What Katie Couric's Breast Cancer Diagnosis Can Teach Us
- Former TV news anchor Katie Couric announced she has breast cancer and is undergoing treatment.
- Couric says her cancer was caught early after a mammogram. Experts say make sure you are getting screened and talk to your doctor about assessing your family history and risk factors.
- Treatment options are evolving. It’s critical to seek out multiple opinions and ask about the specific characteristics of your cancer, which can change treatment options.
- Couric described the difficult conversation with her daughters; women in the SurvivorNet community sometimes say cancer helped them grow closer with family.
- Don’t be afraid to lean on family and friends when given a cancer diagnosis.
Couric, who lost her first husband to colon cancer at the young age of 42, made worldwide headlines when she underwent a live colonoscopy on the "Today" show in the year 2000. She has since been a fierce advocate for cancer prevention and screening, and is a co-founder of Stand Up To Cancer (SU2C), a major cancer initiative. With Couric now going public with her own cancer journey, her story has the potential to educate a whole new group of people about breast cancer and survivorship.Read More
“I felt sick and the room started to spin. I was in the middle of an open office, so I walked to a corner and spoke quietly, my mouth unable to keep up with the questions swirling in my head,” said Couric.
As a cancer community we can learn from this experience and we want to show you some important points Couric can teach us.
1. Get Screened For Breast Cancer
For women who are high risk and have a family history that could put them at a higher risk for breast cancer, SurvivorNet experts agree you should get screened much earlier than some of the guidelines.
That said, the American College of Radiology recommends women have a risk assessment at age 30 to see if screening prior to age 40 is needed, and those at average breast cancer risk begin screening at age 40. Still, a huge number of American women are not up-to-date with recommended screenings.
"One of the most frustrating things that I see in my office, and my practice is when a patient â€¦ comes in with a huge, golf ball breast cancer that could have probably been diagnosed at an earlier age if they were receiving their annual screening mammogram," says Dr. Senayet Agonafer, a radiologist at Montefiore Medical Center.
You should talk to your doctor if you’re unsure of when you should begin breast cancer screening and get all the facts so you can assess your risk, says Dr. Agonafer.
"You should absolutely be tested for your risk of breast cancer starting at the age of 30,” she adds.
2. Access To Treatment Options
Couric was quick to point out that she is extremely lucky to have access to extraordinary care. At SurvivorNet we’ve learned that of course money and access matter, but some of the best physicians and institutions are available to patients and families who push. When it comes to surgery most experts recommend second opinions. Couric describes how she underwent what’s known as breast conservation surgery or a lumpectomy in which doctors try to remove cancer or abnormal tissue from the breast by removing as little of the breast as possible.
Couric said her course of treatment included radiation and medication specifically, something called an aromatase inhibitor, which is used to block the activity of the aromatase enzyme and, therefore, stop the production of estrogen. That in turn helps to slow down the growth of tumor cells that are sensitive to estrogen.
When your doctor determines the treatment for you they have to consider many factors in the decision. Some questions may be: What is the size of the tumor, and are lymph nodes or other parts of the body involved? The biology of your tumor is also important: is your tumor positive for the HER2 receptor or hormone receptors? Did you inherit an increased risk for breast cancer and/or did your lifestyle increase your risk?
For instance, Couric said she took an oncotype test and it was a low score meaning she wouldn’t need chemotherapy, a common drug treatment for cancer. Previous to this test a lot of women would have continued to get chemotherapy.
Oncologists have many options no matter what the stage is of diagnosis.
Below, Dr. Elizabeth Comen, a medical advisor to SurvivorNet and medical oncologist at Memorial Sloan Kettering Cancer Center gives a helpful overview on breast cancer treatment:
3. Know Your Diagnosis
It’s important to know and understand what your oncologist is telling you about your diagnosis and to stay updated on how you are progressing in your treatment.
Couric, in her essay, shared a very detailed account of her path of treatment. She took note of details such as, surgery date, drugs she had been given, number of radiation treatments, progression of the size of her tumor.
“Radiation began on September 7. My radiation oncologist, Dr. John Ng, described it as ‘dishwashing liquid to wash out any microscopic cells that could be problematic down the line.’ Each session lasted about 10 minutes and involved lying face down on a massage-like table with my left breast hanging in an opening, away from my body, so the beams wouldn't veer off course into my lungs or heart,” says Couric.
Dr. Comen shares her insight on the importance of accessing factual information and having an ongoing dialogue with your doctor so you can stay informed.dr
4. Breast Cancer Is Many Different Diseases
It is important to know breast cancer can come in many forms and it is important to know what they are.
Couric says in her essay she was told by her doctor, Dr. Lisa Newman, a surgical breast oncologist at NewYork-Presbyterian/Weill Cornell Medical Center that her tumor was hormone receptor-positive, Her2neu-negative and “highly treatable, particularly if it was detected early."
HER2 is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2. The traditional presence of HER2 has been divided into two groups, either positive or negative. Patients with HER2 positive tumors have tumors that show HER2 over-expression, while patients with HER2 negative tumors show minimal or no expression.
“We look at HER2neu independently because we know if it’s present in very, very high amounts on the cancer cell, maybe in a third of cases, then we need to target HER2neu as part of the treatment strategy,” says Dr. Ruth Oratz, a breast cancer oncologist at NYU Langone Perlmutter Cancer Center.
Oratz adds, very often when HER2neu is over-expressed or amplified chemotherapy is given in addition to other treatment options.
In Couric's case it didn't change her treatment path, but for some women there could be a change in treatment based on the category of "HER2neu."
Separate from HER2neu – negative classification is the presence or absence of hormone receptors on the surface of cancer. The two types are:
- Hormone receptor-positive (HR-positive) breast cancer: When the cells use estrogen, progesterone, or both to grow and replicate.
- Triple-negative breast cancer: When the hormone receptors are absent.
It is important to get the genetic testing done to see if you have these genetic mutations.
5. Lean On Family
No one has a good answer on how to talk to your kids about getting cancer, and in a lot of cases their disease has brought them closer to a loved one.
Couric refers to her daughters Ellie and Carrie in her essay and her reservation to call them “until I had a better idea of my prognosis,” she said.
“Finally, four days after I was diagnosed, I FaceTimed each of them. I tried to be as reassuring as Dr. Newman. Their faces froze in disbelief. Then shock. Then they began to cry. "Don't worry," I told Carrie then Ellie, "I'm going to be fine," trying to convince myself as well as them,” said Couric.
“They'd already lost one parent. The idea of losing another was unfathomable,” she added.
A cancer diagnosis is a very scary time for you. It’s important to lean on family during this time if you can, so you’re not going through it alone.
Dr. Susan Parsons, director of survivorship care at Tufts Medical Center, found it to be very rewarding when she helped her sister through a metastatic cancer diagnosis.
The bottom line is don’t be afraid to ask for help.