turn 40. If you have any of the risk factors, whether it is family history of breast cancer, understanding whether you're an average risk woman or a high risk woman is important. And I think having this conversation early on with your physician, with your primary care provider, with your radiologist, or with your OB/GYN would be a good way to start this conversation.

TARA LATTA: I think for me, just a reminder that breast cancer is not a death sentence. It is a chronic disease that is managed and monitored, and hopefully for many cured, and treatable. And that the most important thing is to kind of learn through the process. I mean, I think that there's so many different ways you can receive support. It could be through friends and family, but it could also be through support groups online, or in person, and to find those ways in which you feel most supported.

KATHLEEN HUMPHRIES: It's not a death sentence.

TARA LATTA: Right.

KATHLEEN HUMPHRIES: There are absolutely inroads have been made well beyond when my aunt had cancer.

TARA LATTA: Right.

KATHLEEN HUMPHRIES: You know, and so now here you are, here I am, and at this time, maybe even 10 years ago, the stories wouldn't have had the same outcome.

TARA LATTA: I think about all the women that have come before us, and the women that are right now going through it, and the inroads that we've made, and I can't wait to see where we'll be in five to 10 years.

SARAH SHUBECK: Yeah, I think the biggest takeaway from everyone is talking about this notion of empowerment over our health, and our bodies, and what we know about ourselves. And so I think the most important takeaway is, like you said, is, look out for yourself. We can't read each other's minds, and we don't know everyone's details and everyone's history.
And so I think the biggest takeaway for me is to have the conversation, and understand what you need to do to take care of yourself. And then make a little space to prioritize your own health. Right? And I hope that is ultimately so women can end up like the two of you, living beautiful full lives after breast cancer. But we know how to do that better by getting you through the doors, and helping us work together and be good partners in this.

KIRTI KULKARNI: Love that.

KATHLEEN HUMPHRIES: I love that.

SARAH SHUBECK: Yeah.