Today celebrity chef Sandra Lee announced that she has breast cancer. As revealed in People she, the long-time partner of New York State Governor Andrew Cuomo, is 48 years old and will soon have a double mastectomy.
As reported, Lee’s diagnosis follows a routine screening mammogram. In late March a biopsy a revealed DCIS, the earliest (non-invasive) stage of malignancy. As Lee recounts in an interview with Robin Roberts on ABC’s Good Morning America, she first opted for lumpectomy. After doctors found malignant cells at the margins of the surgical specimen, a finding that suggests some cancerous cells remain in the breast, Lee chose to have more treatment.
Standard approaches to DCIS include lumpectomy alone, lumpectomy followed by radiation, mastectomy, Tamoxifen or, in some circumstances, careful observation. Given the extent of her DCIS, which was not limited to the lumpectomy area, Lee decided on mastectomy. Feeling – and hearing from her doctors that she, or her breasts, were “a ticking time bomb” – she elected to have bilateral surgery. In the interview with Roberts, who is also a breast cancer survivor, Lee spoke of the value of early detection and encouraged women, including those under 50 years, to get mammograms.
Lee’s decision follows a similar, high-profile case of a low-grade tumor prompting double mastectomy. Just last month, the actress Rita Wilson announced in People that she had bilateral surgery and reconstruction for invasive lobular carcinoma.* Evidently the 58 year old actress, Tom Hanks’s wife, had been monitored for LCIS, a high-risk premalignant condition of the breast, for some time. After a concerning biopsy and additional pathology reviews yielding a diagnosis of early invasive cancer, Wilson decided to have surgery. Weeks later, she returned to her role in Fish in the Dark on Broadway.
It’s an impressive pair of stories, and a tough set of choices for these two women. While some journalists and doctors may pooh-pooh or otherwise minimize the epidemic of early-stage breast cancers detected by screening, it may be that these surgeries are life-saving. It’s hard (impossible) to say. Physicians and scientists today don’t know enough about the course of DCIS or aggressive, pleomorphic LCIS as Wilson had, in women who otherwise will live for decades ahead.
Sparing the costs and toxicity of radiation therapy, which these women would likely need, is worth a lot, besides reducing the risk of invasive cancer warranting treatment later on. These early breast cancer forms, DCIS and LCIS, represent an area for which research is needed, including prospective clinical trials so that 10 years from now all women will have more information to guide their choices.
I don't decry these women’s decisions to have their breasts removed. Having invasive breast cancer is no walk in the park. If a woman can significantly reduce her chances of developing metastatic disease by having surgery at this early stage, it may be worth it. Certainly it’s an understandable choice.
As for celebrities recommending screening on major TV, it’s easy to be critical. What would be helpful is if doctors – including oncologists, breast surgeons, internists, pathologists and radiologists – would give clearer guidelines based on current knowledge and clinical experience with the disease (breast cancer in adult women) on the value of early detection, and how women who choose to be checked can get optimal and safe imaging.
I respect both women, Lee and Wilson, for sharing their diagnoses and decisions. These public conversations may help other women in to understand the relevant terms and choices. Ignoring these conditions – or telling women they’d be better off not knowing about early stage tumors – is not a smart option. It won’t help these individual women, and it won’t enable research for future understanding of these early-stage forms of breast cancer.
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*clarification 9:25 PM 5/12/15
