Back in 2000, we saw the start of what the medical community called “
It followed the tragic passing of her husband, Jay Monahan, from colon cancer, marking a public awareness push that’s continued to this day, encouraging people to get screened for the disease.
Flash forward 22 years, and the iconic television journalist’s very personal disclosure of her recent breast cancer diagnosis has underscored the importance for women to go in for their routine mammograms and reopen dialogues with their doctors and medical providers — something that many put on pause during the COVID-19 pandemic.
Revealed just before the start of October’s Breast Cancer Awareness Month, Couric’s breast cancer journey sheds a very big spotlight on a pressing health reality that the
Experts spoke with Healthline about who is most at risk, what you should know about routine mammograms, and what kind of role this new “Couric effect” might have in keeping breast cancer front and center in people’s minds.
“June 21, 2022, was the first day of summer, my 8th wedding anniversary, and the day I found out I had breast cancer,” Couric wrote in a post on her website simply titled “Why NOT Me?”
Couric detailed that her gynecologist nudged her that it was high time she go in for a routine mammogram, given her most recent screening was in December 2020.
During a recent appearance on her old broadcast home of “Today,” Couric said she was “six months overdue” for a mammogram.
Like many people, Couric wasn’t as on top of her screenings during the disruptions of the pandemic. She decided to echo her famous on-air colonoscopy by filming her screening appointment to share through her platform to encourage others to go in for their screenings.
She has dense breast tissue, which doesn’t mean one’s breasts are physically hard or heavy; it refers to the amount of different types of breast tissue that can only be seen via a mammogram.
Dense breasts typically show high levels of glandular tissue, fibrous connective tissue, and fairly low levels of fatty breast tissue,
Couric wrote that as a result of the fact her breasts have this dense tissue, she also goes in for routine breast sonogram tests along with a mammogram. This is due to the fact this density makes it harder for a mammogram to spot abnormalities on its own.
Then came what Couric wrote was a “heart-stopping, suspended animation feeling.”
Her doctor asked her to stop recording her video on her phone, they found something suspicious on her left breast. They did a biopsy. The next day her breast radiologist Dr. Susan Drossman delivered an unwelcome message: “’Your biopsy came back. It’s cancer. You’re going to be fine, but we need to make a plan,'” Couric wrote.
“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,” she added in her piece.
Her tumor was diagnosed as hormone receptor-positive, Her2neu-negative.
The good news?
It was “highly treatable,” according to her doctor, especially if detected early. She had a lumpectomy, or “breast conservation” surgery in July to remove the 2.5-centimeter tumor. She received radiation treatments that concluded in late September.
“I just feel super lucky that it was diagnosed when it was, that I went — even though I was late — that I went when I did,” Couric told the Today Show.
The fact that Couric was late for her regular breast cancer screening appointments might sound familiar to a lot of women.
“The COVID-19, pandemic disrupted breast cancer screening, including surveillance among women who have been previously diagnosed with breast cancer or were at high risk for developing breast cancer,” said Dr. Monica Sheth, Clinical Associate Professor, Department of Radiology at NYU Long Island School of Medicine and the Co-Section Head, Breast Imaging Department of Radiology, Long Island Division.
Sheth told Healthline that the “long-term impact” on the delay in cancer diagnosis and prognosis due to the pandemic is “unknown” right now, but “modeling studies published by Dr. Norman Sharpless, former Director of the National Cancer Institute, estimate that a large number of excess deaths from breast cancer will be seen over the next 10 years because of the pandemic causing delays in screening, and thus a delay in diagnosis.”
Dr. Deanna Attai, an Associate Clinical Professor of Surgery at the David Geffen School of Medicine at the University of California Los Angeles, explained that the timeline of Couric missing her mammogram for over a year is something that has been “pretty common.”
She said that during the early days of the pandemic, organizations like the American Cancer Society called for screening facilities to shut down, during a pre-COVID-19-vaccine period when the virus was still largely unknown, and providers did not have the protective equipment, masks, and gloves needed to treat people safely in person.
After the vaccines were made available, Attai said she and her peers have seen most facilities start settling back into a normal routine as more people became increasingly comfortable returning to in-person healthcare settings.
“Our screening mammography volumes are comparable to pre-pandemic times. There seems to be little to no reluctance to obtain necessary breast cancer screening at this time due to COVID-19,” Sheth added.
One recent national survey showed that 22% of surveyed women between 35 and 44 “had no plans” to get a mammogram to check for breast cancer.
When asked whether this points to a larger trend or not, Sheth said the data collected from 1,100 adult women online over a four-day period was “very interesting,” but that she would “like to see data for a larger number of patients covering several demographics” to see if this was a trend and determine if the “small sample size is reflective of the larger population.”
“If the numbers are true, and that 22% of women have no plans of getting a mammogram in the future, we have much work to do, not only on the public messaging front but also sharing guidelines with referring doctors and clinicians and finding ways to reach patients that may not have a primary care doctor or a gynecologist that they are seeing routinely,” Sheth said. “Some reluctance may stem from not having a family member or friend with breast cancer and simply thinking their likelihood of getting breast cancer is relatively low.”
When it comes to concerns over the degree of risk concerning missed mammograms, Attai said that it should be noted that clinicians use a variety of “risk assessment models” to take into account factors like one’s family history, age, menstrual history, how old someone was when they had their first pregnancy, and breast density, among others.
There isn’t a once-size-fits-all playbook for risk, given it varies from person to person depending on all of these different factors.
Attai explained that what has been challenging during the pandemic era is that many have put off their regular communications with their personal doctors and providers, which has thrown off the timeline of when each person should be going in for mammograms that make the most sense given their specific risk factors.
“At least for my patient population, most are getting back to their routine imaging, not just mammograms, but just getting back to seeing their primary care doctor or having that pap smear that was recommended a couple years ago, their follow-up colonoscopy, their follow-up appointments that they’ve put off for a few years,” Attai explained. “So, things are slowly getting back to normal.”
Sheth underscored that it’s “important to take care of our health.” This goes for when we are sick and“when we are feeling well.” This means going in to see your primary care doctor annually for a full physical exam, lab work, mental health and safety screenings, and “reminders of age-appropriate screening measures.”
This is especially true for preventive breast cancer appointments and screenings.
“What several studies have shown is that annual screening mammography starting at the age of 40 for average-risk women has the greatest mean mortality risk reduction of approximately 40%,” she said. “Multiple studies have shown that women who are screened regularly have better outcomes than those who are not screened.”
Sheth emphasized that “annual screening mammography is important for all women.”
That being said, some are considered high risk more than others. This means women who have a “greater than 20% lifetime risk developing breast cancer.”
“In these high-risk patients, annual screening mammography is recommended to start at age 30 with consideration of screening breast MRI annually as well, which may start as early as age 25. Because screening recommendations are different for these high-risk women, it’s important for all women to know their lifetime risk of developing breast cancer before they turn 30,” she said.
“This means, by the time a women turn 30 years of age, she should be speaking with her doctor about her lifetime risk for developing breast cancer, especially if she is African Americans, Ashkenazi Jewish, carries genetic-based mutations associated with breast cancer, has untested first-degree relative with breast cancer, or has received chest radiation therapy before age 30,” Sheth added.
The main factors that influence breast cancer risk include being a woman and getting older, Sheth stressed. She added it’s important to note that 85% of breast cancers are diagnosed “in women with no family history or known risk factors for developing breast cancer.”
“Women with dense breasts have a 2-4 times-increased relative risk of developing breast cancer than those without dense breasts. Speak to your doctor about your breast density. If you have dense breast, discuss your personal risk of developing breast cancer with your doctor and if supplemental screening with ultrasound or MRI may be beneficial,” she added.
Additionally, Sheth said that a woman who possess a BRCA1 or BRCA2 gene mutation “has up to a 7 in 10 chance of getting breast cancer by age 80 — compared to 1 in 8 chance for average risk women.”
Couric emphasized how necessary it was that her cancer was detected when it was. Attai said “in general, the earlier the stage — the lower the stage of diagnosis — the better the survival rates.”
But, she emphasized we have a clear-eyed perspective that “it’s not as simple as early detection equals cure.” She noted there are some breast cancers that are incredibly aggressive — like triple-negative subtype of breast cancer, which disproportionately affects Black women — where “it doesn’t matter how early they are detected.”
The earlier the stage, the better the survival, Attai stressed, explaining the importance to go in for routine screenings, and then receive the course of treatment that makes the most sense for the type of breast cancer diagnosis you receive.
For her part, Sheth said early detection for breast cancer by way of a mammography screening is important because it “allows a radiologist to catch breast cancer hopefully at a small size, when it is less likely to have spread outside the breast.”
“This is called ‘localized disease,’ and in such instances, a person is more likely to have treatment options that are much less aggressive while still maintaining incredibly positive treatment outcomes,” Sheth added.
According to the
In 2008, Couric co-founded Stand Up to Cancer, which raises millions of dollars to fund innovations and research tied to cancer.
In 2019, she told Healthline that oftentimes people come to her for advice and support tied to dealing with a cancer diagnosis or assisting a loved one or friend who has recently been diagnosed.
“I remember so well that feeling of hopelessness and powerlessness, and so if I can be helpful or useful in giving people advice or, you know, helping them navigate the system or helping them navigate their own feelings, [it’s] something that I’m happy to do,” Couric said.
How impactful is the “Couric effect” when it comes to breast cancer?
Attai said not every celebrity who wades into public health messaging is helpful. Sometimes it can be all too easy for someone with a major platform to — intentionally or unintentionally — spread misinformation. She said Couric is different given her decades of cancer advocacy and her informed perspective given her own role as a respected journalist.
Sheth said Couric’s recent disclosure will go a long way in helping women across the country reengage with their breast cancer screenings and healthcare.
“I cannot underplay the significant impact Katie Couric’s recent disclosure will have on women’s breast health, not only by encouraging more women to get their screening mammogram but also pushing legislation to cover supplemental screening breast ultrasound and breast MRI in women with dense breasts,” Sheth said. “Her advocacy for colon cancer saw a 20% increase in screening colonoscopies after her disclosure, and I would expect a similar if not greater impact regarding breast cancer screening.”