Thriving during breast cancer treatment, and giving back to others

Nichole Herbst is part of a group no woman wants to join — but is becoming a reality for more young people. The West Chester native was just 44 years old when she was diagnosed with breast cancer.

Nichole knew something was wrong when she awoke with a stabbing pain in her breast, followed by some physical changes in her breast. A mammogram, biopsy and additional imaging revealed the diagnosis — stage two hormone positive breast cancer.

"When I was first diagnosed, a million things went through my mind," she says. "I was not expecting it at all. I was overwhelmed so I went for a walk to process everything. And then I decided to meet with the people at Main Line Health because I've always heard great things about Paoli Hospital."

Hear how Nichole found hope and healing

Making a plan

"Nichole knew that, even though she's young, something wasn't right," says Jennifer Sabol, MD, breast surgeon with Main Line Health. "My first meeting with patients after the diagnosis is always a long and important discussion. I tell them, 'This will be the hardest visit you'll ever have because I'm going to tell you things you may not want to hear. You may be overwhelmed, but at the end of the visit, we're going to have a plan.' When you learn you have cancer, that's your worst day. As the pieces come together, you start to have hope and you realize that, with baby steps, you can continue to move forward."

Dr. Sabol is just one member of the team that handled Nichole's care. "Our interdisciplinary team gets together every week and talks about each case on multiple levels. Many cancer specialists are part of that discussion, from surgery to medical oncology, radiation oncology, genetics, nutrition, social work, research and behavioral and mental health. We discuss each new case and then continue to reassess throughout their treatment. They have the input of many expert opinions, not just one."

Nichole's cancer had spread to a lymph node, but not further. Dr. Sabol assembled her team based on who she thought would fit well with Nichole. This included Grayce Selig, MD, medical oncologist.

Chemotherapy to shrink the tumor

"Dr. Selig made me feel so relaxed and comfortable," Nichole says. "She explained everything about my type of breast cancer and my treatment plan. We decided on chemotherapy first, followed by surgery, radiation and hormone therapy, which would suppress my estrogen since my breast cancer is hormone positive. She wrote down everything and made me feel like I was in the best hands possible."

"When you think about treatment options for patients with breast cancer, the first thing you have to consider is the receptor status of the breast cancer itself; treatments are very different depending on hormone receptor status," Dr. Selig explains.

"Just because you know someone who has had breast cancer doesn't mean their treatment is going to be the same as yours," says Dr. Selig.

"After that, we look at how extensive her disease is, how big the tumor is, whether the lymph nodes are involved and the person's age and hormonal status. Being pre- or postmenopausal changes how we treat patients."

These factors all made Nichole a good candidate for chemotherapy with the goal of shrinking the tumor prior to surgery. During nearly five months of chemotherapy, Dr. Selig got to know her well.

"Nichole is extremely strong," Dr. Selig says. "She knew what we were dealing with. Even when she wasn't feeling well, she came in with a positive attitude and never complained. She is young, she's active, she's otherwise extremely healthy and has her whole life ahead of her. I knew she was going to get through this."

Cancer in young patients

"We can be a bit more aggressive with younger patients with cancer," Dr. Selig adds. "We also think about fertility preservation and may bring in a fertility specialist. We might talk about freezing eggs or using medications to turn off the ovaries during chemotherapy. If patients are on hormone-blocking medications long-term, we may be able to withhold these medications so they can get pregnant naturally.

"Young people are in the prime of their life, so it's challenging to put your life on hold while dealing with work, families, children. We have cancer therapists, social workers and other resources to help patients and their families get through everything."

Nurse navigators are a critical part of that team. "It can be daunting for breast cancer patients who are being shepherded through surgery, chemotherapy, medical oncology, genetics and radiation therapy to know where to go and who to call next," Dr. Selig says. "Our navigators make sure they're getting their scans on time and nothing gets lost between the cracks. If something needs to be expedited, they take care of it. They create a seamless process so the patient can just focus on recovery."

Achieving the best aesthetic

Another critical member of Nichole's Main Line Health team was Michael Tecce, DO, plastic and reconstructive surgeon.

"This part of a patient's journey is like a light at the end of a long tunnel," Dr. Tecce says. "Treatment has been focused on saving their life, and now they get to decide how they want to look. It's important with all my patients that we talk about their wishes and not take a cookie-cutter approach.

"As soon as I met Nichole, I knew she was going to beat this, that she is a fighter and somebody who looks for the positive with anything she's dealing with. Throughout every visit and every call, she was thinking about what was next and how we were going to get through it.

"In Nichole's case, we found a way to improve upon the industry standard and create a new technique that left a nicer aesthetic result. With every breast reconstruction patient, I think about the typical approach and how we can do it better. My goal is for patients to not have a daily reminder that they had surgery, but for them to look as if nothing ever happened.

"When I spoke to Nichole right after the surgery, the first thing I saw was a sense of relief, like a weight had been lifted," Dr. Tecce says. "I told her 'everything went great. We got everything out. We did the reconstruction. You're going to be happy. Everything's going to be okay.' She took a deep breath and exhaled all the worry and anxiety that she had felt."

Planning for the future

Once reconstruction was finished, Nichole underwent six weeks of radiation therapy with Marisa Weiss, MD, radiation oncologist and Director of Breast Health Outreach at Main Line Health.

"From the second I met her, Dr. Weiss was amazing," Nichole says. "She wrote out a timeline for me from now until 90 years plus. We talked about what I should do with diet and exercise. I'm following the Mediterranean diet, exercising five days a week and limiting alcohol. As a breast cancer survivor herself, she's been in my shoes, which made a huge difference."

"It's really important that all of our team members look at each individual patient," says Dr. Sabol. "I knew Dr. Weiss would be perfect for Nichole because she would talk about the future and her full life view into her 50s, 60s and 70s. Dr. Tecce is as skilled as any surgeon anywhere, but he also takes time to truly listen and think about her long-term future. Dr. Selig began Nichole's treatment and will continue to care for her for another five or 10 years. A premenopausal woman's ovaries are still active and producing estrogen, so we have a number of newer options to reduce the risk of recurrence. We encourage patients to get genetic testing to determine treatment options but also to evaluate the risk of developing a second cancer.

"We offer a vast number of resources, options and research protocols here at Main Line Health," Dr. Sabol adds. "We are connected to peers across the country, giving us the most advanced expertise at our fingertips, and we've brought many of the first advances in surgical techniques here to our hospitals.

"When I'm sitting with a patient, I'm not the doctor in a white coat telling you what to do. I'm the person who has the most knowledge about breast cancer, who will see you 15 years from now sitting on my exam table, because you and I are going to be friends for life," she says. "I wouldn't treat my family any differently."

Moving ahead

These days, Nichole is spending time with family and friends and looking forward to just enjoying every day.

"Life now is amazing," she says. "I look back on this past year and so much has happened. Treatment was challenging, but good things came from it. I became stronger. I feel closer with my family and my support system, I am very careful with my health. I exercise more and make sure I eat healthy. I'm even baking my own sourdough bread. I love going on walks, going to the beach, kayaking.

Blooming Hope

Nichole had the idea to start a nonprofit organization, Blooming Hope, to bring joy to others. She delivers fresh flower bouquets to people in Chester County going through cancer treatment and recovering from surgery.

"Every time I received flowers it brightened up my entire day," she says. "I wanted to give back to the community and brighten other people's days when they're going through the hard days of chemotherapy. It's been very rewarding."

"How many people plan to help others when they're the ones that may actually need to be lifted up?" adds Dr. Sabol. "How amazing that a stranger is thinking of you, acknowledging what you are going through and cares enough to make your day better? Over the years, Nichole and I will discuss her family and future relationships and where she goes in the world and what she does. And I will be proud of her accomplishments, and in particular what she's doing with this. It leaves a mark on everyone around her."

Confidence with care within her own community

"I felt like I was in the best hands possible with my cancer care at Main Line Health. I was 100% confident in the treatment plan that they came up with for my specific breast cancer."

"After meeting the team, I realized that the most advanced care for breast cancer is right in my backyard. And now I'm cancer-free," explains Nichole.

"There is light at the end of the tunnel even if you're a young woman, and good things, positive things can come from a cancer diagnosis."

Next steps

Learn more about Jennifer Sabol, MD

Learn more about Grayce Selig, MD

Learn more about Michael Tecce, DO

Learn more about Marisa Weiss, MD

Learn more about cancer care at Main Line Health

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