ABC News’ Amy Robach Diagnosed with Breast Cancer

On October 1, as part of Breast Cancer Awareness Month, Good Morning America news correspondent Amy Robach agreed to do an onscreen mammogram (her first) to promote cancer screening. At 40 years old (the age when screening routinely starts), Robach had been putting off the test, and was initially reluctant to do the test in front of millions of viewers. But GMA producers and co-worker and breast cancer survivor Robin Roberts convinced her that getting the mammogram on-air could possibly save the life of a woman who finally decides to get her own mammogram.

Little did she know that she was about to save her own life.

Brought back for what she thought were just “a few follow-up images”, just a few hours later, Robach was given the news that she had breast cancer.

Robach, who is married to Melrose Place actor Andrew Shue (with whom she has two daughters and three stepsons) made the announcement on GMA this morning that she will undergo a bilateral mastectomy on November 14, followed by reconstructive surgery.

Robach, in a blog posted today, never thought she could have cancer: “I work out, I eat right, I take care of myself and I have very little family history; in fact, all of my grandparents are still alive.”

I’m so grateful that I got the mammogram that day. Robin’s words still echo inside of me ‘If I got the mammogram on-air and saved one life then it’s all worth it’ she had said. It never occurred to me that that life would be mine.

Screening Mammography Guidelines

In 2009, the U.S. Preventive Services Task Force (USPSTF) a group of independent health experts brought together by the Department of Health and Human Services to evaluate screening mammography guidelines made recommendations for sweeping changes to the guidelines. The changes included:

• Routine screening of average-risk women should begin at age 50, instead of age 40.
• Routine screening should end at age 74.
• Women should get screening mammograms every two years instead of every year.
• Breast self-exams have little value, based on findings from several large studies.

Note that these recommendations don’t ban anyone from getting a screening mammogram. These guidelines do not apply to women who have a higher risk of breast cancer, such as those with a family history of close relative with breast cancer. They also do not apply to women with a lump or suspicious findings.

The reasoning behind the changes had to do with balancing the benefits and risks of generalized screening mammography:

Benefits:

Decrease in breast cancer mortality: In the randomized controlled trials , for women aged 40 to 74 years, screening with mammography has been associated with a 15% to 20% relative reduction in mortality due to breast cancer.

Potential Harms:

1. Overdiagnosis and Resulting Treatment of Insignificant Cancers: Diagnosis of cancers that would otherwise never have caused symptoms or death in a woman’s lifetime can expose a woman to the immediate risks of therapy (surgical deformity or toxicities from radiation therapy, hormone therapy, or chemotherapy), late sequelae (lymphedema), and late effects of therapeutic radiation (new cancers, scarring, or cardiac toxicity).

2. False-Positives with Additional Testing and Anxiety: On average, 10% of women will be recalled from each screening examination for further testing, and only 5 of the 100 women recalled will have cancer.

3. False-Negatives with False Sense of Security and Potential Delay in Cancer Diagnosis: 6% to 46% of women with invasive cancer will have negative mammograms, especially if they are young, have dense breasts, or have certain kinds of cancer (mucinous or lobular) or rapidly growing cancers.

Despite the USPSTF report, the American Cancer Society is still recommending:

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
• Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

The case of Amy Robach brings up an interesting issue. Based on the USPSTF guidelines, with no family history of breast cancer, she would not get a screening mammogram for another 10 years!

So which set of guidelines should women follow? The bottom line is that each patient needs to be an advocate for their own healthcare. Key to this is to be a well-informed consumer who actively pursues a dialog with their healthcare providers about what is best for them, given their family medical history and all of the environmental factors that affect their personal health and well being.