Days ago, the actress Julia Louis-Dreyfus shared her breast cancer diagnosis on Twitter. “1 in 8 women get breast cancer. Today, I’m the one,” she wrote.
“The good news is that I have the most glorious group of supportive and caring family and friends, and fantastic insurance through my union,” she stated. “The bad news is that not all women are so lucky, so let’s fight all cancers and make universal health care a reality.”
Louis-Dreyfus, age 56, gave no further details about her condition. Yet her disclosure raises discussion of the positive impact of breast cancer awareness, the unfortunate frequency of this disease, and benefits of having medical insurance.
Yes, we’ve come a long way since the days of Betty Ford. Today, many people talk about breast cancer openly, on-line and in their physical communities. Consider how much has changed since the late Lisa Bonchek Adams began tweeting, in 2009, before dying from breast cancer in 2015. For her openness, she met with flak and, also, earned respect of multitudes. Of course, some women remain tight-lipped about breast cancer. But it’s our choice, now. Almost any patient can ask questions, voice concerns, and find varied perspectives on breast cancer and treatment options.
In 2017, our collective comfort level with the topic of breast cancer is off-the-charts high. Which is great. Because for women to get cancer care, they need not be afraid to enter a medical office. They need to know what kinds of questions to ask of their doctors, to avoid undertreatment or overtreatment. Years ago in my community, some women avoided evaluation of possible breast tumors due to stigma. This kind of thinking persists in less modern regions of the world and even, still, in some communities in North America. Lingering fear and ignorance about breast cancer result in women not receiving therapy that might be life-saving or otherwise helpful. For this reason, I don’t take awareness for granted.
Louis-Dreyfus highlighted the “1 in 8” statistic in her post. The inescapable point is that breast cancer is too common. According to the National Cancer Institute, over 252,000 people in the United States will find out they have an invasive breast tumor in 2017. Approximately 12.4% of women will receive this diagnosis during their lifetime. Breast cancer, in its many forms, affects people of all ethnic groups. Despite progress, this disease will take some 41,000 American lives this year, and over half a million around the globe.
The actress concluded her note by pointing to the critical issue of universal health care. She was right to do so. Because among women with invasive breast cancer, having good insurance affects the stage at diagnosis, prognosis, and likelihood of a favorable outcome. A recent report found a shift toward lower-stage disease since passage of the Affordable Care Act. This finding supports that disparities in breast cancer stage and outcomes can be reduced by removing financial obstacles to screening, such as copays. A paper presented at this year’s ASCO meeting found that stage of breast cancer diagnosis and risk of death are significantly higher in U.S. women who lack private insurance.
In late 2015, JAMA Oncology published a pair of back-to-back papers on how timing of surgery or medical treatment influences survival after a diagnosis of invasive, non-metastatic breast cancer. Although the studies were observational, they were large and yielded the same big-picture result: Long delays in treatment of early-stage, invasive breast cancer reduce disease-specific and overall survival. In the analysis of surgical timing, patients who didn’t have surgery until three or four months after diagnosis didn’t live as long as those who had surgery within the first month, and the proportion of women lacking private insurance was greatest among those who had delayed surgery. In the report on chemotherapy timing, it didn’t matter if chemotherapy was delayed up to three months. But after 90 days, survival dropped among those with early-stage breast cancer compared to their counterparts who received chemotherapy promptly. Risk factors for delays included therapy choices, such as undergoing breast reconstruction, and demographic factors such as poverty, Hispanic ethnicity or non-Hispanic black race, and having nonprivate insurance.
The upshot of these studies is that if you have breast cancer, it helps to have health care. With Medicare or private insurance, a woman is more likely to be diagnosed with a stage 1 tumor (as opposed to stage 2 or more advanced disease), to receive surgery or chemotherapy, if needed, within a reasonable and safe time frame, and to survive longer
Back to Julia Louis-Dreyfus and her revelation. Last month, she appeared stunning and broke a record when she picked up her sixth consecutive Emmy for her portrayal of the fictional politician Selina Meyer in HBO’s VEEP. According to People, she learned of her diagnosis the next day.
I can’t resist wondering how a breast cancer diagnosis might play out on VEEP. What would happen if Louis-Dreyfus's character on the show—as vice president, president, or again-candidate Meyer—received a breast cancer diagnosis? Several real U.S. Presidents have had cancer while in office. They were men, of course. Consider the case of Grover Cleveland. In the summer of 1893, he underwent clandestine surgery for a jaw tumor while on-board a yacht rigged with operating tools. During that time of economic instability, Cleveland elected not to reveal his condition for fear of public worries about his leadership capacity. In 1985, when Ronald Reagan had a colon cancer removed, his diagnosis generated sympathy and concern, but did not threaten his position as leader of the free world.
If “President Selina Meyer” had breast cancer, how she would be treated? One can only imagine.
Last spring, HBO renewed VEEP for a seventh and final season. I’m glad to read that the series will be continued, and look forward to seeing what happens next to Selina Meyer. HBO has stated it will adjust the program’s filming schedule as needed. One could only hope that all employers would be so supportive of all employees with cancer and other medical conditions.
To Ms. Louis-Dreyfus I wish for good care, that she feels well, and the best of possible outcomes.
