Despite Katie Couric's advice, doctors repudiate some ultrasound breast cancer screenings

Many doctors are questioning Katie Couric's new call for ultrasound screenings beyond annual mammograms to detect breast cancer.

A recent online Kaiser Health News story by Michelle Andrews notes that the 65-year-old former co-host of NBC's "Today" show is now pushing those sonograms because they "can sometimes identify malignancies that are hard to spot on a mammogram in women whose breasts are dense — that is, having a high proportion of fibrous tissue and glands vs. fatty tissue."

Dr. Carol Mangione

The KHN article, however, quotes Dr. Carol Mangione, professor of medicine and public health at UCLA who chairs the U.S. Preventive Services Task Force, a group of medical experts who make recommendations for preventive services after weighing their benefits and harm, as being in doubt. She says clearly, "We don't have evidence that auxiliary screening reduces breast cancer mortality or improves quality of life."

Dr. Sharon Mass, an OB-GYN in Morristown, New Jersey, and the former chair of the American College of Obstetricians and Gynecologists' New Jersey section, echoes that sentiment. "On the one hand," Andrews' piece quotes her as saying, "we want to do everything we can to improve detection. But on the other hand, there are lots of costs and emotional distress" associated with false-positive results.

Couric first shared the news of her own breast cancer diagnosis in September.

In addition to regular mammograms, many women are getting 3D mammograms, sonograms or MRIs as supplemental testings. That imaging in those who aren't at high risk for breast cancer, the KHN story says, "may identify potential trouble spots, which can lead to follow-up testing such as breast biopsies that are invasive and raise cancer fears for many patients. But research has found that very often these results turn out to be false alarms."

And that doesn't count the possible extra cost. "An ultrasound screening might cost $250 out-of-pocket while a breast MRI could run $1,084," according to the Brem Foundation to Defeat Breast Cancer," Andrews' story says. 

Meanwhile, Rep. Rosa DeLauro (D-Conn.) recently tweeted that she's working in conjunction with Couric on a bill to cover MRIs and ultrasounds for women with dense breasts "without any out-of-pocet costs," the article reports.

What are the real results of added screenings? Studies show, the KHN piece notes, that "if 1,000 women with dense breasts get an ultrasound after a negative mammogram, the ultrasound will identify two to three cancers. But the extra imaging will also identify up to 117 potential problems that lead to recall visits and test but are ultimately determined to be false positives."

Mass' group doesn't recommend supplemental screening for women with dense breasts who don't have any additional risk factors for cancer, the article reports. "Many other professional groups take a similar position."

Dense breasts, the story says, "are relatively common. In the United States, an estimated 43% of women 40 and older have breasts that are considered dense or extremely dense…Women with dense breasts are up to twice as likely to develop breast cancer as women with average-density breasts, research shows."

Other steps instead of extra screening could be helpful, according to Dr. Karla Kerlikowske, a professor of medicine and epidemiology/biostatistics at the University of California, San Francisco. "If you really want to help yourself, lose weight," she's quoted as saying. "Moderate your alcohol intake and avoid long-term hormone replacement. Those are things you can control."

Additional information on mammograms, sonograms and other screenings can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Katie Couric, diagnosed with breast cancer, intends to publish details about her ordeal

Veteran TV anchor/host Katie Couric, now fighting breast cancer, is planning to speak out more about her experience with the disease — and become an advocate for screenings.

According to a story by Claire Fahy in yesterday's editions of The New York Times, when she received the troubling diagnosis on June 21, she "handled it the way she handles any other news event — as a journalist."

Katie Couric

The 65-year-old TV stalwart is quoted as saying, "I actually treated this whole ordeal like a reporter. I went and tried to learn as much as I could."  

Al Rabson, former leader of the National Cancer Institute, "use to call her 'Dr. Couric' because she had amassed so much knowledge," the Times story says. 

Couric, once the host of the "Today Show" and anchor of "CBS Evening News," apparently will publish more about her ordeal, as well as information about breast cancer in general, throughout October, which has long been designated as Breast Cancer Awareness Month.

She also plans to use her experience as a goad to officialdom. The Times quotes her as saying, "Hopefully this will be a kick in the pants for a lot of policymakers and just a lot of women in general to make sure they are up to date on their screenings."

Fahy also quotes Couric to the effect that this bout with the disease isn't her "first rodeo" — her first husband, Jay Monahan, died from colon cancer in 1998, and her sister, Emily, died from pancreatic cancer in 2001.

The Times observes that Couric published an article yesterday noting that the day of her diagnosis was her eighth wedding anniversary. In that piece, she details the specifics of her cancer, including the fact that her dense breasts, not an uncommon condition, made it difficult for mammograms to detect the cancer. 

According to Fahy, the news anchor colorfully describes finding an abnormality in dense breasts "like looking for a snowball in a snowy field."

Her cancer apparently was found by an additional ultrasound.

The National Cancer Institute reports, not incidentally, that almost half the women over 40 in the United States have dense breasts.

Reportedly, one in eight women develop breast cancer, with the survival rate for those whose cancer has not metastasized as 99 percent. Couric's, which was detected early and is labeled as State 1A, hasn't spread to her lymph nodes or anywhere else.

A lot more information about the disease and its history in the United States can be found in  "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.