October 6, 2022 • 64 mins
Katie has always been vigilant about her health. Ever since her husband Jay died of stage four colon cancer in 1998, Katie has been a cancer screening advocate, sharing information about and helping to normalize seemingly intimidating procedures that can detect cancer early and save lives (you might recall Katie’s on-air colonoscopy?). When Katie realized she had missed a mammogram, she decided to take listeners into the procedure room with her to understand why it’s important for women like Katie, who has dense breasts, to get not only a mammogram but also an ultrasound. But then, Katie gets the news that no one wants to get. On this very personal episode, Katie — with the help of her doctors and daughters — takes listeners behind the scenes of her cancer diagnosis, treatment and long term plan. Katie also introduces listeners to cancer survivor and activist, Michele Young, who beat the odds and is changing the breast cancer screening system. Also, check out Ellie and Carrie Monahan’s podcast, All Each Other Has, wherever you get your podcasts.
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Episode Transcript
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Speaker 1 (00:00):
Hi everyone, I'm Katie Current and this is next Question. Today.
I'm going to tell you a very personal story. The
first thing you should know, though, is that I am vigilant,
even neurotic about taking care of my health and encouraging
others to do the same. I think it's because I
lost my husband Jay to metastatic colon cancer back in
(00:23):
n when he was just forty two years old. At
the time, I was an anchor on The Today Show.
Many of you know that I lost my husband, Jay Monahan,
my loving and beloved husband, last month after createst battle
with colon cancer. Words, of course, will never describe how
devastating this loss has been for me and my daughters
and all of Jay's family as well. But the heartfelt
(00:45):
and compassionate letters and cards that so many of you
sent to me were enormously comforting, and I'm so grateful.
After Jay died, I wanted to share everything I had
learned about this terrible disease. I also wanted to help
people understand there are ways to prevent it, to detect
it early, and that's by getting a colonoscopy, which I
(01:08):
did on National TV. Put the scope and yet did okay,
good that's a good guy. A few years later, I
even got Jimmy Kimmel to get screened. Katie asked me
if she could accompany me for my first colonoscopy. You
know you have to have that when you turned fifty,
and it seemed to be an unusual request, but I
(01:30):
know this is something piteous passionate about, and um, it's
an important thing to do. So with that said, we're
about to watch a camera go where no camera has
ever gone before. All of this is to say that
even I, the cancer screening Queen, missed a cancer screening
appointment because of the pandemic, I was six months overdue
(01:53):
for a mammogram. I'm sure I'm not the only one
who fell into the COVID time warp. So I decided
to turn my own misstep into an upclose and personal opportunity. Okay,
here is the machine as well as a teachable moment,
and this is where my breast will be placed. Since
(02:16):
I started getting screened, my annual breast exam has been
a two step process because I, like women over the
age of forty, have dense breasts. So in addition to
getting a mammogram and now a three D mammogram, which
is superior to the standard kind. I also get a
breast ultrasound. My longtime breast radiologist, Dr Susan Drossman has
(02:42):
been the one doing those exams and analyzing the results
for years. So momography, wall it is the gold standard,
does not do the whole job in terms of saying
that your breasts are normal. Momography is excellent at looking
at calcifications and what we call architectural distortion. Those are
both the ways that certain breast cancers can manifest themselves.
(03:06):
But when the breast tissue is dense, mammography does a
very poor job of looking at masses. I think the
best analogy I can give you is if you're looking
for a snowball in a field of snow. The conspicuity
of finding a snowball in a background of snow is
going to be very difficult. So if you're looking for
a mass, which by definition is dense because the cells
(03:28):
are rapidly multiplying, and you're looking for that in a
background a very dense tissue, it's almost going to be
impossible to find on a mammogram. So breast ultrasound uses
sound waves, so the way that you look at the
tissue is very different, so ultrasound is really an excellent
tool for looking at masses and cysts. It was June
(03:49):
twenty the day of my appointment. I handed my phone
to a technician and asked her to film me better
than Spain. Okay, so you had your mammogram and really
all looked pretty stable. On the mammogram, there was one
area where the tissue looked a little bit more distorted
(04:12):
than in the past. Go back to ultrasound. And we
went into ultrasound and I and I had in my
head this particular area that I really wanted to look at,
and you and I were chit chatting. Breast get bigger
after menopause, so there's definitely a redistribution of body weight
after menopause. And when I got to that area, I
(04:34):
knew that there was something here that bothered me because
on ultrasound what I saw was a mass. So we
were chit chatting, and I think I remember saying to you, Katie,
there's something here that worries me, you know, And you
asked us to turn off the camera because we were
recording this to use to remind women to get screened.
(04:58):
That is true, and I looked at you, and I
looked at the person who is imaging us, and I said,
I could stop for a second. I think we really
need to turn the camera off. I want to speak frankly.
And you said, no, no, we can keep going. And
I said, no, turn that camera off. And you know,
I've been doing this for a long time, so I
(05:19):
do know what my thresholds are, and I was concerned
about it. Obviously. Until we get tissue from it, you
never know for sure. And the only way to get
tissue from the breast is with a biopsy, which Dr
Drossman did the very same day. And you said to me, oh,
I have a bit. I have this I have to
go to, and I have this I have to go to,
(05:39):
and uh, you know, I'm very busy, and of course
I know you're very busy, but I knew what this
was going to be, and I said, I want to
do this today, stay till the end of the day,
and we'll make it happen. And we did. In order
to perform a breast biopsy, a very small incision is
made into a numbed breast using a tiny instrument. The
(06:02):
doctor reaches into the area of concern and pulls out
several pieces of breast tissue. Dr Drossman assured me each
one was minuscule. It's probably about twenty three millimeters long
and about three millimeters wide. So like, compare that to something,
because I'm bad at that. So it's like like a
little worm, like a like a little baby worm, a
(06:25):
little baby worm. Um. And I take multiple samples. We
usually take about five samples, because when you are doing
these biopsies, it's all about sampling. So you want to
show the pathologists what's happening here. So I take some
tissue from the top, from the middle, from the bottom,
and that gets put in a little jar of formula
in and gets sent to the pathology lab. Just twenty
(06:48):
four hours later, Dr Drossman called my cell the mailbox
is full and cannot accept any messages at this time. Goodbye. Yeah, yeah, yeah,
my mailbox is always full. So she resorted to text,
please call me in the office to discuss biopsy results.
(07:08):
So I called you back, and do you remember what
you said? I probably said, do you have a few
minutes to talk. I'll share those results right after the
break when you got the pathology report back for me.
(07:37):
I'm just curious because we've known each other for a
long time, and you know what I've had to deal
with with my husband and my sister. Yes, yes, so
I have to say, you know, I've been doing this
for a long time, and I kind of knew what
it was going to be, So it didn't surprise me
in terms of what the pathology was. But I knew
(07:59):
it was going to be hard for me to tell you,
and hard for me to tell you because I know
what you've gone through in your life. So when I
got that pathology, I said to myself, oh my goodness,
how am I going to say this, which is really
always what I say to myself when I have to
confront somebody with this news. But you know, we have
known each other for a long time, and it's always hard.
(08:22):
It's hard for me every single time I do it.
So I called you back and do you remember what
you said? I probably said, do you have a few
minutes to talk? You know, I try to when I
am worried about something, give people at least a a
premonition that I am going to call and it may
(08:43):
not be great news. And I try to not spring
things on people because I'm the one who calls, you know,
and I think probably what I said it is it's
a small breast cancer. It's totally treatable, but we need
to make a plan. And do you remember what I said?
You probably said, am I going to be okay? Or
(09:05):
or ship ship? Or I gotta go to the handles
that I'm going to Aspen tomorrow. And I have a
lot of things I need to do and can I
still do them? And the answer is yes, but we
need to address this. I was going to visit John's
parents and I was going to a wedding in Aspen,
and I was both shocked and yet not shocked because
(09:26):
I've had so much cancer in my life. I think
a lot of people think, well, if one out of
two men and one out of three women are diagnosed
in their lifetimes, you know there's a good chance that
many of us will be in this position. Well, the
numbers are high, the numbers for breast cancer. A one
in eight women will be diagnosed with a breast cancer
(09:49):
in their lifetime. Those are significant numbers, and that's why
screening is so important. Cancer it's a pretty scary six
letter word. Despite all the strides that have been made,
It's a word that's been part of my world for
much of my adult life, but breast cancer. Breast cancer
(10:10):
was new. No one in my family had even had
breast cancer, and I always thought family history was such
an important factor. So I will tell you the thing
that bothers me the most when patients come in and
they say, oh, I have no family history, I don't
even know quite why I'm here, or I think I
could come every other year because I have no family history.
I think what people need to know is that percent
(10:33):
of breast cancers are sporadic events, things that are unplanned.
I don't know, bad luck. I really can't answer why.
But you know, there is no family history with of
breast cancer. So the small percentage are the ones with
a family history or genetic predisposition. So the majority of
things that we find are in patients that you know
(10:54):
are walk in thinking, you know their day is going
to continue as it always does, and you know, unfortunately,
I think that as we get older, as we talk
to more women, we realize how our lives can change
in a second. Less than twenty four hours later, I
was sitting across from a new and critically important member
of my medical team. My name is doctor Lisa Newman.
(11:18):
I am a surgical breast oncologist and chief of breast
surgery for Wild Cornell Medicine and the New York Presbyterian
Hospital Network. And what did you say to me? And
what do you say to most patients? Do you remember
that day? Well, the first thing that I had to
do was to um take a deep breath and bring
(11:39):
myself down to earth, because to me, you are just
a superstar, magnificent individual. All that you've done in your
career and all that you've done for cancer research. I
was obviously star struck, But the first thing that I
had to do after bringing myself back down to earth
was to understand that meeting you as an individual meant
that I did have to fulfill my responsibility to you
(12:02):
as a physician and make sure that I addressed all
of the same concerns that you were going to have
as a newly diagnosed woman with breast cancer that every
other woman with breast cancer has to deal with, the fear,
the unknown, the uncertainty about the future. A cancer diagnosis
(12:22):
of any type is horrific in life changing, and a
breast cancer diagnosis in particular for a woman, is a
very personal very difficult diagnosis to here. I remember telling you,
Katie number one, you were facing an excellent prognosis and
excellent outcome as long as you complied with appropriate treatment,
(12:45):
you had every reason to be expecting that this cancer
was going to be treated successfully. And this is the
case for most women with breast cancer. Fortunately, number two,
I wanted to make sure you understood that you are
not racing the clock. We know a lot about the
biology of breast cancer, and most women should be confident
in the fact that the cancer is not spreading through
(13:06):
their breast by the day, nor is the cancer spreading
through their body by the day, and so it is
very important that women take the time to understand their
treatment options and their diagnosis before they jump into any
treatment plan prematurely. Now, this doesn't mean that we want
women to delay getting their breast cancer taken care of,
but it does mean that they have a few weeks,
(13:28):
you know, four weeks, six weeks to make sure that
they understand what their options are. After we discussed those
two important messages, it wasn't very important for you to
understand that you had treatment options because your cancer was
detected at an early stage. The first step in your
treatment was going to be surgery, and the goals of
(13:50):
the surgery were to take care of the disease in
your breast as well as to get more information regarding
the stage or the aggressiveness of the cancer. And then
those surgical findings would drive the other types of treatments
that you were going to require, such as radiation needs,
such as possible chemotherapy, taking special cancer fighting pills. The
(14:10):
surgical information would inform all of those decisions. The initial
surgical options that you had included having breast saving surgery,
which involves doing a lumpect to me to focus on
removing just the cancerous area that led to the biopsy
on the diagnosis, and then following a lumpectomy, radiation would
(14:30):
be delivered to the breast, and radiation treatments after a
lumpectomy are very targeted X ray beams going right at
the breast itself, and these radiation beams are designed to
kill the microscopic cancer cells that are hiding in the
normal appearing breast tissue. The alternative surgical plan is mistectomy surgery,
where we completely removed the breast, and when we completely
(14:53):
remove the breast, we're taking care of removing the cancer
identified lump as well as the mic roscopic cancer cells
hiding in the normal appearing breast tissue simply in one
fell swoop with that mstectomy surgery. I remember you telling
me Dr Newman that the outcomes were the same formystectomy
and lump ectomy with radiation and medication. And I thought, well,
(15:18):
if that's the case, I would prefer to have a
lump ectomy. But I also didn't have some of these other,
you know, extenuating circumstances with b R c A or
any of these things, so I felt very comfortable getting
a lumpectomy. And a lumpectomy was extremely appropriate for you
(15:40):
because you did catch your cancer at an early stage.
In fact, it was stage one A. What does that mean?
So stage one A clinically based upon what you're seeing
on examining the patient and what you're seeing on looking
at the mamogram ultrasound pictures, and based upon those characteristics,
those microscopic markers as drigen receptor, progesterone receptor, her too
(16:01):
new and the appearance of the individual cancer cells of
the great what we call the great of the cancer.
All of those things were favorable in your situation, and
that goes along with the stage one breast cancer. Stage
one A is the better category of stage one as
compared to Stage one B, and this is another example
of where we've made advances and understanding breast cancer and
(16:24):
characterizing it much more precisely. In the past, we only
characterize breast cancers by their size and by the limph
note status and by whether or not you saw any
evidence of cancer hiding in other organs of the body
metastatic disease, for example, in the liver, lungs, bones. Today
we are much more precise about the staging because we
(16:46):
understand that these markers that we evaluate are so critically
important in understanding the aggressiveness or the likelihood that the
cancer will ever be a life threatening one, and so
in addition to looking at the size and lymph notes,
we also look at the presence or absence of those
different markers and that will also impact upon the stage
(17:07):
of the cancer. All things considered, I was I am lucky.
My cancer is highly treatable and thanks to Dr Newman,
I had a better understanding of my prognosis and a
treatment plan in place. Surgery was scheduled for July, a
little more than three weeks away. Now, I just had
(17:30):
to share the news. Ellie, why don't you say my
name is Ellie Monahan and I'm Katie's daughter, and then
carry you stay at the same okay, with two very
important people. My name is Ellie Monahan and I'm Katie's daughter,
And my name is Carrie Monahan and I'm Katie's other daughter.
(17:51):
It's not unusual for her to call and text me
a lot. Um, I've gotten better, but I used to
be really uh, sort of unrespond in site to her,
especially when I was in college. But no, it's not
unusual for her to call or FaceTime out of the blue.
We talk all the time throughout the day. But I
noticed when I woke up in the morning I had
(18:13):
a miscall and that she was saying, please call me.
And she does that all the time. Um, it could
be for something totally random and unimportant, but that she
wants to ask me about or something. UM. I remember
I had just woken up and we faced time, and
(18:35):
you know, she told me and it was scary. Um,
she told me that everything was going to be fine.
I think she prefaced it that way, and I felt worried,
but also I think she understood from the get go
that she had access to amazing doctors, that it was
super early, and that she in all likelihood was gonna
(19:01):
be okay. Um. She told me we weren't going to
be able to go on this trip that um, she
and I had planned UM understandably because that was going
to be when the surgery was. And she said, don't
tell Ellie because I'm going to tell her. UM. And
(19:21):
then I guess she then told Ellie. Yeah, so I
found out. I guess she was diagnosed on June one,
which it feels like I think was a Tuesday. And
I'm sort of I'm sort of different than Carrie. I
historically have been very anxious and always in constant communication
(19:43):
with my mom, and I've only learned in the past
few years to like give it arrest a little bit. Um.
You know, I always had her on speed dial, and
I still talked to her all the time, but um,
it used to be every day and now it's, you know,
a couple of times a week, and that's healthy because
(20:04):
I'm thirty one years old and I'm married. Um. And anyway,
so you know, we hadn't been talking that much, especially
because in June I had three weddings and was traveling
back and forth from l A, where I lived, to
the East Coast where these weddings were. I did not
(20:24):
plan my travel well and I remember, UM, I took
a red eye to New Jersey to go to my
my husband's cousin's wedding, and it was the day Roe V.
Wade was overturned. So that Friday, I think the four
of June. I want to say, so, UM already was
(20:45):
very emotionally drained. And that was the same day I
finally got in touch with Mom and she told me,
you know, that she she had been diagnosed with breast cancer,
but it was very early stages, and she, you know,
like Harry, she prefaced it and said, I don't want
you to worry. UM, it's very early stages. It's it's small.
(21:08):
So I think I was. I was really drained and
almost numb when I heard the news, and I obviously
was very upset. UM. So I wasn't numb. I just
mean I felt not myself already to begin with, UM,
So I was really upset. I would say. There were
(21:28):
certain trigger words used like obviously cancer, UM and radiation
was hard to hear. Even the mention of chemotherapy. You know, uh,
imagining mom losing her hair or you know, or going
through chemo, which I think can be really harsh on
your system. Um. That was really scary to me, sadly though,
(21:51):
because when our father was diagnosed with cancer, he had
stage four you know, hearing it's you know, stage point
five or one was very reassuring. UM. But I knew
we were gonna, you know, get more information as it came,
(22:11):
and that she has amazing doctors, and she was so
calm about it. So I was really comforted by that
after the initial shock of you know, hearing the C word,
and I think she was you know, protecting us, which
was really nice in her time of need to. You know,
that's a real mom move. And I think my brain
(22:31):
just could not go to a place where she wasn't
going to be okay, having lost our other our father,
another parent, so I just couldn't really go there. I'm
not really being clear. I was going. I was all
over the place, But yeah, I think you called me
and I was just like, it's gonna be okay, It's
(22:53):
gonna be okay, because I really I don't want to
minimize the experience or that it was scary, because it was,
but I think because of the way our mom set
the tone, and she's not somebody who would say it's
going to be okay if it's not, so I don't know.
I think Ellie was very, very overwhelmed. I think the
(23:17):
reason for Ellie and my desperate reactions to the news
also has to do with the fact that I was
basically an infant and Ellie was six years old at
the time our dad was sick, so I have no
memory of it, and I think being that close to
(23:41):
cancer UM that ultimately resulted in death when she was
that young UM made the experience much more visceral for her. UM.
I think Ellie, you're recently sharing with me kind of
your memory of being very freaked out by a mannequin
(24:01):
head that had one of our dad's wigs on it, UM,
and just lots of other memories like that that I
don't have. So I think that is part of it
for Ellie and why it's different for me. Yeah, you know,
I have been learning a lot about myself through therapy
(24:23):
over gosh the past four years, and UM, like the
planet these days, I have anxiety and I think a
lot of it is rooted to the fact that, you know,
we were living this wonderful life and everything was great
and until it wasn't. And I'm constantly, you know, trying
(24:47):
to anticipate or look out for the next you know,
the next catastrophe, the next catastrophy. Um. And you know,
I think that I've done so much work understanding that
that I wasn't. You know, It's like I was definitely triggered,
(25:07):
but I was aware and understood. I was aware of
and understood that trigger, so I could kind of deal
with it more and not let it consume me so
much emotionally. Um. It's funny to me that, you know,
the old me would say, I can't believe that, you know,
(25:28):
that month in June that you weren't calling your mom
every day. Look what happened as a result. You know.
But I think I know now that life is going
to throw you obstacles and you just have to do
the best you can and you can't anticipate them. And
calling your mom every day, moving back to the same
city where she lives, you know, that's not going to
(25:50):
change anything. My Dad's assured me that if I followed
the appropriate protocol, I had every reason to expect the
cancer would be treated successfully. So the first step was surgery.
(26:11):
So my job on the morning of your surgery is
to make a path um Usually I call it a
GPS for the surgeons. It was scheduled for July four tea,
and I began the day with a stop at Dr
Drossman's office. It's not just taking out the tumor. It's
getting a good margin around the tumor and also making
it cosmetically pleasing, because if you're doing a lumpectomy, the
(26:35):
whole purpose is to remove that tumor preserve the rest
of the breast with a good cosmetic appearance. So we
did that on the morning of the surgery. You came
in early in the morning. Again, I used ultrasound to
guide us. I cleaned the skin um with Beta dign
same as before, gave you local and then put a
very skinny little wire almost it's like a little horsetail hair.
It's very very thin and flexible. It goes right into
(26:58):
the tumor and marks the site. And then we taped
it to your skin and you went to go see
Dr Newman. First. I was prepped for surgery Hieron. This
is Aaron, she is helping me. Aaron, what is your
job here at your hospital? I am here in the
breast surgery service. Here's the sitch, had a wire put
(27:19):
in my boob, which is basically providing guidance for the
surgeon because I have a little lump situation. And then
I was wheeled into the surgical suite where I was
given a nice dose of profo fall and drifted off.
I remember very distinctly you going to sleep and going
(27:39):
to sleep in you with your type of surgery, simply mensedation.
You did not need to be under general anesthesia for
this type of operation, for this type of surgery. But
I'm happy to report I didn't feel anything, which is
the way it's supposed to be. Thank Goodness for that,
so we can do these operations under local anesthesia and sedation.
But as you were falling asleep, I remember just being
even more amazed by you and even more star struck,
(28:03):
because you were talking about how you wanted to help
other women, and you went to sleep talking about how
you wanted to make sure that other women could take
advantage of all the advances that exist out there for
breast cancer, and you were talking about how privileged you felt.
It's it. It was so hard warming to see somebody
(28:23):
as amazing as you still thinking about others as you
were going under anesthesia. Will make sure this isn't edited
out of the podcast. But kidding, but so amazing. But
how did you go in? And actually I mean you
cut around? Well you tell me so it. While we
want to prioritize taking care of the cancer, it is
(28:45):
also important to make sure that you project into the
future and try to keep the patients looking as whole
and as herself as possible. So for breast cancer, that's
quite important, and it doesn't mean that we need to
be respect full and thoughtful about where we plan our
incision sites. For many women, it can be helpful to
(29:06):
bring in um their favorite brazier or bathing suit top
so that we can make sure that we get an
idea of where their tan line is located, so that that
we can keep the incision out of the way if
they were wearing a sif they were showing off some cleavage.
So in your case, we had the very nice option
of making the incision at what we call the peri
(29:27):
aiolar edge, so that I made the incision at the
site where the skin color changes at the areolar edge
so that the incision could be camouflaged by that normal
change in skin coll And you made sort of a
half moon incision, didn't you? Around my areola. We're getting
very up close and personally are people And then okay,
I'm gonna use earm ups. But then what did you do?
(29:49):
Because I'm a little squeamish, but go ahead. So through
that half moon incision at your areolar edge, I was
then able to dissect down following that guide wire to
get to the location of the tumor and basically carve
out a wedge of breast tissue surrounding that wire. And
(30:11):
in the middle of that wedge of breast tissue your
tumor was located. And that's the piece of tissue that
gets sent to the pathology laboratory for analysis. So do
you send the whole the whole thing, or does somebody
there who kind of cut sitters at the pathologist who's
sort of slicing pieces of my tumor. The pathologist does
that actual processing, and you're pretty busy operating table. You
(30:35):
can't be like, stand by, I'm going to slice her
tumor now. So you send that off, and then you
are able to determine I had clear margins or you
told me something when I when I came to yea.
So we can get some preliminary clues regarding the margins
from the information that we get in the operating room.
(30:56):
We get a mammogram of the piece of tissue that
was from moved itself, so that we can get an
assessment of whether or not there appears to be any
abnormalities approaching the margins. And we also do something called
a section of cavity shave margins where we basically sample
little slivers of breast tissue surrounding the lumpectomy that was removed.
(31:17):
And those strategies give us a pretty good chance of
getting those negative margins. At the same time that you
underwent the lampectomy surgery, you also needed to undergo the
sentinel lymphno biopsy, which is the operation to evaluate the
glands and the underwarm and give us more information regarding
the aggressiveness of your cancer. So you cut under my
(31:38):
arm just a sliver yes? Or how big? Yeah? So
we make an incision about that long in the underwarm
areas like yeah, probably, it basically needs to be wide
enough so that we can insert a little probe into
the underwarm area, which is a Geiger counter probe, and
the Geiger counter detects the ray EEO activity that was
(32:02):
injected into the breast from the radioactive isotope. It was
like a heat seeking missile to my lymph nodes. That's
pulled out lymph nodes, and they are what is used
to determine how if the cancer is potentially spread, right,
it gives us clues about the ability of that cancer
(32:23):
to spread. And so a cancer from the breast that's
capable of getting into those lymph nodes is a cancer
that in general will will require more aggressive medical treatments
for us to eradicate the microscopic cancer that might be
hiding in other organs. So it's the lymph node information
is a very important clue enabling us to decide whether
(32:45):
or not chemotherapy will be important in managing that patient's cancer.
You stitched me up. Actually you use surgical glue, didn't you. Yes,
All of the stitches for the that that that I
used in your case were buried underneath the skin, and
then I sealed the skin up with a special skin
adhesive asterial adhesive that's designed specifically for bringing the skin
(33:07):
edges together so that you didn't need to have any
stitches from overed afterwards. So it went pretty smoothly all
things considered, right, and it was I mean not to
make myself feel common, but it was kind of a
run of the mill breast cancer situation for this kind
of tumor, wasn't it. We do see a lot of that. Unfortunately,
with the advances of mammography screening, we do identify most
(33:31):
breast cancers at an early stage, and so most women
can take advantage of breast saving surgery and that's a
wonderful thing. That certainly wasn't always the case. But happily
this was the situation for you, Katie. It took a
few weeks to get my pathology report, and to be
honest with you, that was slightly nerve racking. I had
(33:52):
mixed feelings when the results did come in because while
my lymph noes were clear, the tumor was bigger than
expected two point five centimeters, about the size of an olive.
But luckily that didn't change my staging, which was still
one A. But there was still one more piece of
information I was waiting for the onche type is a
(34:17):
gene expression profile that basically lets us do a deeper
dive into the genetic machinery. It gives us a snapshot
of the genetic machinery of these cancers to figure out
whether it's an aggressive one or a less aggressive one,
and then that information will determine whether or not chem
a therapy should come into the picture, in addition to
(34:38):
the targeted hormonally active medications that we use for the
cancers that are estrogen receptor positive. So there was a
chance I would have to do chemotherapy and these aromatase inhibitors.
So you called me or someone called me, I can't
remember at this point and said my score was nineteens.
That was you Dr Newman and anything below. It's interesting
(35:03):
the ranges are shifting, but the let's see simplify it
by saying that some the scores go from zero to
a hundred, and some categories of the score are considered
low risk, others are intermediate risk, and the third category
is high risk. But as data evolve, the cut points
(35:25):
do change over time, and therefore our recommendations will change
over time. For you, that score of nineteen was low
enough that it was clear that chemotherapy would not be necessary.
We'll be right back. It's September seven, and it is
(36:00):
my first day of radiation. They'll be radiating my left
breast to get rid of any kind of microscopic cancerous tissue.
It sounds pretty easy, but um, I'll let you know
how it goes. Every morning I was greeted by this
fantastic team from the New York Presbyterian Wild Cornell Radiation Department.
(36:24):
So do you need to go to the bath before
we start? No, I'm good. If you ever do, just
mention my name and get a good seat. Okay, Oh,
this is apparently the checky of the radiology department. Okay,
here we go. I love them so much. They actually
made radiation weirdly fun. By the way. That's Caesar Carter. Caesar,
(36:46):
what do you do my I'm his senior radiation therapist. Here.
Oh great, and this is Tina, also a therapist. Hi everyone, good, Hi,
nice to see you, sucker. And of course the grand
fromage of the operation. I'll be set up and make
sure everything is as we expect today. Will take That
(37:08):
voice you're hearing is Dr John Ng, my radiation oncologist.
I'm just curious before I go in. Has radiation advanced
a lot in recent years? Because I've been amazed by
the technology involved in cancer treatment. Have you seen the
same amount of progress in this field, doctor Ring? Oh? Dramatic?
(37:29):
So you know, I had a colleague, Coup, recently retired
and he tells stories about when he started training, they
actually had a parakey in the room to tell you
when there was enough radiation delivered. Really this is this
sounds crazy, right, but this actually occurred. I think in
the nineteen seventies. This was how you measured radiation treatment.
(37:52):
What did the pair keep heal over? Yeah, it would
make a sound exactly really like the canary in the
coal mine sound when enough radiation that's been delivered. I
think it was around the sixties and seventies that the
doctors would usually prescribe treat until the skin peel. That
was how you prescribe your radiation dose. So we actually
(38:13):
still live with that legacy today. I think patients still
have that perception. But really, radiation technologies have improved to
a point where we can't take a CT scan and
just delineate the target where we're trying to deliver the
radiation treatment. For and so the radiation is much more
precisely delivered. Now that's exciting. All right, Well, let's do
(38:35):
this thing, kids. I did this for fifteen days. Okay,
here it is day two and my buddy Caesar is
greeting me. And for fifteen days it was always the
same setup. Go into the changing rooms, I get a
robe out, pick a locker, put my things in it
(38:58):
called my robe on, and go to the room. Greet
my jovial team. Hi, good morning. That would be me
Katie Kirk. Make sure it's actually me? And can I
have your birthday one seven nineteen? Excuse me? And what
(39:21):
part of the treat today? And pick the music I'd
listened to while I got radiation? What music? How about
Dolly Parton's greatest hits? Okay, greatest hits sounds good? Uh,
you know I'm not the biggest sorry Dolly Joline fans.
So let's start with like two doors down or something.
(39:43):
They're laughing and singing and having a party. Sure, my
radiation team was fantastic. They made the whole process not
only as painless as possible. But is it weird to
say they actually made it fun? But as I saw
(40:04):
other patients in their robes milling around. I wondered what
are they dealing with? And of course I thought about
my own family. You know, I've been thinking a lot
about Jay during this whole process, how grueling and terrifying
his treatment was, how bad his prognosis was, How you
(40:30):
don't get more real than that facing your mortality. I'm
just so lucky, you know. I was warned about the
side effects that I would feel fatigued and my skin
(40:50):
might turn pink. But besides my left breast looking like
I've been sunbathing topless, at least on that side, I
have felt pretty good. Now with radiation done, I'm moving
onto the long term stage of care, which includes a medication,
something I discussed with Dr Drossman. I'm on something called
(41:13):
an aromatase inhibitor, which I guess keeps estrogen out. What
is that doing? So your tumor was what we call
estrogen receptor positive? Does it also progesters progesteron receptor positive
and what we call here to negative. These are three
receptors that we do on all invasive cancers to kind
of create a profile. Because all breast cancers are not
(41:36):
created equal. You can have a small tumor that's highly aggressive.
You could have a large tumor that's very indolent. So
we really when we're treating patients, aside from doing lumpectomies,
we want to understand the receptors so that after the
surgery we can treat them appropriately. You wouldn't want to
treat somebody with an anti estrogen if their tumor was
(41:57):
estrogen receptor negative, it does nothing. So for you, your
tumor was estrogen receptor positive, so you can be treated
with an oral agent, something called an aromatas inhibitor, which
acts to kind of suppress that estrogen. But I like,
I know you do, but we're gonna have to do
something else for you because estrogen, I don't know, it
(42:19):
keeps you feeling young, it's good for your face. We're
going to get your right. But I'm going to take
that every day for five years, and you will tolerate
it well. Majority of people really tolerate it very well.
The other thing that you're going to be doing is
that for the first two years, we're going to be
(42:40):
seeing you every six months for a mammogram on the
involved side and a breast ultrasound on the involved side,
because we want to follow that and make sure that
you're healing well and that there's nothing going on at
that site. So the involved side gets followed every six
months for the first two years. The uninvolved side is
(43:01):
still on a yearly basis. So we're going to be
a lot more of each other for sure. For sure,
what is your message to women? Because this is why
I wanted to quote unquote go public with this. I
really want women to be educated to obviously get screened.
(43:22):
But what would you say to people listening to this conversation?
So I think it's really important to be your own advocate,
to understand your personal history, your genetic predisposition, the density
of your breasts, to understand so that when you walk
into a physician's office, you can advocate for yourself if
ultrasound is not offered to you and you have dense breasts.
(43:45):
You know, I hope that this podcast really allows people
to understand the importance of breast ultrasound in terms of
evaluating tissue that is dense and understanding what your own
risk factors are. Well, hopefully we'll save some lives here
to make a difference. I think that's really important and
I admire you for going public on this, Katie. Well,
(44:08):
I mean I've shown the world my calling, why not
my breast, that's for sure. One thing I think that's
been really valuable is our mom has always taken care
of us, um, you know, when we've been sick. UM.
For me, the most seriously I've ever been sick was
(44:30):
having a kidney infection when I was in high school
that was pretty serious, or randomly last year I was
in the hospital, but it was just strapped throat that
got really bad. But she's just always there and communicating
with the doctors, getting the things we need, and just
being such a source of comfort and reassurance. Like I
(44:53):
would never I wouldn't want to be sick with anybody
else taking care of me, but my mom so to
be taken care of her. UM. In the aftermath of
her surgery, or you know, the day the lead up
to it, I slept over. I went with her to
the hospital. During the surgery itself, I took a nap,
(45:13):
and then the doctor called me to come downstairs her
wake up from the anesthesia and taking her home, and
I don't know, it was it was sort of a
humbling experience, and Um, I don't know one that was
really meaningful to me, but also made me sad and
(45:34):
nostalgic in some ways because it made me think of, oh,
is this what it's going to be like as mom
gets older? And you know that's part of life, um
that we reverse roles um in terms of taking care
of our parents. But that was mostly what I got
out of it, just I guess renewed appreciation for all
(45:59):
the time she's taken in care of me. I think
for me because I wasn't there for the diagnosis or
the surgery um and connected with her in August when
she you know, had a scar but um was healing. Uh.
To me, it really just reaffirmed that her mom is
(46:20):
like a superhuman and so strong and uh still has
boundless energy and can't sit still. I kept being like,
why don't you watch Ship's Creek or just hang out?
And you know, I think she was a little a
little bored. But it's all a small price to pay,
this whole deal. Even at my young age, you know,
(46:42):
I am predisposed to colon cancer. It was a good
reminder that I need to get on top of it
and everyone should and everyone really should prioritize their health,
and it's not always easy because you have work and
sometimes it's just hard to navigate with healthcare. I think, um,
but I really think people have to advocate for themselves
(47:06):
and you have to look out for yourself and educate
yourself as much as possible. I think those are the
things that we can do as as informed patients when
we come back, some critically important takeaways from this experience,
and I'll introduce you to a warrior, a breast cancer
survivor who's already changing the system. That's right after this.
(47:39):
I'm sharing my breast cancer story because I love a
good teachable moment, and this, in fact could be a
life saving one for the women out there listening, and
for all of you who love them, please please go
get your annual mammogram, but even more importantly, find out
if you need additional screen. Nearly half of all women
(48:02):
have dense breasts, which can make it difficult for mammograms
alone to detect abnormalities, and only thirty eight states require
doctors to notify their patients if they have dense breasts,
and even that mandated information often isn't enough. There's a
little verbal uh, some verbiage in a pamphlet that we
(48:24):
hand to patients that says, your breast tissue is dense,
you may benefit from an ultrasound or another modality other
than mammography. But I think in many practices, when patients here, oh,
my mammogram is fine, they assume my breasts are fine,
and they walk out the door and neither their physician
nor themselves think about having anything additional. And you know,
(48:47):
you hear the story all the time. I went from
my mammogram, they told me everything was fine, and two
weeks later I felt a lump and I had a
breast cancer. How can that be? And the answer is, really,
when you have dense bress, mammography doesn't do the whole job.
And if your facility is not offering it and you
do have dense breass, I think you need to advocate
for yourself. And here's another thing that really makes me mad.
(49:11):
Only fourteen states in Washington, d C. Require insurance companies
to fully or partially cover secondary screenings like breast ultrasounds.
I think it's disgraceful, to be honest with you, and
I think that it really is very poor medicine, and
it doesn't really make sense because if we have the
ability to find more breast cancers with a tool that
(49:33):
has absolutely no radiation and is relatively easy to use.
I don't really understand. You know, this is really a
has been a discussion round and round and round among
breast imagers and state you know, state legislatures. She said,
it's an injustice. I said, well, I said that we've
(49:54):
got to change the law. Michelle Young is intimately familiar
with this injustice that the health care you receive really
depends on where you live. Michelle's a lawyer and a
mother of five, and she lives in Cincinnati. Ohio was
one of the states that didn't require doctors to notify
their patients about the risks of having dense breasts. It
(50:17):
also didn't mandate any kind of insurance coverage for additional screening,
and in Michelle came face to face with the dire
consequences of not having those requirements in place. Dr Lee
Slower calls me, who's the head of sinsating breast cancer.
She said, your stage four, Michelle, And he said, are
(50:37):
we talking palliative? And I said I'm too young, And
she said, well it can extend your life. My internet,
of course, told me do my bucket list, as did others.
And I said, Dr Laur, how did this happen to me?
(50:58):
And she said it happened all the time, sometimes every day.
You have dense breast and mamograms don't catch cancer undense breast.
It shouldn't happen to any woman. If the technology is there,
and it is it's affordable. We have short him our eyes,
we have ultrasounds. The question of whether I would live
(51:18):
or die was a question of geography, whether I was
in the right state with a or for this. So
that day we mean two vows. One vow was that
we were going to change the law, and the second
I asked her as they said, Dr Laur, can we
go for me to live? I really am not that type.
(51:41):
I want to try. And while there was a I
was definitely meta static. I had it in um over
twenty notes. It had spread to my right hip, my spine,
my left arm, and I said, Okay, even if I
(52:02):
have a very short lifespan according to most people, let's
go for it. And Dr Laur agreed, And that was lucky.
While you were being treated, you decided something needed to
be done about this. Women like you needed to understand
that additional screening is necessary, and not just for extremely
(52:26):
dense breass, for just dense breasts in general, because there
are four categories of dense breass A, B, C, and D.
D is very dense, but C is pretty damn dense. Yes,
it is. So what did you do? How did you
approach this and how did you get the law changed?
In Ohio? I went to Dr Lisa, my doctor in Ohio,
(52:47):
and I said, we gave each other our word, we
have to do this, and we don't know what's going
to happen. Because the chances of me being in long
term remission, which to me is three years, really slim.
We have to move fast. So she and I gathered
together Dr Mahoney, who's the head of the American Mediology,
and we also brought together Dr Andy Brown, who you
(53:09):
would love. Said, you see, they're both that you see.
I brought in two legislators. One was Jeane Schmidt, who
was a congresswoman who is a conservative Republican, and Cedric
Denson was an African American progressive Democrat, and these two
offered to be the authors and to keep it going
even if I was not here, and we met bi
(53:31):
weekly to put together what we thought was dream legislation.
We vetted it with Commerce, with conservatives, but just about everybody,
all the hospitals before we brought it forth. So we
had everything vetted by the Chamber of Commerce, which is
really important in advance, and no one testified against it.
(53:55):
We passed it in the House with only one vote
against it, and then it was sitting there for months
and months in the Senate. Ohio. It was a very
divided state, and I saw it wasn't passing yet, it
wasn't being put on the schedule, and it has to
be put on the agenda and past. So I went
(54:20):
to Columbus actually wearing this outfit or similar outfits, pink
outfits with pink carnations, and knocked on the doors of
every senator to talk to them about what we needed.
What I found out when I knocked on the doors
is every time I knocked on a door, Republican or not,
(54:40):
there was someone who had experienced breast cancer. And I
knew we were succeeding. I I went to the governor
at an event and said, I need to talk to you. Yes,
and but so as you see, so is my doctor
Andy Brown, so are others and we had the ole
(55:01):
stayed with us at that point, but the question was
how do we get on the agenda? And I didn't
know what was holding us up. So I kept on
going with my little carnations. And I knew we were
safe when the head of the Senate invited me over
and we were only two weeks before the end, three
weeks before the end, and I said, as a session.
(55:23):
And I said, well, according to Jane Schmidt, congress you know,
former Congressman. I said, it looks like we could get
this done in twenty four hours if we try, like
in a one day massive session. We're in the morning,
we passed the committee, we go to the Senate vote,
then we go back to the committee to reconcile the bills.
(55:43):
If we go back to the House, we then vote
again and then be passed by the evening. And I said,
who we do this? And he said absolutely so. And
one day, between seven o'clock in the morning and seven
o'clock in the evening, it was passed. Take me back
to the day the legislation passed and it became law.
(56:07):
It was a lovely day because in this divided nation,
and I was a two thousand sixteen candidate, Democratic endorsed
candidate for Congress. I have work to elect woman to
office for years. I was heartbroken over all our divisions
(56:31):
and the way nothing ever moves forward. And I had
never seen or had the opportunity to be there and
see a bill passed. And there I was very far
off in the I guess they called the galleys, and
each time I was applauded, and I thought, the first bill,
(56:56):
the only bill I may ever pass, is actually from
the galleys as a state for survivor never as a legislator.
But there was this beautiful moment where everything I dreamed
of came together, which is that everyone cared only about
doing the right thing. That it was. We were no
longer Republicans or Democrats, or men or woman. We just
(57:19):
wanted to see that we fixed a problem and save lives.
And I was so grateful for that moment to see
that and to see my friends, I mean Jean and
said on opposite sides of the aisle, both of them
(57:41):
in this beautiful moment together feeling they've done something great
for everyone. All I had suffered. I'm just someone who
wanted to do something good, and I finally did so
I felt it was like a girl's gut getting her badge. Okay,
I did something good. It was the way I wanted
(58:02):
to do it, which is and and that we all
were happy we did it. So I was just pleased
that it worked out and that we overcame the odds.
So I guess I just felt that day that a
chapter was closing, and thank God that I had resolved
(58:23):
this and with decency, and that you're healthy and for
the moment, for the moment fingers crossed, and that you
will ensure that hundreds, maybe thousands of women will be healthy.
Before we talk about the impact, tell me specifically, in
(58:43):
kind of simple terms, if you could, Michelle, what does
this new law actually say and do well? This law,
what it says and does, which makes it different is
that women were not allowed before to get mamograms except
every two years according to their age, and now it's
every year every age, which means if you're under forty
(59:07):
you would find it too late. And we have so
many deaths for a woman under forty, but it was
considered statistically not as important. So when we're allowed to
die and not be detected, that won't happen anymore. Because
every woman has a right for a mammogram, and every
mammogram if in the judgment of the radiologist, not the
(59:30):
insurance company, not anyone else. If the radiologists can't see
clearly or says you have dense breasts, she can go
or any other conditions, she can get the right screening
technology to check on you. And we never had that
right before. And that's huge because it means if we
(59:51):
could catch every cancer early, that's nine nine out of
a hundred cancers will likely not come back. Then then
the third thing we did is we change uch the
gobbledy book on the language. It is really clear English. Now, hey,
you've got dense pressed, you've got a problem, and you
know what You've better talk to your doctor and you
can ask for additional testing. It is clear as a bell.
(01:00:14):
Not only can you ask for additional testing, your insurance
company is obligated to pay for it. Yes, yes, And
that is the point. Your insurance company is obligated to
pay for it because for some women they might even
be told that. But an ultrasound abreast ultrasound is four
hundred dollars and m r S four thousand dollars. I
(01:00:35):
mean a lot of women a don't know and be
even when they find out, Michelle, they can't afford it. No,
and and and you were right, And that is why
this was so important to us. I mean this was
critical because in most states in the nation they say
to you, hey, I think we need an extra test.
We couldn't really tell, and then you say how much
is it? And then you don't do it? And African
(01:00:59):
American woman and have such a higher death rate it's astronomical.
It's about income and access and access. And what we
did now is try to make access as universal as
possible for all women. That does not mean it's still
(01:01:21):
the issue of the deductible we have to take on next.
But yeah, I would say what this did, hopefully we'll
save thousands of lives within the first year of it
being enacted. I'm so impressed by what you've done, and
I hope you don't stop. And whatever we can do
(01:01:43):
to inform women and get laws changed everywhere, um, the better. Well,
I need your help on this. Every woman should have
a right. It is a grotesque injustice to all women
and by the way, their husbands and their children and
(01:02:05):
everyone in their life that they could be gone because
we didn't care enough. I saved the colin's why can't
I save the breasts? Wouldn't that be the most wonderful
thing on earth to do? This October? We could do it,
all right, Let's do it. The bill that Michelle shepherded
through the Ohio State Legislature officially went into effect in September,
(01:02:31):
almost four years from Michelle's cancer diagnosis. Michelle Young is
currently in remission. Before we go, I want to give
my daughters a special shout out. Thank you Ellien Carey
for being part of this podcast, and of course to
(01:02:52):
my incredible doctors for taking the time out of their
very busy schedules, busy saving lives to join me for
this episode. I'll have much more information not only about
my journey, but really important information about secondary screenings, the
risk of dense breast and all kinds of information about
(01:03:13):
breast cancer in general, for the entire month of October
on my website. Just go to Katie correct dot com
for more. Next Question with Kati Kurik is a production
of I Heart Media and Katie Curic Media. The executive
producers Army Katie Curic and Courtney Litz. The supervising producer
(01:03:37):
is Lauren Hansen. Associate producers Derek Clements and Adriana Fasio.
The show is edited and mixed by Derrick Clements. For
more information about today's episode, or to sign up for
my morning newsletter, Wake Up Paul, go to Katie currect
dot com. You can also find me at Katie Currik
on Instagram and all my social media channels. For more
(01:03:58):
podcasts from My heart Radio, visit the I Heart Radio app,
Apple Podcast, or wherever you listen to your favorite shows.
H
Hi everyone, I'm Katie Current and this is next Question. Today.
I'm going to tell you a very personal story. The
first thing you should know, though, is that I am vigilant,
even neurotic about taking care of my health and encouraging
others to do the same. I think it's because I
lost my husband Jay to metastatic colon cancer back in
(00:23):
n when he was just forty two years old. At
the time, I was an anchor on The Today Show.
Many of you know that I lost my husband, Jay Monahan,
my loving and beloved husband, last month after createst battle
with colon cancer. Words, of course, will never describe how
devastating this loss has been for me and my daughters
and all of Jay's family as well. But the heartfelt
(00:45):
and compassionate letters and cards that so many of you
sent to me were enormously comforting, and I'm so grateful.
After Jay died, I wanted to share everything I had
learned about this terrible disease. I also wanted to help
people understand there are ways to prevent it, to detect
it early, and that's by getting a colonoscopy, which I
(01:08):
did on National TV. Put the scope and yet did okay,
good that's a good guy. A few years later, I
even got Jimmy Kimmel to get screened. Katie asked me
if she could accompany me for my first colonoscopy. You
know you have to have that when you turned fifty,
and it seemed to be an unusual request, but I
(01:30):
know this is something piteous passionate about, and um, it's
an important thing to do. So with that said, we're
about to watch a camera go where no camera has
ever gone before. All of this is to say that
even I, the cancer screening Queen, missed a cancer screening
appointment because of the pandemic, I was six months overdue
(01:53):
for a mammogram. I'm sure I'm not the only one
who fell into the COVID time warp. So I decided
to turn my own misstep into an upclose and personal opportunity. Okay,
here is the machine as well as a teachable moment,
and this is where my breast will be placed. Since
(02:16):
I started getting screened, my annual breast exam has been
a two step process because I, like women over the
age of forty, have dense breasts. So in addition to
getting a mammogram and now a three D mammogram, which
is superior to the standard kind. I also get a
breast ultrasound. My longtime breast radiologist, Dr Susan Drossman has
(02:42):
been the one doing those exams and analyzing the results
for years. So momography, wall it is the gold standard,
does not do the whole job in terms of saying
that your breasts are normal. Momography is excellent at looking
at calcifications and what we call architectural distortion. Those are
both the ways that certain breast cancers can manifest themselves.
(03:06):
But when the breast tissue is dense, mammography does a
very poor job of looking at masses. I think the
best analogy I can give you is if you're looking
for a snowball in a field of snow. The conspicuity
of finding a snowball in a background of snow is
going to be very difficult. So if you're looking for
a mass, which by definition is dense because the cells
(03:28):
are rapidly multiplying, and you're looking for that in a
background a very dense tissue, it's almost going to be
impossible to find on a mammogram. So breast ultrasound uses
sound waves, so the way that you look at the
tissue is very different, so ultrasound is really an excellent
tool for looking at masses and cysts. It was June
(03:49):
twenty the day of my appointment. I handed my phone
to a technician and asked her to film me better
than Spain. Okay, so you had your mammogram and really
all looked pretty stable. On the mammogram, there was one
area where the tissue looked a little bit more distorted
(04:12):
than in the past. Go back to ultrasound. And we
went into ultrasound and I and I had in my
head this particular area that I really wanted to look at,
and you and I were chit chatting. Breast get bigger
after menopause, so there's definitely a redistribution of body weight
after menopause. And when I got to that area, I
(04:34):
knew that there was something here that bothered me because
on ultrasound what I saw was a mass. So we
were chit chatting, and I think I remember saying to you, Katie,
there's something here that worries me, you know, And you
asked us to turn off the camera because we were
recording this to use to remind women to get screened.
(04:58):
That is true, and I looked at you, and I
looked at the person who is imaging us, and I said,
I could stop for a second. I think we really
need to turn the camera off. I want to speak frankly.
And you said, no, no, we can keep going. And
I said, no, turn that camera off. And you know,
I've been doing this for a long time, so I
(05:19):
do know what my thresholds are, and I was concerned
about it. Obviously. Until we get tissue from it, you
never know for sure. And the only way to get
tissue from the breast is with a biopsy, which Dr
Drossman did the very same day. And you said to me, oh,
I have a bit. I have this I have to
go to, and I have this I have to go to,
(05:39):
and uh, you know, I'm very busy, and of course
I know you're very busy, but I knew what this
was going to be, and I said, I want to
do this today, stay till the end of the day,
and we'll make it happen. And we did. In order
to perform a breast biopsy, a very small incision is
made into a numbed breast using a tiny instrument. The
(06:02):
doctor reaches into the area of concern and pulls out
several pieces of breast tissue. Dr Drossman assured me each
one was minuscule. It's probably about twenty three millimeters long
and about three millimeters wide. So like, compare that to something,
because I'm bad at that. So it's like like a
little worm, like a like a little baby worm, a
(06:25):
little baby worm. Um. And I take multiple samples. We
usually take about five samples, because when you are doing
these biopsies, it's all about sampling. So you want to
show the pathologists what's happening here. So I take some
tissue from the top, from the middle, from the bottom,
and that gets put in a little jar of formula
in and gets sent to the pathology lab. Just twenty
(06:48):
four hours later, Dr Drossman called my cell the mailbox
is full and cannot accept any messages at this time. Goodbye. Yeah, yeah, yeah,
my mailbox is always full. So she resorted to text,
please call me in the office to discuss biopsy results.
(07:08):
So I called you back, and do you remember what
you said? I probably said, do you have a few
minutes to talk. I'll share those results right after the
break when you got the pathology report back for me.
(07:37):
I'm just curious because we've known each other for a
long time, and you know what I've had to deal
with with my husband and my sister. Yes, yes, so
I have to say, you know, I've been doing this
for a long time, and I kind of knew what
it was going to be, So it didn't surprise me
in terms of what the pathology was. But I knew
(07:59):
it was going to be hard for me to tell you,
and hard for me to tell you because I know
what you've gone through in your life. So when I
got that pathology, I said to myself, oh my goodness,
how am I going to say this, which is really
always what I say to myself when I have to
confront somebody with this news. But you know, we have
known each other for a long time, and it's always hard.
(08:22):
It's hard for me every single time I do it.
So I called you back and do you remember what
you said? I probably said, do you have a few
minutes to talk? You know, I try to when I
am worried about something, give people at least a a
premonition that I am going to call and it may
(08:43):
not be great news. And I try to not spring
things on people because I'm the one who calls, you know,
and I think probably what I said it is it's
a small breast cancer. It's totally treatable, but we need
to make a plan. And do you remember what I said?
You probably said, am I going to be okay? Or
(09:05):
or ship ship? Or I gotta go to the handles
that I'm going to Aspen tomorrow. And I have a
lot of things I need to do and can I
still do them? And the answer is yes, but we
need to address this. I was going to visit John's
parents and I was going to a wedding in Aspen,
and I was both shocked and yet not shocked because
(09:26):
I've had so much cancer in my life. I think
a lot of people think, well, if one out of
two men and one out of three women are diagnosed
in their lifetimes, you know there's a good chance that
many of us will be in this position. Well, the
numbers are high, the numbers for breast cancer. A one
in eight women will be diagnosed with a breast cancer
(09:49):
in their lifetime. Those are significant numbers, and that's why
screening is so important. Cancer it's a pretty scary six
letter word. Despite all the strides that have been made,
It's a word that's been part of my world for
much of my adult life, but breast cancer. Breast cancer
(10:10):
was new. No one in my family had even had
breast cancer, and I always thought family history was such
an important factor. So I will tell you the thing
that bothers me the most when patients come in and
they say, oh, I have no family history, I don't
even know quite why I'm here, or I think I
could come every other year because I have no family history.
I think what people need to know is that percent
(10:33):
of breast cancers are sporadic events, things that are unplanned.
I don't know, bad luck. I really can't answer why.
But you know, there is no family history with of
breast cancer. So the small percentage are the ones with
a family history or genetic predisposition. So the majority of
things that we find are in patients that you know
(10:54):
are walk in thinking, you know their day is going
to continue as it always does, and you know, unfortunately,
I think that as we get older, as we talk
to more women, we realize how our lives can change
in a second. Less than twenty four hours later, I
was sitting across from a new and critically important member
of my medical team. My name is doctor Lisa Newman.
(11:18):
I am a surgical breast oncologist and chief of breast
surgery for Wild Cornell Medicine and the New York Presbyterian
Hospital Network. And what did you say to me? And
what do you say to most patients? Do you remember
that day? Well, the first thing that I had to
do was to um take a deep breath and bring
(11:39):
myself down to earth, because to me, you are just
a superstar, magnificent individual. All that you've done in your
career and all that you've done for cancer research. I
was obviously star struck, But the first thing that I
had to do after bringing myself back down to earth
was to understand that meeting you as an individual meant
that I did have to fulfill my responsibility to you
(12:02):
as a physician and make sure that I addressed all
of the same concerns that you were going to have
as a newly diagnosed woman with breast cancer that every
other woman with breast cancer has to deal with, the fear,
the unknown, the uncertainty about the future. A cancer diagnosis
(12:22):
of any type is horrific in life changing, and a
breast cancer diagnosis in particular for a woman, is a
very personal very difficult diagnosis to here. I remember telling you,
Katie number one, you were facing an excellent prognosis and
excellent outcome as long as you complied with appropriate treatment,
(12:45):
you had every reason to be expecting that this cancer
was going to be treated successfully. And this is the
case for most women with breast cancer. Fortunately, number two,
I wanted to make sure you understood that you are
not racing the clock. We know a lot about the
biology of breast cancer, and most women should be confident
in the fact that the cancer is not spreading through
(13:06):
their breast by the day, nor is the cancer spreading
through their body by the day, and so it is
very important that women take the time to understand their
treatment options and their diagnosis before they jump into any
treatment plan prematurely. Now, this doesn't mean that we want
women to delay getting their breast cancer taken care of,
but it does mean that they have a few weeks,
(13:28):
you know, four weeks, six weeks to make sure that
they understand what their options are. After we discussed those
two important messages, it wasn't very important for you to
understand that you had treatment options because your cancer was
detected at an early stage. The first step in your
treatment was going to be surgery, and the goals of
(13:50):
the surgery were to take care of the disease in
your breast as well as to get more information regarding
the stage or the aggressiveness of the cancer. And then
those surgical findings would drive the other types of treatments
that you were going to require, such as radiation needs,
such as possible chemotherapy, taking special cancer fighting pills. The
(14:10):
surgical information would inform all of those decisions. The initial
surgical options that you had included having breast saving surgery,
which involves doing a lumpect to me to focus on
removing just the cancerous area that led to the biopsy
on the diagnosis, and then following a lumpectomy, radiation would
(14:30):
be delivered to the breast, and radiation treatments after a
lumpectomy are very targeted X ray beams going right at
the breast itself, and these radiation beams are designed to
kill the microscopic cancer cells that are hiding in the
normal appearing breast tissue. The alternative surgical plan is mistectomy surgery,
where we completely removed the breast, and when we completely
(14:53):
remove the breast, we're taking care of removing the cancer
identified lump as well as the mic roscopic cancer cells
hiding in the normal appearing breast tissue simply in one
fell swoop with that mstectomy surgery. I remember you telling
me Dr Newman that the outcomes were the same formystectomy
and lump ectomy with radiation and medication. And I thought, well,
(15:18):
if that's the case, I would prefer to have a
lump ectomy. But I also didn't have some of these other,
you know, extenuating circumstances with b R c A or
any of these things, so I felt very comfortable getting
a lumpectomy. And a lumpectomy was extremely appropriate for you
(15:40):
because you did catch your cancer at an early stage.
In fact, it was stage one A. What does that mean?
So stage one A clinically based upon what you're seeing
on examining the patient and what you're seeing on looking
at the mamogram ultrasound pictures, and based upon those characteristics,
those microscopic markers as drigen receptor, progesterone receptor, her too
(16:01):
new and the appearance of the individual cancer cells of
the great what we call the great of the cancer.
All of those things were favorable in your situation, and
that goes along with the stage one breast cancer. Stage
one A is the better category of stage one as
compared to Stage one B, and this is another example
of where we've made advances and understanding breast cancer and
(16:24):
characterizing it much more precisely. In the past, we only
characterize breast cancers by their size and by the limph
note status and by whether or not you saw any
evidence of cancer hiding in other organs of the body
metastatic disease, for example, in the liver, lungs, bones. Today
we are much more precise about the staging because we
(16:46):
understand that these markers that we evaluate are so critically
important in understanding the aggressiveness or the likelihood that the
cancer will ever be a life threatening one, and so
in addition to looking at the size and lymph notes,
we also look at the presence or absence of those
different markers and that will also impact upon the stage
(17:07):
of the cancer. All things considered, I was I am lucky.
My cancer is highly treatable and thanks to Dr Newman,
I had a better understanding of my prognosis and a
treatment plan in place. Surgery was scheduled for July, a
little more than three weeks away. Now, I just had
(17:30):
to share the news. Ellie, why don't you say my
name is Ellie Monahan and I'm Katie's daughter, and then
carry you stay at the same okay, with two very
important people. My name is Ellie Monahan and I'm Katie's daughter,
And my name is Carrie Monahan and I'm Katie's other daughter.
(17:51):
It's not unusual for her to call and text me
a lot. Um, I've gotten better, but I used to
be really uh, sort of unrespond in site to her,
especially when I was in college. But no, it's not
unusual for her to call or FaceTime out of the blue.
We talk all the time throughout the day. But I
noticed when I woke up in the morning I had
(18:13):
a miscall and that she was saying, please call me.
And she does that all the time. Um, it could
be for something totally random and unimportant, but that she
wants to ask me about or something. UM. I remember
I had just woken up and we faced time, and
(18:35):
you know, she told me and it was scary. Um,
she told me that everything was going to be fine.
I think she prefaced it that way, and I felt worried,
but also I think she understood from the get go
that she had access to amazing doctors, that it was
super early, and that she in all likelihood was gonna
(19:01):
be okay. Um. She told me we weren't going to
be able to go on this trip that um, she
and I had planned UM understandably because that was going
to be when the surgery was. And she said, don't
tell Ellie because I'm going to tell her. UM. And
(19:21):
then I guess she then told Ellie. Yeah, so I
found out. I guess she was diagnosed on June one,
which it feels like I think was a Tuesday. And
I'm sort of I'm sort of different than Carrie. I
historically have been very anxious and always in constant communication
(19:43):
with my mom, and I've only learned in the past
few years to like give it arrest a little bit. Um.
You know, I always had her on speed dial, and
I still talked to her all the time, but um,
it used to be every day and now it's, you know,
a couple of times a week, and that's healthy because
(20:04):
I'm thirty one years old and I'm married. Um. And anyway,
so you know, we hadn't been talking that much, especially
because in June I had three weddings and was traveling
back and forth from l A, where I lived, to
the East Coast where these weddings were. I did not
(20:24):
plan my travel well and I remember, UM, I took
a red eye to New Jersey to go to my
my husband's cousin's wedding, and it was the day Roe V.
Wade was overturned. So that Friday, I think the four
of June. I want to say, so, UM already was
(20:45):
very emotionally drained. And that was the same day I
finally got in touch with Mom and she told me,
you know, that she she had been diagnosed with breast cancer,
but it was very early stages, and she, you know,
like Harry, she prefaced it and said, I don't want
you to worry. UM, it's very early stages. It's it's small.
(21:08):
So I think I was. I was really drained and
almost numb when I heard the news, and I obviously
was very upset. UM. So I wasn't numb. I just
mean I felt not myself already to begin with, UM,
So I was really upset. I would say. There were
(21:28):
certain trigger words used like obviously cancer, UM and radiation
was hard to hear. Even the mention of chemotherapy. You know, uh,
imagining mom losing her hair or you know, or going
through chemo, which I think can be really harsh on
your system. Um. That was really scary to me, sadly though,
(21:51):
because when our father was diagnosed with cancer, he had
stage four you know, hearing it's you know, stage point
five or one was very reassuring. UM. But I knew
we were gonna, you know, get more information as it came,
(22:11):
and that she has amazing doctors, and she was so
calm about it. So I was really comforted by that
after the initial shock of you know, hearing the C word,
and I think she was you know, protecting us, which
was really nice in her time of need to. You know,
that's a real mom move. And I think my brain
(22:31):
just could not go to a place where she wasn't
going to be okay, having lost our other our father,
another parent, so I just couldn't really go there. I'm
not really being clear. I was going. I was all
over the place, But yeah, I think you called me
and I was just like, it's gonna be okay, It's
(22:53):
gonna be okay, because I really I don't want to
minimize the experience or that it was scary, because it was,
but I think because of the way our mom set
the tone, and she's not somebody who would say it's
going to be okay if it's not, so I don't know.
I think Ellie was very, very overwhelmed. I think the
(23:17):
reason for Ellie and my desperate reactions to the news
also has to do with the fact that I was
basically an infant and Ellie was six years old at
the time our dad was sick, so I have no
memory of it, and I think being that close to
(23:41):
cancer UM that ultimately resulted in death when she was
that young UM made the experience much more visceral for her. UM.
I think Ellie, you're recently sharing with me kind of
your memory of being very freaked out by a mannequin
(24:01):
head that had one of our dad's wigs on it, UM,
and just lots of other memories like that that I
don't have. So I think that is part of it
for Ellie and why it's different for me. Yeah, you know,
I have been learning a lot about myself through therapy
(24:23):
over gosh the past four years, and UM, like the
planet these days, I have anxiety and I think a
lot of it is rooted to the fact that, you know,
we were living this wonderful life and everything was great
and until it wasn't. And I'm constantly, you know, trying
(24:47):
to anticipate or look out for the next you know,
the next catastrophe, the next catastrophy. Um. And you know,
I think that I've done so much work understanding that
that I wasn't. You know, It's like I was definitely triggered,
(25:07):
but I was aware and understood. I was aware of
and understood that trigger, so I could kind of deal
with it more and not let it consume me so
much emotionally. Um. It's funny to me that, you know,
the old me would say, I can't believe that, you know,
(25:28):
that month in June that you weren't calling your mom
every day. Look what happened as a result. You know.
But I think I know now that life is going
to throw you obstacles and you just have to do
the best you can and you can't anticipate them. And
calling your mom every day, moving back to the same
city where she lives, you know, that's not going to
(25:50):
change anything. My Dad's assured me that if I followed
the appropriate protocol, I had every reason to expect the
cancer would be treated successfully. So the first step was surgery.
(26:11):
So my job on the morning of your surgery is
to make a path um Usually I call it a
GPS for the surgeons. It was scheduled for July four tea,
and I began the day with a stop at Dr
Drossman's office. It's not just taking out the tumor. It's
getting a good margin around the tumor and also making
it cosmetically pleasing, because if you're doing a lumpectomy, the
(26:35):
whole purpose is to remove that tumor preserve the rest
of the breast with a good cosmetic appearance. So we
did that on the morning of the surgery. You came
in early in the morning. Again, I used ultrasound to
guide us. I cleaned the skin um with Beta dign
same as before, gave you local and then put a
very skinny little wire almost it's like a little horsetail hair.
It's very very thin and flexible. It goes right into
(26:58):
the tumor and marks the site. And then we taped
it to your skin and you went to go see
Dr Newman. First. I was prepped for surgery Hieron. This
is Aaron, she is helping me. Aaron, what is your
job here at your hospital? I am here in the
breast surgery service. Here's the sitch, had a wire put
(27:19):
in my boob, which is basically providing guidance for the
surgeon because I have a little lump situation. And then
I was wheeled into the surgical suite where I was
given a nice dose of profo fall and drifted off.
I remember very distinctly you going to sleep and going
(27:39):
to sleep in you with your type of surgery, simply mensedation.
You did not need to be under general anesthesia for
this type of operation, for this type of surgery. But
I'm happy to report I didn't feel anything, which is
the way it's supposed to be. Thank Goodness for that,
so we can do these operations under local anesthesia and sedation.
But as you were falling asleep, I remember just being
even more amazed by you and even more star struck,
(28:03):
because you were talking about how you wanted to help
other women, and you went to sleep talking about how
you wanted to make sure that other women could take
advantage of all the advances that exist out there for
breast cancer, and you were talking about how privileged you felt.
It's it. It was so hard warming to see somebody
(28:23):
as amazing as you still thinking about others as you
were going under anesthesia. Will make sure this isn't edited
out of the podcast. But kidding, but so amazing. But
how did you go in? And actually I mean you
cut around? Well you tell me so it. While we
want to prioritize taking care of the cancer, it is
(28:45):
also important to make sure that you project into the
future and try to keep the patients looking as whole
and as herself as possible. So for breast cancer, that's
quite important, and it doesn't mean that we need to
be respect full and thoughtful about where we plan our
incision sites. For many women, it can be helpful to
(29:06):
bring in um their favorite brazier or bathing suit top
so that we can make sure that we get an
idea of where their tan line is located, so that that
we can keep the incision out of the way if
they were wearing a sif they were showing off some cleavage.
So in your case, we had the very nice option
of making the incision at what we call the peri
(29:27):
aiolar edge, so that I made the incision at the
site where the skin color changes at the areolar edge
so that the incision could be camouflaged by that normal
change in skin coll And you made sort of a
half moon incision, didn't you? Around my areola. We're getting
very up close and personally are people And then okay,
I'm gonna use earm ups. But then what did you do?
(29:49):
Because I'm a little squeamish, but go ahead. So through
that half moon incision at your areolar edge, I was
then able to dissect down following that guide wire to
get to the location of the tumor and basically carve
out a wedge of breast tissue surrounding that wire. And
(30:11):
in the middle of that wedge of breast tissue your
tumor was located. And that's the piece of tissue that
gets sent to the pathology laboratory for analysis. So do
you send the whole the whole thing, or does somebody
there who kind of cut sitters at the pathologist who's
sort of slicing pieces of my tumor. The pathologist does
that actual processing, and you're pretty busy operating table. You
(30:35):
can't be like, stand by, I'm going to slice her
tumor now. So you send that off, and then you
are able to determine I had clear margins or you
told me something when I when I came to yea.
So we can get some preliminary clues regarding the margins
from the information that we get in the operating room.
(30:56):
We get a mammogram of the piece of tissue that
was from moved itself, so that we can get an
assessment of whether or not there appears to be any
abnormalities approaching the margins. And we also do something called
a section of cavity shave margins where we basically sample
little slivers of breast tissue surrounding the lumpectomy that was removed.
(31:17):
And those strategies give us a pretty good chance of
getting those negative margins. At the same time that you
underwent the lampectomy surgery, you also needed to undergo the
sentinel lymphno biopsy, which is the operation to evaluate the
glands and the underwarm and give us more information regarding
the aggressiveness of your cancer. So you cut under my
(31:38):
arm just a sliver yes? Or how big? Yeah? So
we make an incision about that long in the underwarm
areas like yeah, probably, it basically needs to be wide
enough so that we can insert a little probe into
the underwarm area, which is a Geiger counter probe, and
the Geiger counter detects the ray EEO activity that was
(32:02):
injected into the breast from the radioactive isotope. It was
like a heat seeking missile to my lymph nodes. That's
pulled out lymph nodes, and they are what is used
to determine how if the cancer is potentially spread, right,
it gives us clues about the ability of that cancer
(32:23):
to spread. And so a cancer from the breast that's
capable of getting into those lymph nodes is a cancer
that in general will will require more aggressive medical treatments
for us to eradicate the microscopic cancer that might be
hiding in other organs. So it's the lymph node information
is a very important clue enabling us to decide whether
(32:45):
or not chemotherapy will be important in managing that patient's cancer.
You stitched me up. Actually you use surgical glue, didn't you. Yes,
All of the stitches for the that that that I
used in your case were buried underneath the skin, and
then I sealed the skin up with a special skin
adhesive asterial adhesive that's designed specifically for bringing the skin
(33:07):
edges together so that you didn't need to have any
stitches from overed afterwards. So it went pretty smoothly all
things considered, right, and it was I mean not to
make myself feel common, but it was kind of a
run of the mill breast cancer situation for this kind
of tumor, wasn't it. We do see a lot of that. Unfortunately,
with the advances of mammography screening, we do identify most
(33:31):
breast cancers at an early stage, and so most women
can take advantage of breast saving surgery and that's a
wonderful thing. That certainly wasn't always the case. But happily
this was the situation for you, Katie. It took a
few weeks to get my pathology report, and to be
honest with you, that was slightly nerve racking. I had
(33:52):
mixed feelings when the results did come in because while
my lymph noes were clear, the tumor was bigger than
expected two point five centimeters, about the size of an olive.
But luckily that didn't change my staging, which was still
one A. But there was still one more piece of
information I was waiting for the onche type is a
(34:17):
gene expression profile that basically lets us do a deeper
dive into the genetic machinery. It gives us a snapshot
of the genetic machinery of these cancers to figure out
whether it's an aggressive one or a less aggressive one,
and then that information will determine whether or not chem
a therapy should come into the picture, in addition to
(34:38):
the targeted hormonally active medications that we use for the
cancers that are estrogen receptor positive. So there was a
chance I would have to do chemotherapy and these aromatase inhibitors.
So you called me or someone called me, I can't
remember at this point and said my score was nineteens.
That was you Dr Newman and anything below. It's interesting
(35:03):
the ranges are shifting, but the let's see simplify it
by saying that some the scores go from zero to
a hundred, and some categories of the score are considered
low risk, others are intermediate risk, and the third category
is high risk. But as data evolve, the cut points
(35:25):
do change over time, and therefore our recommendations will change
over time. For you, that score of nineteen was low
enough that it was clear that chemotherapy would not be necessary.
We'll be right back. It's September seven, and it is
(36:00):
my first day of radiation. They'll be radiating my left
breast to get rid of any kind of microscopic cancerous tissue.
It sounds pretty easy, but um, I'll let you know
how it goes. Every morning I was greeted by this
fantastic team from the New York Presbyterian Wild Cornell Radiation Department.
(36:24):
So do you need to go to the bath before
we start? No, I'm good. If you ever do, just
mention my name and get a good seat. Okay, Oh,
this is apparently the checky of the radiology department. Okay,
here we go. I love them so much. They actually
made radiation weirdly fun. By the way. That's Caesar Carter. Caesar,
(36:46):
what do you do my I'm his senior radiation therapist. Here.
Oh great, and this is Tina, also a therapist. Hi everyone, good, Hi,
nice to see you, sucker. And of course the grand
fromage of the operation. I'll be set up and make
sure everything is as we expect today. Will take That
(37:08):
voice you're hearing is Dr John Ng, my radiation oncologist.
I'm just curious before I go in. Has radiation advanced
a lot in recent years? Because I've been amazed by
the technology involved in cancer treatment. Have you seen the
same amount of progress in this field, doctor Ring? Oh? Dramatic?
(37:29):
So you know, I had a colleague, Coup, recently retired
and he tells stories about when he started training, they
actually had a parakey in the room to tell you
when there was enough radiation delivered. Really this is this
sounds crazy, right, but this actually occurred. I think in
the nineteen seventies. This was how you measured radiation treatment.
(37:52):
What did the pair keep heal over? Yeah, it would
make a sound exactly really like the canary in the
coal mine sound when enough radiation that's been delivered. I
think it was around the sixties and seventies that the
doctors would usually prescribe treat until the skin peel. That
was how you prescribe your radiation dose. So we actually
(38:13):
still live with that legacy today. I think patients still
have that perception. But really, radiation technologies have improved to
a point where we can't take a CT scan and
just delineate the target where we're trying to deliver the
radiation treatment. For and so the radiation is much more
precisely delivered. Now that's exciting. All right, Well, let's do
(38:35):
this thing, kids. I did this for fifteen days. Okay,
here it is day two and my buddy Caesar is
greeting me. And for fifteen days it was always the
same setup. Go into the changing rooms, I get a
robe out, pick a locker, put my things in it
(38:58):
called my robe on, and go to the room. Greet
my jovial team. Hi, good morning. That would be me
Katie Kirk. Make sure it's actually me? And can I
have your birthday one seven nineteen? Excuse me? And what
(39:21):
part of the treat today? And pick the music I'd
listened to while I got radiation? What music? How about
Dolly Parton's greatest hits? Okay, greatest hits sounds good? Uh,
you know I'm not the biggest sorry Dolly Joline fans.
So let's start with like two doors down or something.
(39:43):
They're laughing and singing and having a party. Sure, my
radiation team was fantastic. They made the whole process not
only as painless as possible. But is it weird to
say they actually made it fun? But as I saw
(40:04):
other patients in their robes milling around. I wondered what
are they dealing with? And of course I thought about
my own family. You know, I've been thinking a lot
about Jay during this whole process, how grueling and terrifying
his treatment was, how bad his prognosis was, How you
(40:30):
don't get more real than that facing your mortality. I'm
just so lucky, you know. I was warned about the
side effects that I would feel fatigued and my skin
(40:50):
might turn pink. But besides my left breast looking like
I've been sunbathing topless, at least on that side, I
have felt pretty good. Now with radiation done, I'm moving
onto the long term stage of care, which includes a medication,
something I discussed with Dr Drossman. I'm on something called
(41:13):
an aromatase inhibitor, which I guess keeps estrogen out. What
is that doing? So your tumor was what we call
estrogen receptor positive? Does it also progesters progesteron receptor positive
and what we call here to negative. These are three
receptors that we do on all invasive cancers to kind
of create a profile. Because all breast cancers are not
(41:36):
created equal. You can have a small tumor that's highly aggressive.
You could have a large tumor that's very indolent. So
we really when we're treating patients, aside from doing lumpectomies,
we want to understand the receptors so that after the
surgery we can treat them appropriately. You wouldn't want to
treat somebody with an anti estrogen if their tumor was
(41:57):
estrogen receptor negative, it does nothing. So for you, your
tumor was estrogen receptor positive, so you can be treated
with an oral agent, something called an aromatas inhibitor, which
acts to kind of suppress that estrogen. But I like,
I know you do, but we're gonna have to do
something else for you because estrogen, I don't know, it
(42:19):
keeps you feeling young, it's good for your face. We're
going to get your right. But I'm going to take
that every day for five years, and you will tolerate
it well. Majority of people really tolerate it very well.
The other thing that you're going to be doing is
that for the first two years, we're going to be
(42:40):
seeing you every six months for a mammogram on the
involved side and a breast ultrasound on the involved side,
because we want to follow that and make sure that
you're healing well and that there's nothing going on at
that site. So the involved side gets followed every six
months for the first two years. The uninvolved side is
(43:01):
still on a yearly basis. So we're going to be
a lot more of each other for sure. For sure,
what is your message to women? Because this is why
I wanted to quote unquote go public with this. I
really want women to be educated to obviously get screened.
(43:22):
But what would you say to people listening to this conversation?
So I think it's really important to be your own advocate,
to understand your personal history, your genetic predisposition, the density
of your breasts, to understand so that when you walk
into a physician's office, you can advocate for yourself if
ultrasound is not offered to you and you have dense breasts.
(43:45):
You know, I hope that this podcast really allows people
to understand the importance of breast ultrasound in terms of
evaluating tissue that is dense and understanding what your own
risk factors are. Well, hopefully we'll save some lives here
to make a difference. I think that's really important and
I admire you for going public on this, Katie. Well,
(44:08):
I mean I've shown the world my calling, why not
my breast, that's for sure. One thing I think that's
been really valuable is our mom has always taken care
of us, um, you know, when we've been sick. UM.
For me, the most seriously I've ever been sick was
(44:30):
having a kidney infection when I was in high school
that was pretty serious, or randomly last year I was
in the hospital, but it was just strapped throat that
got really bad. But she's just always there and communicating
with the doctors, getting the things we need, and just
being such a source of comfort and reassurance. Like I
(44:53):
would never I wouldn't want to be sick with anybody
else taking care of me, but my mom so to
be taken care of her. UM. In the aftermath of
her surgery, or you know, the day the lead up
to it, I slept over. I went with her to
the hospital. During the surgery itself, I took a nap,
(45:13):
and then the doctor called me to come downstairs her
wake up from the anesthesia and taking her home, and
I don't know, it was it was sort of a
humbling experience, and Um, I don't know one that was
really meaningful to me, but also made me sad and
(45:34):
nostalgic in some ways because it made me think of, oh,
is this what it's going to be like as mom
gets older? And you know that's part of life, um
that we reverse roles um in terms of taking care
of our parents. But that was mostly what I got
out of it, just I guess renewed appreciation for all
(45:59):
the time she's taken in care of me. I think
for me because I wasn't there for the diagnosis or
the surgery um and connected with her in August when
she you know, had a scar but um was healing. Uh.
To me, it really just reaffirmed that her mom is
(46:20):
like a superhuman and so strong and uh still has
boundless energy and can't sit still. I kept being like,
why don't you watch Ship's Creek or just hang out?
And you know, I think she was a little a
little bored. But it's all a small price to pay,
this whole deal. Even at my young age, you know,
(46:42):
I am predisposed to colon cancer. It was a good
reminder that I need to get on top of it
and everyone should and everyone really should prioritize their health,
and it's not always easy because you have work and
sometimes it's just hard to navigate with healthcare. I think, um,
but I really think people have to advocate for themselves
(47:06):
and you have to look out for yourself and educate
yourself as much as possible. I think those are the
things that we can do as as informed patients when
we come back, some critically important takeaways from this experience,
and I'll introduce you to a warrior, a breast cancer
survivor who's already changing the system. That's right after this.
(47:39):
I'm sharing my breast cancer story because I love a
good teachable moment, and this, in fact could be a
life saving one for the women out there listening, and
for all of you who love them, please please go
get your annual mammogram, but even more importantly, find out
if you need additional screen. Nearly half of all women
(48:02):
have dense breasts, which can make it difficult for mammograms
alone to detect abnormalities, and only thirty eight states require
doctors to notify their patients if they have dense breasts,
and even that mandated information often isn't enough. There's a
little verbal uh, some verbiage in a pamphlet that we
(48:24):
hand to patients that says, your breast tissue is dense,
you may benefit from an ultrasound or another modality other
than mammography. But I think in many practices, when patients here, oh,
my mammogram is fine, they assume my breasts are fine,
and they walk out the door and neither their physician
nor themselves think about having anything additional. And you know,
(48:47):
you hear the story all the time. I went from
my mammogram, they told me everything was fine, and two
weeks later I felt a lump and I had a
breast cancer. How can that be? And the answer is, really,
when you have dense bress, mammography doesn't do the whole job.
And if your facility is not offering it and you
do have dense breass, I think you need to advocate
for yourself. And here's another thing that really makes me mad.
(49:11):
Only fourteen states in Washington, d C. Require insurance companies
to fully or partially cover secondary screenings like breast ultrasounds.
I think it's disgraceful, to be honest with you, and
I think that it really is very poor medicine, and
it doesn't really make sense because if we have the
ability to find more breast cancers with a tool that
(49:33):
has absolutely no radiation and is relatively easy to use.
I don't really understand. You know, this is really a
has been a discussion round and round and round among
breast imagers and state you know, state legislatures. She said,
it's an injustice. I said, well, I said that we've
(49:54):
got to change the law. Michelle Young is intimately familiar
with this injustice that the health care you receive really
depends on where you live. Michelle's a lawyer and a
mother of five, and she lives in Cincinnati. Ohio was
one of the states that didn't require doctors to notify
their patients about the risks of having dense breasts. It
(50:17):
also didn't mandate any kind of insurance coverage for additional screening,
and in Michelle came face to face with the dire
consequences of not having those requirements in place. Dr Lee
Slower calls me, who's the head of sinsating breast cancer.
She said, your stage four, Michelle, And he said, are
(50:37):
we talking palliative? And I said I'm too young, And
she said, well it can extend your life. My internet,
of course, told me do my bucket list, as did others.
And I said, Dr Laur, how did this happen to me?
(50:58):
And she said it happened all the time, sometimes every day.
You have dense breast and mamograms don't catch cancer undense breast.
It shouldn't happen to any woman. If the technology is there,
and it is it's affordable. We have short him our eyes,
we have ultrasounds. The question of whether I would live
(51:18):
or die was a question of geography, whether I was
in the right state with a or for this. So
that day we mean two vows. One vow was that
we were going to change the law, and the second
I asked her as they said, Dr Laur, can we
go for me to live? I really am not that type.
(51:41):
I want to try. And while there was a I
was definitely meta static. I had it in um over
twenty notes. It had spread to my right hip, my spine,
my left arm, and I said, Okay, even if I
(52:02):
have a very short lifespan according to most people, let's
go for it. And Dr Laur agreed, And that was lucky.
While you were being treated, you decided something needed to
be done about this. Women like you needed to understand
that additional screening is necessary, and not just for extremely
(52:26):
dense breass, for just dense breasts in general, because there
are four categories of dense breass A, B, C, and D.
D is very dense, but C is pretty damn dense. Yes,
it is. So what did you do? How did you
approach this and how did you get the law changed?
In Ohio? I went to Dr Lisa, my doctor in Ohio,
(52:47):
and I said, we gave each other our word, we
have to do this, and we don't know what's going
to happen. Because the chances of me being in long
term remission, which to me is three years, really slim.
We have to move fast. So she and I gathered
together Dr Mahoney, who's the head of the American Mediology,
and we also brought together Dr Andy Brown, who you
(53:09):
would love. Said, you see, they're both that you see.
I brought in two legislators. One was Jeane Schmidt, who
was a congresswoman who is a conservative Republican, and Cedric
Denson was an African American progressive Democrat, and these two
offered to be the authors and to keep it going
even if I was not here, and we met bi
(53:31):
weekly to put together what we thought was dream legislation.
We vetted it with Commerce, with conservatives, but just about everybody,
all the hospitals before we brought it forth. So we
had everything vetted by the Chamber of Commerce, which is
really important in advance, and no one testified against it.
(53:55):
We passed it in the House with only one vote
against it, and then it was sitting there for months
and months in the Senate. Ohio. It was a very
divided state, and I saw it wasn't passing yet, it
wasn't being put on the schedule, and it has to
be put on the agenda and past. So I went
(54:20):
to Columbus actually wearing this outfit or similar outfits, pink
outfits with pink carnations, and knocked on the doors of
every senator to talk to them about what we needed.
What I found out when I knocked on the doors
is every time I knocked on a door, Republican or not,
(54:40):
there was someone who had experienced breast cancer. And I
knew we were succeeding. I I went to the governor
at an event and said, I need to talk to you. Yes,
and but so as you see, so is my doctor
Andy Brown, so are others and we had the ole
(55:01):
stayed with us at that point, but the question was
how do we get on the agenda? And I didn't
know what was holding us up. So I kept on
going with my little carnations. And I knew we were
safe when the head of the Senate invited me over
and we were only two weeks before the end, three
weeks before the end, and I said, as a session.
(55:23):
And I said, well, according to Jane Schmidt, congress you know,
former Congressman. I said, it looks like we could get
this done in twenty four hours if we try, like
in a one day massive session. We're in the morning,
we passed the committee, we go to the Senate vote,
then we go back to the committee to reconcile the bills.
(55:43):
If we go back to the House, we then vote
again and then be passed by the evening. And I said,
who we do this? And he said absolutely so. And
one day, between seven o'clock in the morning and seven
o'clock in the evening, it was passed. Take me back
to the day the legislation passed and it became law.
(56:07):
It was a lovely day because in this divided nation,
and I was a two thousand sixteen candidate, Democratic endorsed
candidate for Congress. I have work to elect woman to
office for years. I was heartbroken over all our divisions
(56:31):
and the way nothing ever moves forward. And I had
never seen or had the opportunity to be there and
see a bill passed. And there I was very far
off in the I guess they called the galleys, and
each time I was applauded, and I thought, the first bill,
(56:56):
the only bill I may ever pass, is actually from
the galleys as a state for survivor never as a legislator.
But there was this beautiful moment where everything I dreamed
of came together, which is that everyone cared only about
doing the right thing. That it was. We were no
longer Republicans or Democrats, or men or woman. We just
(57:19):
wanted to see that we fixed a problem and save lives.
And I was so grateful for that moment to see
that and to see my friends, I mean Jean and
said on opposite sides of the aisle, both of them
(57:41):
in this beautiful moment together feeling they've done something great
for everyone. All I had suffered. I'm just someone who
wanted to do something good, and I finally did so
I felt it was like a girl's gut getting her badge. Okay,
I did something good. It was the way I wanted
(58:02):
to do it, which is and and that we all
were happy we did it. So I was just pleased
that it worked out and that we overcame the odds.
So I guess I just felt that day that a
chapter was closing, and thank God that I had resolved
(58:23):
this and with decency, and that you're healthy and for
the moment, for the moment fingers crossed, and that you
will ensure that hundreds, maybe thousands of women will be healthy.
Before we talk about the impact, tell me specifically, in
(58:43):
kind of simple terms, if you could, Michelle, what does
this new law actually say and do well? This law,
what it says and does, which makes it different is
that women were not allowed before to get mamograms except
every two years according to their age, and now it's
every year every age, which means if you're under forty
(59:07):
you would find it too late. And we have so
many deaths for a woman under forty, but it was
considered statistically not as important. So when we're allowed to
die and not be detected, that won't happen anymore. Because
every woman has a right for a mammogram, and every
mammogram if in the judgment of the radiologist, not the
(59:30):
insurance company, not anyone else. If the radiologists can't see
clearly or says you have dense breasts, she can go
or any other conditions, she can get the right screening
technology to check on you. And we never had that
right before. And that's huge because it means if we
(59:51):
could catch every cancer early, that's nine nine out of
a hundred cancers will likely not come back. Then then
the third thing we did is we change uch the
gobbledy book on the language. It is really clear English. Now, hey,
you've got dense pressed, you've got a problem, and you
know what You've better talk to your doctor and you
can ask for additional testing. It is clear as a bell.
(01:00:14):
Not only can you ask for additional testing, your insurance
company is obligated to pay for it. Yes, yes, And
that is the point. Your insurance company is obligated to
pay for it because for some women they might even
be told that. But an ultrasound abreast ultrasound is four
hundred dollars and m r S four thousand dollars. I
(01:00:35):
mean a lot of women a don't know and be
even when they find out, Michelle, they can't afford it. No,
and and and you were right, And that is why
this was so important to us. I mean this was
critical because in most states in the nation they say
to you, hey, I think we need an extra test.
We couldn't really tell, and then you say how much
is it? And then you don't do it? And African
(01:00:59):
American woman and have such a higher death rate it's astronomical.
It's about income and access and access. And what we
did now is try to make access as universal as
possible for all women. That does not mean it's still
(01:01:21):
the issue of the deductible we have to take on next.
But yeah, I would say what this did, hopefully we'll
save thousands of lives within the first year of it
being enacted. I'm so impressed by what you've done, and
I hope you don't stop. And whatever we can do
(01:01:43):
to inform women and get laws changed everywhere, um, the better. Well,
I need your help on this. Every woman should have
a right. It is a grotesque injustice to all women
and by the way, their husbands and their children and
(01:02:05):
everyone in their life that they could be gone because
we didn't care enough. I saved the colin's why can't
I save the breasts? Wouldn't that be the most wonderful
thing on earth to do? This October? We could do it,
all right, Let's do it. The bill that Michelle shepherded
through the Ohio State Legislature officially went into effect in September,
(01:02:31):
almost four years from Michelle's cancer diagnosis. Michelle Young is
currently in remission. Before we go, I want to give
my daughters a special shout out. Thank you Ellien Carey
for being part of this podcast, and of course to
(01:02:52):
my incredible doctors for taking the time out of their
very busy schedules, busy saving lives to join me for
this episode. I'll have much more information not only about
my journey, but really important information about secondary screenings, the
risk of dense breast and all kinds of information about
(01:03:13):
breast cancer in general, for the entire month of October
on my website. Just go to Katie correct dot com
for more. Next Question with Kati Kurik is a production
of I Heart Media and Katie Curic Media. The executive
producers Army Katie Curic and Courtney Litz. The supervising producer
(01:03:37):
is Lauren Hansen. Associate producers Derek Clements and Adriana Fasio.
The show is edited and mixed by Derrick Clements. For
more information about today's episode, or to sign up for
my morning newsletter, Wake Up Paul, go to Katie currect
dot com. You can also find me at Katie Currik
on Instagram and all my social media channels. For more
(01:03:58):
podcasts from My heart Radio, visit the I Heart Radio app,
Apple Podcast, or wherever you listen to your favorite shows.
H
Host
Katie Couric
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