Katie Couric’s Breast Cancer | MedPage Today

In 2000, 2 years after the demise of her husband, Jay Monahan, from colon most cancers, Katie Couric underwent a colonoscopy stay on “The As we speak Present,” resulting in a 20% bounce in nationwide colonoscopy screening charges, one thing the College of Michigan dubbed the “Couric Impact.”
Now, Couric is as soon as once more advocating for most cancers screening.
On September 28, Couric wrote an essay on her website, detailing her breast most cancers analysis in June. Throughout a routine physician’s go to, she was informed she was due for a mammogram. Though she thought she had “simply obtained one,” her final mammogram was truly in December 2020. “Wait, what? How might that be? Had the pandemic given me a skewed sense of time? Had it messed with my reminiscence?” she wrote. She made an appointment straight away.
She had meant to movie her mammogram to share on her web site. If she had forgotten to make an appointment throughout the pandemic, certainly others will need to have as effectively, and this might be a reminder for them, she mentioned. Whereas a technician filmed her, she underwent a 3D mammogram — and due to her historical past of dense breasts — a breast ultrasound.
Afterwards, her breast radiologist, Susan Drossman, MD, informed her that there was one thing in her left breast that seemed suspicious, recommending a needle biopsy to test it out.
The following day, Couric was recognized with stage IA HER2-negative breast most cancers. She underwent a lumpectomy in July, adopted by 15 rounds of radiation remedy. She is going to quickly start aromatase inhibitor remedy to decrease her estrogen ranges.
In a Today interview with Savannah Guthrie and Hoda Kotb, Couric defined her new mission to boost consciousness of the necessity for breast most cancers screening, noting that solely 70% of eligible girls obtain screening (and this fee additional decreased throughout the pandemic), and to teach girls about dense breasts and the way this situation could relate to breast most cancers.
Couric mentioned that 45-50% of girls have dense breasts, which is recognized by mammogram. Having dense breasts makes detecting breast most cancers tougher. Supplemental screening with breast ultrasound is usually really helpful for these girls. Nevertheless, solely 38 states have legal guidelines that require physicians to inform sufferers that they’ve dense breasts, and even in states that do, the notification does not essentially clearly clarify what to do with this data.
As well as, not all insurance coverage cowl breast ultrasound (solely 14 states and Washington, D.C. require insurance coverage firms to at the least partially cowl the check).
Couric is working with Rep. Rosa DeLauro (D-Conn.) on laws that may be certain that girls and their healthcare suppliers have entry to the details about breast density to make knowledgeable healthcare choices. DeLauro can even introduce laws this month that may require insurance coverage firms to fully cowl the prices for breast ultrasound for girls with dense breasts.
Breast Most cancers
Breast most cancers is the most typical noncutaneous most cancers in girls within the U.S., with an estimated 51,400 instances of ductal carcinoma in situ (DCIS) and 287,850 instances of invasive illness recognized in 2022, based on the American Cancer Society. Though widespread adoption of breast most cancers screening has elevated the incidence of breast most cancers, it additionally has modified the traits of the cancers detected, with elevated numbers of lower-risk cancers, pre-malignant lesions, and DCIS.
Breast most cancers is usually handled by numerous combos of surgical procedure, radiation remedy, chemotherapy, and hormone remedy. In response to the National Cancer Institute, collection of remedy could also be influenced by the next scientific and pathological options:Menopausal statusStage of the diseaseGrade of the first tumorEstrogen receptor (ER) and progesterone receptor (PR) standing of the tumorHER2 overexpression and/or amplificationHistologic sort
The usage of molecular profiling in breast most cancers contains ER and PR standing testing, HER2 standing testing, and gene profile testing by microarray assay or RT-PCR (e.g., MammaPrint, Oncotype DX, Prosigna). On the idea of ER, PR, and HER2 outcomes, breast most cancers is classed as one of many following varieties:Hormone receptor positiveHER2 positiveTriple unfavorable (ER, PR, and HER2 unfavorable)ER, PR, and HER2 standing are essential for figuring out prognosis and predicting response to endocrine and HER2-directed therapies.
Breast Density
Breasts include glandular, connective, and fatty tissue. Breast density describes the relative quantities of those tissues. Dense breasts have comparatively excessive quantities of glandular and fibrous connective tissue and comparatively low quantities of fatty tissue.
Breast density is set by mammography — it’s not one thing that may be decided by bodily breast examination.
Breast density may be inherited, however different elements can affect it. Decrease breast density is related to growing age, childbirth, and use of tamoxifen. Elements related to greater breast density embrace use of postmenopausal hormone alternative remedy and low physique mass index.
Breast density is categorized utilizing a scale developed by the American Faculty of Radiology known as the Breast Imaging Reporting and Knowledge System (BI-RADS), which helps radiologists interpret mammogram outcomes. BI-RADS divides breast density into 4 classes:A: Virtually totally fatty breast tissue, present in about 10% of womenB: Scattered areas of dense glandular tissue and fibrous connective tissue (scattered fibroglandular breast tissue) present in about 40% of womenC: Heterogeneously dense breast tissue with many areas of glandular tissue and fibrous connective tissue, present in about 40% of womenD: Extraordinarily dense breast tissue, present in about 10% of womenIs There a Relationship Between Dense Breasts and Breast Most cancers?
Sure — in two methods. First, it’s tougher to detect breast most cancers in dense breasts. Dense breast tissue and a few irregular breast modifications, corresponding to calcifications and tumors, seem as white areas within the mammogram. In consequence, mammography is much less delicate in girls with dense breasts. Girls with dense breasts could also be known as again for follow-up checks extra usually than girls with fatty breasts. Dense breasts may also put girls at greater danger of interval breast most cancers.
Secondly, a number of research have proven that ladies with dense breasts have an elevated danger of breast most cancers. Girls with extraordinarily dense breasts have a four- to six-fold greater danger of breast most cancers in contrast with these with fatty breasts. That is unbiased of the impact of breast density on mammogram interpretation.
Is supplemental testing warranted for girls with dense breasts?
That is the large query, and sadly it hasn’t been satisfactorily answered but. The final suggestions from the U.S. Preventive Companies Job Pressure in 2016 acknowledged that “present proof is inadequate to evaluate the stability of advantages and harms of adjunctive screening for breast most cancers utilizing breast ultrasonography, magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), or different strategies in girls recognized to have dense breasts on an in any other case unfavorable screening mammogram.”
These suggestions are presently underneath overview, and it’s unclear when the up to date suggestions will probably be launched. Till then, girls with dense breasts ought to have a dialogue with their healthcare suppliers to tailor screening to every affected person’s breast density and general lifetime danger of breast most cancers.
A 2021 Mayo Clinic Proceedings overview outlined the advantages and limitations of the assorted out there supplemental screening checks for girls with dense breasts, together with:DBT, which x-rays the breast in an arc for multiple-angle photographs which are reconstructed right into a 3D picture. This reduces overlap of photographs and will increase the sensitivity of the mammogram. Many hospitals and bigger facilities use DBT as their customary screening mammogram; nonetheless, this system isn’t out there in every single place.Complete-breast ultrasonography has change into a typical supplemental screening technique for a lot of girls with dense breasts. It’s broadly out there, has no ionizing radiation, and may successfully differentiate between tissues of various densities (fluid vs delicate tissue). It may well additionally enable a doctor to do a real-time biopsy of a suspicious lesion. Nevertheless, it might result in false-positive outcomes.Breast MRI is probably the most delicate check for detecting breast most cancers. Like ultrasound, there is no such thing as a ionizing radiation. It additionally reduces the danger of interval cancers. In contrast with different modalities, it’s extra expensive, requires a gadolinium distinction agent, and cannot be utilized in sufferers with morbid weight problems or these with extreme claustrophobia.Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She skilled at Johns Hopkins, Washington College in St. Louis, and St. Louis Youngsters’s Hospital. Her mission is each journalistic and academic: to report on frequent illnesses affecting unusual individuals and summarize the evidence-based medication behind the headlines.