Just in Time: Mammogram Saves Woman's Life

Finally putting her health needs first meant diagnosing breast cancer before it was too late

When Maureen Strassburger walks into the lobby of the Hunter Family Center for Women’s Health at Northwestern Lake Forest Hospital, you see someone who looks far younger than her 44 years — a petite blonde with rosy cheeks and big hazel eyes. She’s joking with the nurses and her bright smile is flashing. Her husband and two kids are trailing behind her, trying to keep up with her quick step.

You’d never know that Maureen is in the middle of the toughest fight of her life — against breast cancer. But thanks to a last-minute mammogram at the Center — and finally putting her health needs first — it’s a battle she plans to win.

“This isn’t my real hair,” Maureen says, pointing to the long locks that seamlessly match her skin tone. “These are fake eyelashes, too. My eyebrows are nearly gone; I don’t even have nose hair left. Who thinks their nose hair is going to go?” she asks, laughing.

Maureen’s sense of humor — and the support of family, friends and the “amazing” oncology team at Northwestern Lake Forest Hospital — are helping her get through the most demanding days of her treatment. A lifelong Lake Forest resident, and an infant massage therapist at the Hospital, Maureen recently had a double mastectomy and is now undergoing aggressive chemotherapy.

The journey began when Maureen had her first mammogram at age 44 — four years after the recommend screening age of 40.

The demands of family

“So many women are busy with everything else. They’re likely to brush off how they’re feeling and point to something else. They’ll say, ‘Oh, it’s this or that acting up.’ Or, ‘It’s just that time of the month —  that’s why I’m tired,’” she says. “We put our families first, and sometimes forget to take care of ourselves. We fear our own health problems might bring more stress into our lives.”

For Maureen, the need to care for others increased sharply when her father died in 1998, followed closely by her first pregnancy. “My father had been sick for a long time. Finally, I ended up quitting my job to help take care of him. Not long after he died, I found myself pregnant, single and without insurance.“

Fortunately for Maureen, her mother learned about Northwestern Lake Forest Hospital gynecologist Dr. Robert Hartman in a bereavement class. “Dr. Hartman took me under his wing,” she says. “He got me involved with Northwestern Lake Forest Hospital and helped me arrange for medical coverage.”

But things were still going to get a little more difficult for Maureen, pushing her own health even further from her mind. “I had a car accident then, and that caused my daughter, Molly, to be born earlier than expected,” she says. “And I was still grieving for my father. The stress was incredible.”

In sickness and in health

A bright spot came when Maureen reconnected with her future husband Karl, an architect with the Lake Forest firm Strassburger and Associates. Friends since high school (both had grown up in the area), they had stayed in touch over the years and started dating while Maureen was pregnant with Molly.

Eventually they were married, but soon after returning from their honeymoon Carl began experiencing serious pain in his back and arm. He had struggled for years with degenerative spine disease and had already undergone knee and back surgery that resulted in complications. And during this time, Maureen had become pregnant with their son Kyle.

“I had one small child, and I was six months pregnant,” Maureen remembers. “But I needed to help him get through this. We spent months just trying to find someone who would take on his complex surgery.”

It was a long process, with Karl eventually having seven major surgeries in a three-year period. The second of those surgeries occurred just a week after their son Kyle was born in 2004. Maureen was one day away from turning 40 — the age for most women to start having an annual mammogram screening.

“Around this time, I discovered about an inch of hardness in my right breast. I chalked it up to dried milk, or a clogged duct. I was taught to look for lumps, and it didn’t look or feel like a lump. I knew about baseline screenings, but I thought you couldn’t have a conclusive exam until about a year after nursing.”

Awareness — and confusion — about testing

Maureen was right about nursing having an effect on exams. But, according to Dr. Reni Butler, a radiologist at Northwestern Lake Forest Hospital who specializes in women’s imaging, the recent pregnancy was less of a barrier than Maureen might have thought.

“There are no hard and fast guidelines. Pregnancy and nursing stimulate hormones that result in more dense breast tissue — so it can make the mammogram less accurate.” But, she adds, “If you feel something, or if you’re over 40, you should still get checked even if you’re pregnant or you recently delivered. And in just three to six months after pregnancy or breastfeeding, the breasts do go back to normal.”

Maureen also knew about the importance of regular physical examinations. In fact, she had at least three physical breast exams from three different doctors while in her forties — and with each she was given a clean bill of health.

“The exams I had took away any worry about breast cancer. And I knew about family risk, too. We have many, many females in our family,” she says. “I have five sisters, including a twin. But there are no female cancers in our family. My father died of leukemia, but that was likely because of the industrial petroleum products he worked with.”

According to Dr. Butler, family history and physical exams are an important part of breast cancer prevention, but they’re only part of the picture.

“Seventy-five percent of breast cancer cases occur in women with no family history,” says Dr. Butler. “Family history is a concern, but the rest of us are not immune. Just getting older is a strong risk factor, though we see plenty of cases in young women, too.”

And the fact that Maureen had several normal breast exams prior to her cancer diagnosis?

“It’s not unusual. You can’t palpate [examine by feeling] a growth unless it’s large, or happens to be close to the surface,” explains Dr. Butler. “Only a minority of breast cancer diagnoses arises from something the doctor feels. That’s why a timely mammogram is important — it provides early detection for what can’t be felt or seen.”

Time slips by and sickness follows

Although Maureen could have come in for a mammogram during or not long after her pregnancy, the months started to slip past her. She was working, raising two young children, helping her husband heal — and becoming increasingly fatigued. Again, she looked elsewhere for reasons.

“I thought it was all of the stress from what we were going through with a new baby and the surgeries. And I wasn’t sleeping that well at night,” she says.

Maureen’s fatigue persisted, and new problems cropped up. “I was just feeling lousy. I got strep throat and had trouble getting rid of it. I had a cough that wouldn’t go away,” she says.

Again, Maureen looked to other conditions and had her thyroid tested. Thyroid problems had been a concern a few years earlier, when she was trying to get pregnant. “I ended up at a leading medical center, and they told me it might be depression. But I knew it wasn’t. I was depressed when my father died — so I knew what depression was like and this wasn’t it. I wasn’t in denial. I knew something was wrong. But I was thinking about other causes.”

"Messengers" trigger a life-saving decision

While Maureen was trying to get her thyroid medication adjusted in hopes of alleviating her symptoms, something else began happening.

“I kept meeting women with breast cancer, during the fall and throughout the next six months. And each woman was a little worse off than the one before,” she recalls. “One had a lump removed, the next had a mastectomy and one of them eventually died. These women seemed to come out of nowhere and cross my path. I think of them now as my ‘messengers.’”

With her insurance in order and no immediate financial obstacle to getting screened, Maureen finally made an appointment for her first mammogram at Northwestern Lake Forest Hospital’s Posy Krehbiel Breast Care Center. “I remember having some kind of commitment one particular day that I wanted to get out of or avoid — so I made an appointment,” she says. “It’s probably not the best reason, but it got me in.”

During her initial screening and the follow-up biopsies, Maureen’s doctors discovered she not only had breast cancer, but that it had been developing for several years.

“After my biopsies, they called the next day and I found out that I had DCIS [ductal carcinoma in situ] with 3.4 centimeters of growth and HER-2,” she says.

Dr. Butler explains that DCIS are malignant cells within the milk duct of the breast. It’s an early form of cancer that can become invasive and spread beyond the breast if left untreated.

“DCIS is considered a curable disease, and with a mammogram it can be caught early, before it breaks through,” she says. “HER-2/neu is a marker on those cells; it indicates a poorer prognosis because it’s more likely to spread to lymph nodes and other areas.”

Despite the difficult news and impending chemotherapy, Maureen was in some ways relieved. “HER-2/neu means my cancer is now invasive, so the cells may be setting up camp elsewhere. But my lymph nodes are clear and it’s not in my major organs,” she says. “With each chemotherapy treatment, I can lower my chances of recurrence, down to 16%. If I hadn’t gone in for that mammogram, it might all be over already.”

Cathy Spagnoli, a Nurse Navigator at Northwestern Lake Forest Hospital, helped Maureen coordinate all of her care with a team. In December 2008, in the middle of a blizzard, Maureen had her double mastectomy. She has since completed five of six chemotherapy treatments, with medication and reconstructive surgery to follow.

Healing through support and advanced care

Maureen is not one to “sugar coat” her situation, and she believes that the real-life experiences of fighting the disease can serve as a potent warning to others.

“Imagine giving birth to triplets and having the flu at the same time,” she jokes. “You feel it tearing you up inside. It taxes everything — your heart, your immune system. I’m cold all the time, and I have bruises from leaning on my elbows over the toilet. It hurts to carry or hold anything — like my son — close to my chest.”

At the same time, Maureen is quick to point out that her attitude, family support, and Northwestern Lake Forest Hospital’s advanced medical team are critical in getting through the treatments that can help her survive.

“I’m not the cheerleader type. I will honestly tell you that this is grueling. There are days when I hate this world. But I have a very strong belief that I’m going to be okay. My friends and family are there for me, they stand by me,” she says.

“I grew up in Lake Forest, but I had no idea how many nice people are here — especially at the hospital. The doctors and radiologists are amazing,” she says. “The nurse navigators took care of everything and became my best friends in this process. There’s a lot of coordination that has to be done quickly. But I never felt rushed or nervous. There’s a tremendous amount of sensitivity and calm at the Women’s Center.”

Looking back, looking ahead

Maureen acknowledges that there was a one-to-two year window when she could have caught her cancer earlier. She had her son at 39, and her first mammogram at 44. If she had come in for the mammogram even at 42 or 43, the cancer would have been found just as it was turning aggressive.

“I’m not sad or angry with myself. I think I was going to get this disease,” she says. “But I gave myself a harder time with it, more aggressive treatment and a worse initial prognosis, by not finding out about it sooner.”

Maureen is hardly alone. A 2004 study in Cancer, a peer-reviewed journal of the American Cancer Society, found that just over half of all women get their first mammogram by the recommended age of 40. What’s more, only 16 percent of women get follow-up screenings, as recommended.

But Maureen’s battle hasn’t been in vain, and she’s using it to help make a difference for others. She’s keeping a close eye on her twin sister, who may have similar risks, and she has convinced some girlfriends to get their first mammogram. And she’s using her massage expertise to volunteer with chemotherapy patients at Northwestern Lake Forest Hospital.

“I’ve worked with patients before at the Hospital, but now I have a different perspective. I understand the discomfort they’re feeling. My hands are my gift, and I can use them in a new way,” she says. “I can also tell my story, in hopes that other women will think more about their health — for their own sake, and for their families. So, I guess I’m a messenger now, too.”

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