Katie Couric’s cancer diagnosis sheds light on breast density and mammograms

Katie Couric, a longtime proponent of colonoscopies, is now advocating breast cancer screening after a routine mammogram and ultrasound in June revealed she herself had a tumor.

After a successful lumpectomy and radiation therapy, the 65-year-old journalist is using her experience to highlight the importance of breast cancer screening as we head into Breast Cancer Awareness Month in October. Breast cancerwhich affects 1 in 8 women, is the most common non-skin cancer in women and the second deadliest cancer in women, just behind lung cancer.

Couric said she was six months late for her mammogram and intended to film it to raise awareness of the screening procedure, as she did when the Today show filmed her colonoscopy in 2000. (Her first husband, Jay Monahan, died of colon cancer in 1998.)

“If I had forgotten to schedule a mammogram, this could also be a useful reminder for other people,” she wrote in a writing on its website. The booster is especially needed now, as mammogram rates fall during the pandemic.

His diagnosis of a stage 1A olive-sized tumor, however, shed even more light on the matter. “Please have your annual mammogram. I was six months late this time. I shudder to think of what might have happened if I had delayed any longer,” she wrote. “But equally important, please know if you need further screening.”

Couric also had an ultrasound, which is recommended for people who have dense breasts. Breast density, which is unrelated to the size of your breasts, is an additional risk factor for breast cancer because it can make cancer harder to see on a mammogram. Luckily, her cancer hadn’t spread anywhere else and she didn’t need chemotherapy.

Bethany Kandel, New York-based writer and founder of the Breast Cancer Resource website BreastCancerFreebies.comhad a similar experience.

“Like Katie, I’ve postponed my annual mammogram/ultrasound – I have dense breasts,” she said. She was only two months late, healthy, and had just turned 50. “And when I finally got there, there was a little cancerous tumor. I ended up needing surgery – a lumpectomy like Katie – chemo and radiation. Kandel, however, wonders if she had left earlier, if she would have needed the chemo.

“I fought about it for a while,” she said. “I had scares before it turned out to be nothing, so I wasn’t worried. I should have left earlier. The result might have been the same, but I wouldn’t have felt the guilt I ended up carrying. Kandel has been cancer free for 15 years.

There is no doubt that mammograms have become a crucial part of healthcare. “Breast cancer screening saves lives,” said Ruth Oratz, MD, breast cancer oncologist at Perlmutter Cancer Center at NYU Langone. “Because Katie Couric went for a screening mammogram, her breast cancer was detected when it was small and curable.”

Breast cancer death rates fell by 40% between 1990 and 2017 as awareness campaigns brought attention to mammograms. “Recent advances in treating and improving breast cancer survival are due in part to routine screening,” said Nancy Chan, MD, medical oncologist and director of clinical research in breast cancer also at Perlmutter Cancer Center at NYU Langone.

When should you start getting routine screening mammograms?

When to start having mammograms and how often to have them can vary a bit, depending on the the medical organization makes the recommendation.

For example, the US Task Force on Preventive Services says the decision to start mammograms before age 50 is an “individual decision” and that people over age 50 should have them every two years; the American Cancer Society offers a choice for those under 45, but then recommends annual mammograms starting at age 45; the American College of Physicians says the potential harms of mammograms outweigh the benefits for most people ages 40 to 49 and recommends biannual screening for people over 50.

Mammograms require a small amount of radiationand because the risk of breast cancer increases with age, starting regular screenings too soon can in some cases lead to unnecessary tests or biopsies – and the psychological stress that can accompany them.

“Different medical organizations have different approaches,” said Jessica Leung, MD, professor of breast imaging at the University of Texas MD Anderson Cancer Center. They may use different data or analytical methods. “But perhaps more importantly, they may have different concepts of benefit versus risk or harm,” she said. “For example, patient anxiety is considered a screening mammogram risk. But how to quantify this risk in relation to the benefit of lives saved? »

Many doctors recommend annual mammograms after age 40 for people at average risk of breast cancer. Basically, you should speak with your doctor when you hit 40, although you can have this conversation sooner if you have certain risk factors. (For example, if you have a family history of breast cancer, inherited a BRCA1 or BRCA2 gene mutation, or had radiation therapy to your chest between the ages of 10 and 30, you might start earlier.)

“Generally, we recommend a baseline mammogram around age 40 and then once a year thereafter,” Oratz said. Dr. Sheldon M. Feldman, chief of breast surgery and breast surgical oncology and director of breast cancer services at Montefiore Einstein Cancer Center, also says to start at age 40 unless he there is a history of breast cancer in close family members.

“Mammograms allow for early diagnosis and better survival with less aggressive treatment,” he said, which may mean that if you catch it early enough, you can avoid chemo or mastectomy.

Like Dr. Leung, Christine Staeger-Hirsch, attending physician for breast imaging at Montefiore Health System, follows guidelines from the American College of Radiology.

“There are other guidelines, [but] we believe the best and most inclusive protocol is annual screening mammograms starting at age 40 and continuing beyond age 75, as long as you are otherwise healthy,” she said. “It’s so important to have your annual mammogram, so that small, subtle changes can be detected earlier.” Although survival rates are similar at an early or later stage, she said, “individual patient treatment is easier at an early stage.”

If you have dense breasts, you may need to perform additional tests

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