Robin Roberts Faces Cancer With Courage, Grace

I am certain everyone who has seen ABC News' "Good Morning America" anchor Robin Roberts' announcement that she has been diagnosed with breast cancer is as touched as I am by this news.

I have commented frequently about public figures facing cancer, and the special role they play in our lives. Not only do they have to deal with a serious diagnosis, but they also frequently have to cope with that diagnosis while in the public eye.

Here we have someone who is very special to so many facing just that circumstance. She did so with the grace and sincerity that is so much a trademark of her "on camera" persona.

Roberts said she'd found a lump in her breast and promptly sought medical attention. She said a mammogram failed to show the cancer, but an ultrasound ordered by her physician did find the lump and a biopsy confirmed the diagnosis. Surgery is scheduled for Friday.

Roberts emphasized the importance of access to quality medical care. For her, the system worked.

But her comment acknowledges a serious problem in this country, namely that too many women do not have access to someone they can identify as their primary medical clinician, and too many women either don't have access to mammography or don't take advantage of the opportunity to be screened for breast cancer.

Roberts' announcement has also raised some questions about the role of ultrasound in the diagnosis and screening of breast cancer.

To understand the issue, we need to understand the scenarios when ultrasound is helpful and when it is not.

In many women, particularly those who are younger with denser breast tissue, the accuracy of a mammogram may not be as great as in older, postmenopausal women whose breast tissue has more fatty elements, and cancers are more easily seen.

So, when a doctor feels a new lump, an ultrasound is perfectly appropriate to take a look at the lump and determine some of its characteristics, such as whether it is solid or filled with fluid. Even when the mammogram is negative, the ultrasound can be very helpful in this type of situation.

However, there is still no convincing evidence that using ultrasound to screen for breast cancer, even in young women, is an appropriate routine test. Studies are currently under way to find out whether or not this remains the case, given improvements that have occurred in ultrasonograpy.

For Roberts, there was a new lump and the doctor was appropriately concerned. In this situation, the ultrasound was used as a diagnostic tool, not a screening tool.

The difference may seem subtle, but the implications are not. Screening means looking for a disease when none is detectable; diagnostic means the doctor is looking for more information about something (in this case a lump) that is present and may be a serious disease (in this case, breast cancer).

We know that Robin Roberts is relatively young, and that she is African-American. Roberts has told us the disease was caught early, which is good news.

African-American women do get breast cancer at a younger age than Caucasian women, and their disease is usually more advanced at the time of diagnosis. And while African-American women have a lower risk of getting breast cancer than do Caucasian women, their chances of survival after diagnosis are lower.

For too many African-American women who don't have access to adequate health care in this country, the situation is frequently much more serious than appears to be the case for Roberts.

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