Behind the scenes of Katie’s cancer diagnosis and treatment

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Speaker 1: 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 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 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 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 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 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 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 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. 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 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 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 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 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. 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 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, 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 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 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 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. 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. 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 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. 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 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 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 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 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 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 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 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. 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 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 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 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, 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 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, 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 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 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 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 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, 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 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 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 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 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 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 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. 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 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 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 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 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 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 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 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 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. 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 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, 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, 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 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 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 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 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 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 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 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, 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, 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 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. 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 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 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 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 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, 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 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 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 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 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? 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 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 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. 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. 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 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 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 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 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 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 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 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 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 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 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 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 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. 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, 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 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? 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. 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 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 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 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 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. 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 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 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 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 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 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 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 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 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 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. 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. 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, 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 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 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, 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 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 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 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, 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 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. 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 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 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, 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. 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 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 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 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 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? 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 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. 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 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 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, 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 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 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. 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 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, 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 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. 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. 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. 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 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, 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 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 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 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 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 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 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 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 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. 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 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 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 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 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 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, 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 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 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 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. 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