Henda Salmeron is not a large woman. A slight, angular brunette, she’s the kind of woman who upsets other women when she says she needs to lose weight.
When she turned 42, Salmeron decided that’s exactly what she needed to do. A few extra pounds had stacked up thanks to stress and lack of exercise. So she left her Lakewood home and headed for White Rock Lake. During the spring of 2009, the South Africa native learned to scull. Between February and April, she lost 12 pounds.
Those 12 pounds, she says now, probably saved her life. That’s an understatement. Those 12 pounds most likely saved the lives of hundreds, if not thousands, of women. Those 12 pounds may be 12 of the most important pounds in the history of women’s health in Texas. They led to Henda’s Law.
After Salmeron lost the weight, she noticed a lump, about the size of a pea, near her right breastbone. Mammograms at age 35, 40, 41, and 42 were normal, but Salmeron couldn’t let it go.
“My mother-in-law said, ‘Henda, no lump is nothing. Don’t let them tell you it’s nothing. Go get it checked again,’ ” she says. “And you know what? It was probably the single best advice I’ve gotten in my life.”
Salmeron had another mammogram, which also showed nothing. But the BB-size bump on her chest wouldn’t let her drop it. A sonogram was the next step. The sonogram revealed a shadow, a shadow big enough to maybe mask cancer. The shadow led to a needle biopsy, which led to Sunday, June 7, 2009, at 8:35 am. Salmeron—a senior vice president at Ellen Terry Realtors—was on her way to write a contract for a $900,000 home in Preston Hollow when she got the call. Her gynecologist was on the line. They had found cancer in her right breast.
What followed was the most surreal afternoon of Salmeron’s 42 years. She helped a couple—not even her own clients—write a contract on their house, then headed to her daughter Dominique’s ballet recital at SMU. Apart from Dominique’s brief appearance on stage, Salmeron spent the entire afternoon pacing the terrace at McFarlin Auditorium, the cancer altering her world’s spin.
By Monday afternoon, Salmeron was under the care of Dr. Roshni Rao, a surgical oncologist at UT Southwestern. By Tuesday afternoon, she got the worst phone call of her life, less than two days after receiving her previous worst call.
Instead of the 1-centimeter lump found by the sonogram, Salmeron’s was 4 centimeters, invasive and advanced.
“I was like, ‘F---, what?’ You’re dazed and confused already, and now you hear, in my case, it was far more of a death sentence than I heard two days ago. I was afraid. I was afraid I would not see my kids graduate from elementary school.”
Later that day, Salmeron found herself in a waiting room at UT Southwestern, surrounded by grandmothers in Pepto-Bismol-pink hospital gowns. Ten, 20, 30 years separated her from her comrades. How did she pull this card?
Her thoughts quickly turned to her mammograms, the ones that showed clear. Looking at them, anyone would have a hard time finding a lump or tumor. They look like a photo from space of clouds passing over Earth; the whitish muscle quickly transitions into black and gray fat.
The reason the cancer wasn’t diagnosed at a smaller size, Rao says, was dense breast tissue. A condition that affects more than half of women younger than 50, and one-third of women older than 50, dense breast tissue can mask small lumps or tumors, as the tissue appears as the same color on mammograms as lumps: white. Breasts with a higher percentage of tissue than fat are considered dense.
“It’s like a snowball in a blizzard,” Salmeron says.
Women with dense breast tissue are not only at a higher risk of a hidden tumor, they are also at a higher risk for tumors in general. A 2007 New England Journal of Medicine study showed women with dense breast tissue are four to six times as likely to develop breast cancer as those with regular breast density.
“Henda was not happy, understandably,” Rao says. “And women like her are angry. They feel like they are doing all the right things, and they’re still in this position.”
For those wondering, no, you can’t feel breast density by hand. The firmest breast could be the fattiest breast. As women age, their breasts naturally become less dense, making mammograms more accurate, Rao says. There’s less tissue to mask problems.
According to the American Medical Association, mammograms may miss up to 40 percent of tumors in women with dense breast tissue, and Salmeron had never even heard of the condition. The phrase never even grazed her vernacular.
That was the most inexcusable part of the whole situation. After having years of mammograms, no single doctor had told her she had dense tissue.
She was angry. But out of that anger grew advocacy.After her appointment with Rao, Salmeron went home. She couldn’t sleep that night. She was up pacing, thinking about her life, her family, her new unwanted gift.
“I stood there and thought, ‘What can I do?’ ” she says. “I can handle things if I have focus and goals. I can’t just sit here and focus on myself.”
The next morning she called her state representative, Allen Vaught. “I was like, ‘Screw this. I will not rest until women are told [about dense breast tissue],’ ” Salmeron says. “Because when you are told information like this, then you can take action, then you can decide. If you know your grandfather and aunt and uncle had heart disease, you are going to do something about your heart. But if you don’t know anything, you can’t advocate for yourself.”
Perhaps no one in the legislature was better equipped for the case than Vaught. A Democrat, he knew his way around cancer and cancer legislation after spending years representing asbestos victims who had contracted mesothelioma or lung cancer. After hearing Salmeron’s story, he thought about his wife and children, the children who wouldn’t have a mother if she died because dense breast tissue hid a tumor.
He was onboard.
While Salmeron was heading toward a lumpectomy to remove the 4-centimeter growth, Vaught hit the road, speaking with doctors at UT Southwestern, Baylor Medical Center, the Paul L. Foster School of Medicine in El Paso, and the M.D. Anderson Cancer Center in Houston, looking for their support. His goal was to introduce legislation that would require FDA-approved mammogram facilities to inform women with dense breast tissue of the limitations of their mammogram results.
The same day that Salmeron was going under the knife, Connecticut became the first state to pass legislation regarding dense breast tissue. Vaught and Salmeron tinkered with the wording for Texas, after deciding the Connecticut bill as it stood wouldn’t work here.
As Salmeron jumped from surgery to radiation to surgery throughout the summer and fall of 2009, Vaught was drumming up support for the legislation. The American Cancer Society supported the bill, but didn’t push it, while the medical community was wary of government intervention, but eventually ceded. From the summer of 2009 to the fall of 2010, it made slow but sure progress to becoming a law.
Then Vaught lost re-election.
“I thought it was going to die,” Vaught says. Instead, it flourished. Yes, there were moments when it looked like the bill wouldn’t pass, but Salmeron wouldn’t stop. The same tenacity that led her to White Rock Lake, the same tenacity that forced her doctor to perform a sonogram instead of just another mammogram, that tenacity kept the bill alive.
Vaught’s legislative director, Jo Cassandra Cuevas, moved on to Rep. Ana Hernandez Luna’s office, taking the bill with her. Salmeron’s weeks quickly devolved into a series of Austin road trips. At 7 am, she’d get a call from Hernandez Luna’s office asking if she could testify that day. Salmeron would throw on some clothes—“It was always something pink”—and drive the 200 miles from Lakewood to the State House. Before and after she testified, she’d roam the halls, handing out pink folders with the bill, her tumor-hiding mammogram, and breast cancer facts tucked inside. Each letter was signed, “Thank You, Henda,” in fuchsia handwriting.
As the bill worked its way through the House and Senate, its name, Henda’s Law, became known. People recognized Salmeron in the cafeteria and hallways. She talked to aides, directors, parking attendants. It didn’t matter. If she actually grabbed the ear of a representative or senator, it was a coup. From its March 3, 2011, filing date through the end of the 82nd Texas Legislature in June, the bill was formally discussed, motioned, passed, or debated 60 times. The number of informal debates in the cafeteria is unknown.
The House passed the bill 136 to 5, with two absences. The Senate vote was unanimous. In October 2009, Henda Salmeron had her last radiation treatment for breast cancer. By June 2011, she had a law named after her.
“The person who got that passed wasn’t any legislator, it was Henda,” Vaught says. “That woman was down there nonstop, reminding people that if it’s going to pass it’s going to save some child’s mom or some person’s wife.”
As we sit in Salmeron’s kitchen, she slides off a black wedge to show me her battle scars. She’s just returned from a trip to the Rockies. As a participant in the TransRockies run, she ran 120 miles over the course of six days, and her feet are still bleeding.
Since her radiation treatments ended in 2009, Salmeron set her sights on her latest endeavor: ultramarathons. The surgeries affected her rowing, so she switched gears, traded in the water for the road, and started running. Her first endurance race, in 2010, was the Himalaya 100, as in “sunrise over Mount Everest” Himalaya. In backward fashion, she’ll tackle her first marathon, the New York Marathon, this month. She’s lost an additional 15 pounds from her new hobby.
As we’re sitting, I bring up the fact that in less than eight hours her bill will become law. She pauses for a second, does the math, realizes I am right, and chuckles. The week before, she had lunch with a few doctors and administrators at UT Southwestern. She had achieved the ultimate, 21st-century definition of fame, they said: she had become a verb.
“In radiology circles we’re saying, ‘Have you Henda-ed your center yet?’ ” she says, nonplussed that she’s joined the ranks of Google and Facebook. “I said to him ‘It’s time. It’s time to have dense breast tissue on the table. It’s time that women know.’ ”
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Salmeron is working with women on a national level to pass federal legislation informing women of the risks associated with dense breast tissue. For more information, visit hendaslaw.com.