Breast Health BFF

Dr. Pam Strickland provides the expert care and calming presence needed to fight the breast cancer battle, proving a formidable foe to the disease and a strong ally for her patients.

Growing up in small-town Mississippi, Montgomery breast surgeon Dr. Pam Strickland didn’t know a single other student headed to med school. She only knew of a few women doctors anywhere, much less in her circle. She saw it as a challenge, and as a young woman, she was looking for a way to push herself. Today, she’s helping her patients tackle the challenge of a breast cancer diagnosis with both her surgical skills and her straightforward yet soothing bedside manner, leaning on more than 23 years of experience specializing in breast surgery. She’s also a longtime and staunch supporter of the Joy to Life Foundation. JOY magazine chatted with Strickland about her path to becoming a breast surgeon, the latest breast health news and why she stands with JTL and its work.

JOY: Why did you specialize in breast health?
Dr. Strickland: I was volunteering at an emergency room one summer during college, and that’s where I got interested in surgery. I scrubbed in and watched surgery on an abdomen gunshot wound, and I was hooked and knew that’s what I wanted to do. So, I stayed in that lane all through med school.

But getting further specialized in breast surgery was just one of those directions that life took me. I went to med school on an Air Force scholarship, so after I was done, I owed the Air Force four years and was stationed at Maxwell AFB. While I was there, I ended up in an administrative position as chief of the medical staff, but that meant I could only do my practice part time. And it was just me, no one to split call with, no backup, so to make it manageable, I decided to narrow my focus. I decided to just handle breast patients.

I would have never said that was what I’d do while I was still in medical school. I remember people even telling me that I might end up doing this because I was a woman, and I didn’t agree. But then, once I started, I realized I really did have something extra to offer these patients because I am a woman. It goes beyond my gender though. I’ve gotten feedback that my calm and
compassionate demeanor helps patients feel more at peace with their diagnosis, so if I can truly do that, then I want to keep doing that for patients. So, even once I was out of the Air Force and able to concentrate on my practice fulltime, I stayed with breast surgery. I think I am making a difference for my patients.

What have you learned about breast cancer during your time as a doctor?
The main thing I want people to know: Breast cancer is not a death sentence. Most women when they hear it, they think first about losing their breasts, rounds of chemo and losing their hair but also dying. But that is just not the case. These days, the majority of women with breast cancer are diagnosed at early and treatable stages. I like to tell my patients, this is a problem, but it is a problem we can fix. Over the past 10 to 12 years, there has been so much come out about mammograms. If you looked at all women who die of breast cancer in the United States in any given year, about 75 percent of them were not getting regular mammograms when they were diagnosed. So, we do know that mammograms work and are important.

Breast cancer is not a death sentence. These days, the majority of women with breast cancer are diagnosed at early and treatable stages. I like to tell my patients, this is a problem, but it is a problem we can fix.

What are the latest advancements in breast health?
From surgery perspective, it has to do with management of lymph nodes. That is the first place breast cancer goes if it spreads, so we used to remove the lymph nodes on that side, and that put patients at high risk of lymphedema, which can be a very big, bad deal. Today, research is showing that removing normal lymph nodes or even those with a tiny bit of cancer really does not improve outcomes. So, we are moving away from the lymph node part of the surgery these days, and that is exciting for me. I hate doing a procedure I know has a high risk of complications.

Other advances include more genetic testing to look at an individual’s genetic makeup and identify if there are mutations that put them at increased risk of cancer. We used to just do BRAC 1 and BRAC 2. Now, we can look for up to 30 or more mutations. And they are specific to different types of cancer. So that allows us to, in combination with family history, flag people for risk and monitor them more closely or with other tests like MRIs. We can even offer medicines that help lower the risk of breast cancer. And if the risk is high enough, we can offer prophylactic surgery. All of this just keeps getting better and better; the more information we have the more we can do with it.

I had a patient, a young woman with breast cancer, who had a family history of gastric cancer, and there is one mutation associated with both. And for those people, the stomach cancer is hard to find, so her risk of dying from that was much higher than from her breast cancer. Now we know this, and she is a candidate for increased monitoring, for medicines.
In her situation, knowing about this gene makes a big difference.

There are also continuous advancements in genomic testing, where we look at changes in the cancer’s DNA. This is helping us understand cancer itself and allows us to say, “Ok, these types
of changes are associated with a high risk of cancer coming back somewhere else in your body. And these changes in the cancer’s DNA are not.” That helps us make decisions about pursuing chemotherapy based on the individual, and what type of chemo to give. It lets us tailor our treatments much better.

Share a bit about your new office and new role with UAB.
I was in private practice by myself with one nurse practitioner and two office staff. Then, lots of other breast surgeons in the area retired, and so I kept getting busier and busier, and it was too much. In 2019, sold my practice to the hospital and became an employee of UAB, and I moved into this new office in 2021. I think the partnership with UAB is such a great thing for our community. It has been good for me personally in practice. I’ve also had Dr. Kaitlyn Holmes join me as my partner, and that is especially exciting.
We are so lucky to have her here. She’s young and energetic, shares my approach to patient care, and really cares about what she does.

L I K E -M I N D E D
Dr. Pam Strickland shared why she has been and remains so supportive of the Joy to Life Foundation. “I support the mission,” she said. “The Foundation fills a need not being met in our community and our state and is doing really crucial work. Joy and the whole organization have done such a great job and not just with the screening services the Foundation provides, but with awareness efforts. That work has really put breast cancer and the needs associated with it on the map and proven a real game changer. Plus, I just really like Joy and Dickie."

M A M M O G R A M  M AT H
While there is no doubt that regular mammograms lead to early diagnosis and save lives, exactly when most women should start and how often they should get them have been topics of some debate in the medical community. “For the general population—not including women with a family history of breast cancer—many say mammograms should start yearly at age 45,” Dr. Pam Strickland said. “There is some benefit from doing it at age 40, but younger women have very dense breast tissue, which can make it harder to see, so the likelihood they will get called back for additional tests is higher, and doing that can increase stress and increase costs, so that’s why the recommendation of age 45.” There has even been some controversy surrounding whether women should do breast self-exams and even whether doctors should. “It’s the same thinking about dense breast tissue, namely, what, if anything can they feel or if they do feel things that are not an issue, does that cause unnecessary anxiety.” But Strickland worries about sending the wrong message. “I think saying stop the self-exams might suggest women don’t need to do anything, and that’s wrong. We need to be proactive, and I think, by checking your own breasts routinely, you get familiar with what your ‘normal’ is,” she said. “Maybe your normal is lumpy, but if it is, you’ll know that and then you will be able to tell if there is a change. Then you go get that change checked out.”