Katie Couric Breast Cancer | MedPage today
In 2000, 2 years after her husband Jay Monahan died of colon cancer, Katie Couric underwent a colonoscopy live on “The Today Show”, leading to a 20% increase in national colonoscopy screening rates , which the University of Michigan has dubbed the “couric effect.”
Now Couric is again advocating for cancer screening.
On September 28, Couric wrote an essay on her website, detailing her breast cancer diagnosis in June. During a routine visit to the doctor, she was told she needed to have a mammogram. Although she thought she “just had one,” her last mammogram was actually in December 2020, she wrote. She made an appointment right away.
She intended to film her mammogram to share on her website. If she forgot to make an appointment during the pandemic, surely others must have forgotten too, and it could be a reminder for them, she said. While a technician filmed her, she underwent a 3D mammogram – and due to her history of dense breasts – a breast ultrasound.
Afterwards, her breast radiologist, Susan Drossman, MD, told her there was something in her left breast that looked suspicious, recommending a needle biopsy to check it out.
The next day, Couric was diagnosed with stage IA HER2 negative breast cancer. She underwent a lumpectomy in July, followed by 15 rounds of radiation therapy. She will soon be starting aromatase inhibitor therapy to lower her estrogen levels.
In a Today interview with Savannah Guthrie and Hoda Kotb, Couric explained her new mission to raise awareness of the need for breast cancer screening, noting that only 70% of eligible women receive screening (and that rate has dropped even further during the pandemic), and to educate women about dense breasts and how this condition may be linked to breast cancer.
Couric said 45-50% of women have dense breasts, which is diagnosed by mammography. Having dense breasts makes breast cancer detection more difficult. Additional breast ultrasound screening is often recommended for these women. However, only 38 states have laws that require physicians to notify patients that they have dense breasts, and even in states that do, the notification does not necessarily explain clearly what to do with this information. .
Additionally, not all insurance plans cover breast ultrasound (only 14 states and Washington, DC require insurance companies to at least partially cover the test).
Couric is working with Rep. Rosa DeLauro (D-Conn.) on legislation that would ensure women and their healthcare providers have access to breast density information to make informed healthcare decisions. DeLauro will also introduce legislation this month that would require insurance companies to fully cover breast ultrasound costs for women with dense breasts.
Breast cancer is the most common non-cutaneous cancer in women in the United States, with approximately 51,400 cases of ductal carcinoma in situ (DCIS) and 287,850 cases of invasive disease diagnosed in 2022, according to the American Cancer Society. . Although the widespread adoption of breast cancer screening has increased the incidence of breast cancer, it has also changed the characteristics of the cancers detected, with an increase in the number of low-risk cancers, precancerous lesions and DCIS.
Breast cancer is usually treated with various combinations of surgery, radiation therapy, chemotherapy, and hormone therapy. According to the National Cancer Institute, the choice of treatment can be influenced by the following clinical and pathological characteristics:
- Menopausal status
- Disease stage
- Primary tumor grade
- Tumor Estrogen Receptor (ER) and Progesterone Receptor (PR) Status
- Overexpression and/or amplification of HER2
- Histological type
The use of molecular profiling in breast cancer includes ER and PR status testing, HER2 status testing, and gene profile testing by chip assay or RT-PCR (e.g. MammaPrint, Oncotype DX, Prosigna) . Based on the ER, PR, and HER2 results, breast cancer is classified into one of the following types:
- Hormone receptor positive
- HER2 positive
- Triple negative (ER, PR and HER2 negative)
ER, PR, and HER2 status are important in determining prognosis and predicting response to endocrine and HER2 therapies.
The breasts contain glandular, connective and fatty tissue. Breast density describes the relative amounts of these tissues. Dense breasts have relatively high amounts of glandular and fibrous connective tissue and relatively low amounts of fatty tissue.
Breast density is determined by mammography – it is not something that can be determined by a physical breast exam.
Breast density can be hereditary, but other factors can influence it. Lower breast density is associated with increased age, childbirth, and tamoxifen use. Factors associated with higher breast density include use of post-menopausal hormone replacement therapy and low body mass index.
Breast density is categorized using a scale developed by the American College of Radiology called the Breast Imaging Reporting and Data System (BI-RADS), which helps radiologists interpret mammogram results. BI-RADS divides breast density into four categories:
- A: Almost entirely fatty breast tissue, present in about 10% of women
- B: Scattered areas of dense glandular tissue and fibrous connective tissue (sparse fibroglandular breast tissue) found in approximately 40% of women
- C: Dense heterogeneous breast tissue with many areas of glandular tissue and fibrous connective tissue, found in approximately 40% of women
- D: extremely dense breast tissue, present in about 10% of women
Is there a relationship between dense breasts and breast cancer?
Yes – in two ways. First, it is more difficult to detect breast cancer in dense breasts. Dense breast tissue and some abnormal breast changes, such as calcifications and tumors, show up as white areas on the mammogram. Therefore, mammography is less sensitive in women with dense breasts. Women with dense breasts may be called back for follow-up testing more often than women with oily breasts. Dense breasts can also put women at higher risk for interval breast cancer.
Second, several studies have shown that women with dense breasts have an increased risk of breast cancer. Women with extremely dense breasts have a four to six times higher risk of breast cancer than those with oily breasts. This is independent of the effect of breast density on the interpretation of mammography.
Are additional tests warranted for women with dense breasts?
This is the big question, and unfortunately it has not yet received a satisfactory answer. The latest recommendations from the U.S. Task Force on Preventive Services in 2016 stated that “current evidence is insufficient to assess the balance of benefits and harms of additional breast cancer screening using breast ultrasound, magnetic resonance imaging (MRI) , digital breast tomosynthesis (DBT), or other methods in women identified as having dense breasts on an otherwise negative screening mammogram.”
These recommendations are currently under review, and it is not known when the updated recommendations will be released. Until then, women with dense breasts should talk with their healthcare providers about tailoring screening to each patient’s breast density and overall lifetime risk of breast cancer.
A 2021 Mayo Clinic Proceedings review highlighted the benefits and limitations of various additional screening tests available for women with dense breasts, including:
- DBT, which X-rays the breast in an arc for multi-angle images that are reconstructed into a 3D image. This reduces image overlap and increases the sensitivity of mammography. Many hospitals and large centers use DBT as the standard screening mammogram; however, this technique is not available everywhere.
- Whole breast ultrasound has become a common additional screening method for many women with dense breasts. It is widely available, has no ionizing radiation, and can effectively differentiate between tissues of different densities (liquid vs. soft tissue). It can also allow a doctor to take a real-time biopsy of a suspicious lesion. However, this can lead to false positive results.
- Breast MRI is the most sensitive test for detecting breast cancer. Like ultrasound, there is no ionizing radiation. It also reduces the risk of interval cancers. Compared to other modalities, it is more expensive, requires a gadolinium contrast agent, and cannot be used in patients with morbid obesity or severe claustrophobia.
Michele R. Berman, MD, is a pediatrician turned medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Its mission is both journalistic and educational: to report on common diseases affecting uncommon people and to summarize the evidence-based medicine behind the headlines.