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.