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The American Cancer Society

Robin Roberts: The Journey Begins

by Dr. Len July 31, 2007

I am certain everyone who has seen ABC Good Morning America anchor Robin Roberts’s announcement that she has been diagnosed with breast cancer is as touched as I am by this news.

 

I have commented frequently about public figures facing cancer, and the special role they play in our lives.  Not only do they have to deal with a serious diagnosis, but they also frequently have to cope with that diagnosis while in the public eye.

 

Here we have someone who is very special to so many facing just that circumstance.  She did so with the grace and sincerity that is so much a trademark of her “on camera” persona.

 

Ms. Roberts says she found a lump in her breast and promptly sought medical attention.  She said a mammogram failed to show the cancer, but an ultrasound ordered by her physician did find the lump and a biopsy confirmed the diagnosis.  Surgery is scheduled for Friday.

 

Ms. Roberts emphasized the importance of access to quality medical care.  For her, the system worked. 

 

But her comment acknowledges a serious problem in this country, namely that too many women do not have access to someone they can identify as their primary medical clinician, and too many women either don’t have access to mammography or don’t take advantage of the opportunity to be screened for breast cancer.

 

Ms. Roberts’ announcement also has raised some questions about the role of ultrasound in the diagnosis and screening of breast cancer.

 

To understand the issue, we need to understand the scenarios when ultrasound is helpful and when it is not.

 

In many women, particularly those who are younger with denser breast tissue, the accuracy of a mammogram may not be as great as in older, post-menopausal women where the breast tissue has more fatty elements, and cancers are more easily seen.

 

So, when a doctor feels a new lump, an ultrasound is perfectly appropriate to take a look at the lump and determine some of its characteristics, such as whether it is solid or filled with fluid.  Even when the mammogram is negative, the ultrasound can be very helpful in this type of situation.

 

However, there is still no convincing evidence that using ultrasound to screen for breast cancer, even in young women, is an appropriate routine test.  Studies are currently underway to find out whether or not this remains the case, given improvements that have occurred in ultrasonograpy.

 

For Ms. Roberts, there was a new lump and the doctor was appropriately concerned. In this situation, the ultrasound was used as a diagnostic tool, not a screening tool. 

 

The difference may seem subtle, but the implications are not.  Screening means looking for a disease when none is detectable; diagnostic means the doctor is looking for more information about something (in this case a lump) that is present and may be a serious disease (in this case, breast cancer).

 

We know Ms. Roberts is relatively young, and that she is African American. Ms. Roberts has told us the disease is early, which is good news.

 

African American women do get breast cancer at a younger age than Caucasian women, and their disease is usually more advanced at the time of diagnosis.  And while African American women have a lower risk of getting breast cancer than Caucasian women, their chances of survival after diagnosis are lower.

 

For too many African-American women who don’t have access to adequate health care in this country, the situation is frequently much more serious than appears to be the case for Ms. Roberts.

 

One additional thought that I think is important to keep in mind:

 

When I started practice in the mid 1970s, we didn’t have particularly good mammograms.  We didn’t have adjuvant chemotherapy, and we were just being introduced to medications like tamoxifen that treated breast cancer with fewer side effects in women where the breast cancer was sensitive to estrogen. 

 

Today, that picture has changed considerably. 

 

We have much better mammography equipment, along with other tools like MRI and ultrasound, better surgical approaches to the treatment of breast cancer, and better radiation therapy.  We have new drugs to prevent the recurrence of breast cancer and new ways of determining whether a woman will benefit from targeted therapies to substantially reduce the risk of recurrence.

 

We also have many more survivors of breast cancer today than we had in the 1970s, because of all of these advances. 

 

We have much more hope for our patients today than we did then.  We can now offer life, when before we too frequently couldn’t avoid tragedy.

 

I recall the images of Ms. Roberts during Katrina, and especially when she made her way to her family’s home in Pass Christian, Mississippi. 

 

I can still remember watching her while that morning, mesmerized by her recollections of her youth, the importance of her family, and the meaning of the devastation that was all about her.

 

But what I remember most was her optimism that her family was OK, and that they would be OK.  The strength of Ms. Roberts’ faith literally brought tears to my eyes at that moment.

 

As I have said before, celebrities represent all of us, especially when they share some of their most personal life events.  Few have done so with such grace.

 

Robin, we wish you well.

 

 

Comments

7/31/2007 11:46:30 PM #

Ellen Ladden

Dear Dr. L,
In a day and age when "heros/heroines" for young people are questionable, Robin Roberts is stellar!!  Not just a wonderful athlete, not just a competent tv personality, but someone who is one of the best models of healthly, holy and wholesome living.  

Robin is not just "grace", but "Amazing Grace".  

I, along with you and thousands of other viewers will keep her in our prayers - not just on Friday when she has her surgery, but in the days, weeks and months ahead.

God writes straight with crooked lines - Robin has already demonstrated that she will be an advocate for early detection.

Ellen

Ellen Ladden

8/1/2007 12:48:00 AM #

Andrea Hershey

Dr. L
Can you please comment on MRI screening?  I am a recent breast cancer survivor (38 when detected last  year) who had only one sibling relative with breast cancer (at 42)and no other risk factors.  However I had seen an article in NEJM concerning MRIs and my OB/GYN and I decided we should use this along with my annual Mammogram.  My mammograms were always "normal" but in reality my breasts were so dense they were unreadable. I think the radiologists should have picked up on this. The MRI was abnormal with an obvious invasive 1.3 cm tumor.  (Mammo was normal and follow up ultrasound would not have detected the cancer).  I know the oncology guidelines have recently changed recommending this as a screening tool for certain high risk young women. In the literature I read it appeared that even thougth there are false positives with the MRI, it catches a much higher rate of tumors than Mammo and US, especially in young women.  If this was a more cost effective interention I think it would be more widely utilized.  As breast cancer incidence increases in the younger women the MRI seems like a tool that should be more highly utilized.

Andrea Hershey

8/1/2007 8:07:34 AM #

Richard Reid

Dr. L, Ms. Roberts' on-air announcement of  her having breast cancer was indeed poignant, and I pray for her speedy recovery. I do wonder what portion of her ancestry is African-American, Caucasian, American Indian, or other? Her classification into one group seems too superficial given what we now know about the complexity of genetic inheritance.

Richard Reid

8/1/2007 9:45:13 AM #

Jodie Mannlin

I am a four year survivor of breast cancer, caught early (and small) by routine mammography, and confirmed by sonography.  It was not palpable by myself or my doctor.  I had a lumpectomy, 30 radiation treatments, and have completed 3.5 years of the 5 years of Tamoxifen.  I did not have chemo.  Robin and her loved ones will remain in my prayers and thoughts.

Jodie Mannlin

8/1/2007 11:34:32 AM #

Sandra Sively

Question for Jodie Mannlin and Dr. L.  I have a friend who had a double mastectomy a year ago and chemotherapy afterwards.  She recently had a mammogram and was normal.  A few weeks later, she had pain under her arm.  The result was cancer in three lynphnodes.  All lymphnodes on the left side were taken out.  Now they are recommending radiation of both breasts and the neck and has been told her breast reconstruction will be ruined.  Could you tell me how damaging to your tissue was radiation, and if it is visible.  She is afraid her implants will be ruined and won't be able to get them back because of scar tissue, and possibly losing movement of her right hand/arm.  She makes a living as an artist.  Could you please tell me more about radiation effects?

Sandra Sively

8/1/2007 11:51:43 PM #

Paula Boyette

Dr. L. I have stage 4 metastatis Breast Cancer, lymph node and lung diagnoised in 2004, given 1 yr to live. Found lump in breast, not seen on mammogram, seen with ultrasound, had biospy came back lobular carcirnoma.  Had a lumpectomy, 10 lymph nodes removed with 6 positive. Had 3 tumors in my lung. Had 12 fields of radiation and then over 8 months of Chemo four different kinds.  Since then I have had mammaogram, ultrasounds without good response.  Last year I had MRI and got better results.  The surgeon said no more mammograms they were not good for  me.  Did not show the lump and I had had mammogram every year from age 35 and my cancer was diagnoised at age 55, and the lump was 5cm.  What is you imput.  I had not side effects from radiation and chemo, never got sick and work the whole time during the treatments.  I am a nurse and had great support with my fellow workers.  I wish Robin all the best and know she will come thru with flying colors. Positive atitude and fortitude and prayer and friends, families may life so much better. May god bless you and I will be praying for you.  I feel great and I am 2 years in remission.   Thanks

Paula Boyette

8/2/2007 10:34:16 AM #

Len Lichtenfeld

My thanks to all of you for your comments. Unfortunately, the limited space here doesn't allow detailed responses, and I am not in a position to provide specific medical advice.

That said, I can address some of the questions.

Regarding MRI, the American Cancer Society has recently provided professional guidelines which can be found online at our CA journal website in the March 2007 issue (caonline.amcancersoc.org/.../75).

It is important to remember that these guidelines are for women at high risk as defined in the guidelines and that MRI should NOT be used by all women. The technology is simply not appropriate as a general screening tool.  Most important, these MRI studies should be done ONLY at centers that have considerable experience in using MRI for breast screening and are equipped to follow through with MRI guided breast biopsy, if needed.  There are, in reality, only a small number of institutions who have this capability.

I am not going to go into ethnic issues in detail, other than to say there are influences based on our inherited characteristics.  For example, Ashkenazic Jewish women are at much higher risk of having a BRCA abnormality in their genes, which leads to an increased risk of breast and ovarian cancer.

As I noted, I cannot comment on a specific treatment question as posed by Ms. Sively.  I can say that current radiation techniques are much improved from what we had years ago, but her radiation oncologist will have to talk with her about specific risks related to implants.  You can also contact the ACS at our 24 hour Cancer Information Center (1-800-ACS-2345) for more information.

Ms. Boyette's comments reflect a changing world for women with metastatic breast cancer.  Our hope is to catch the disease early; our reality is that that is not always possible.  With newer drugs and newer approaches to cancer treatment, we are blessed to have more people living longer, effective, and meaningful lives.  Thanks for sharing your experience with us.

Len Lichtenfeld

8/4/2007 12:01:47 AM #

Lisa

Okay, now I am confused! SmileI am celebrating my 3 years of survival from stage 2, invasive ductal carcinoma with no lymph node involvement. After a mastectomy and 4 months of chemo, with one reconstructed breast and a small implant for symmetry in the other, I am very concerned about risks of a cancer diagnosis in my remaining breast. The first lump was not found with my annual mammograms. I am now 49, post menopausal, thanks to the chemo, and taking 20 mg. Tomoxifin daily. My oncologist said that an MRI is not necessary. If the mammo did not detect the first lump, why would it detect anything new in the remaining breast? What ARE the guidelines?
Thanks!

Lisa

8/7/2007 3:13:02 PM #

acs

Hello Lisa, for questions regarding the guidelines, please call our National Cancer Information Center (NCIC)at 1-800-ACS-2345 to get answers to questions about this and other cancer-related issues. The NCIC is open 24 hours a day, 7 days a week.

acs

8/15/2007 9:47:27 PM #

Janet Scott

Dr.L, I am a registered Mammographer.  Thank you for your comments on using ultrasound as a diagnostic tool and not as a screening tool. The difference between screening and diagnostic is confusing to many patients.  Thank you for clarifying that ultrasound is useful when there is a specific area of concern.  I wish that point would have been said on GMA so as to not raise more confusion among viewers.

Janet Scott

9/14/2007 5:35:40 PM #

MAGGIE GUERRA

DR.L.I WAS DIAGNOSIS WITH BREAST CANCER IN 2000,RIGHT CARCINOMA IN SITU, I WAS GIVEN NOVALDAX 20MG FROM JAN 2000 THRU DEC 2000, CAUSE IN DEC I REPEATED MY MAMMOGRAN AND IT SHOW LEFT LOBULAR INVASIVE CARCINOMA, SO I DECIDED TO HAVE A DOUBLE MASTECTOMY, ON LEFT IT WAS MODIFIED RADIAL MASTECTOMY AND SIMPLE RIGHT MASTECTOMY AND ON JAN 23, 2001 I STARTED CHEMO FOR 3 MONTHS I WAS GIVEN ADROMCYMIN, 5FU, CYTOXIN IV AND 3MONTHS DMP. SO I WAS BEING CHECKED EVERY 3 MONTHS DOING GOOD. MY ONCOLOGIST STARTED ME ON FEMARA 2.5 MG ONCE DAILY, BEEN ON IT FOR 1 1/2 YEARS AGO AND DOING GOOD. DID BONE DENSITY AND FINE, THEN GOT ANEMIA BUT GIVEN TAMDEN ONCE DAILY AND VITAMIN B-12 WEEKLY AND NOW MONTHLY. DOING GOOD, BUT THIS LAST VISIT I WENT AND TOLD ME ABOUT A STUDY THEIR DOING ON PATIENTS ON BREAST CANCER AND WANTS TO SEE IF I CAN TAKE THIS NEW MEDICINE TYKERB BUT I NEED TO GO THRU SEVERAL BOOD TESTS, CT SCANS AND EKG'S AND THATS IF I PASS THEM ALL. SO WHAT CAN YOU TELL ME ABOUT THIS NEW MEDICINE, I'VE CANCER FREE FOR 7 YEARS SO FAR, I DID HAVE 9 LYMPHS NODES REMOVED FROM MY LEFT ARM AND ONLY I WAS POSITIVE AND HER 2, HE TOLD ME ITS A MEDICINE FOR REOCURRENCE OF CANCER. AND I THOUGHT I WAS CURED. BUT HE TOLD ME TO GO AND SEE HIM IN 6 MONTHS IF I DECIDED NOT TO DO THE STUDY.
WHAT DO YOU ADIVE ME DR.L.I'M VERY UNDECIDED DUE TO ALL THE SIDE EFFECTS.
THANKS, MAGGIE

MAGGIE GUERRA

10/4/2007 10:09:14 AM #

PATRICIA CARROLL

hi , i had a routine manogram 2years ago and was told i have a 7-8mm fibroadenoma. was told  these are benign tumors of the breast. i am 53 years old i now hve been getting a mamo and ultrasounds every 6 mo. for the past year and half. i just had a 1st cousin who has been just diagnosed with ductal carsinoma insitu non invasive she is the only family history i have of breast cancer i have . my mother past at age 51.  my cousin also was diagnosed with a fibroadenoma.  do you think i should have my breast biopsied?

PATRICIA CARROLL

10/13/2007 2:11:44 AM #

Robert Watts

we offer the only breast cancer awareness bracelet that acknowledges prayer as a possible aid to a cure.

www.imprintitems.com/awarenessitems/breastcancer

click on pink bracelet / wrist band photo

Robert Watts

6/6/2008 6:41:39 PM #

Debbie

My Gyn told me that the small lump I found in 8-2006 was just a sebacous cyst/hair folicle inverted. She recommended I apply hot packs and pop it with a neddle when it comes to a head. The Radiologist came in after my ultrasound was complete and said it was a cyst.My mammogram was normal. I went to the ER with what I thought was an infected boil that had grown over the 8 months. The ultrasound again showed a cyst. The neddle biopsy done in the ER by a surgeon proved otherwise. They took out a 4.0 cm stage 2 tumor left breast. No lymph node involvement. IDC and the tumor is boderline to hormone. My new Mammogram showed calcifications now what??

Debbie

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About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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