What Katie Couric's Advocacy Can Help Us Understand About Cancer Screening

What she actually said

In an NPR interview on October 26, 2022, Katie Couric described her own breast cancer diagnosis in her own words.

She said the cancer was stage 1A. She said she had completed 15 rounds of radiation. She said she was then looking into aromatase inhibitors, a hormone treatment taken for five years as an added safeguard, and was still talking to specialists about which one to use.

She also gave the interview two specific pieces of advice: do not put off a mammogram, and ask whether you have dense breasts.

Everything below builds on that, plus federal screening guidance. Nothing here describes her care beyond what she chose to say.

The event that started the advocacy

Couric's husband, Jay Monahan, died of colon cancer in 1998. In March 2000 she had a colonoscopy broadcast on the Today show.

Researchers measured what happened next. A 2003 study in the Archives of Internal Medicine, led by a University of Michigan team, tracked colonoscopies in a 400-endoscopist database and in a managed care plan with 44,000 adult members.

Colonoscopies per participating physician rose from 15.0 per month before the campaign to 18.1 after. In the health plan, the rate went from 1.3 to 1.8 per 1,000 members per month. After adjusting for existing trends, the higher rate held for nine months.

That is the "Couric effect," and it is one of the few times a celebrity screening message has been measured rather than assumed.

Why colonoscopy is a different kind of test

Most cancer screening finds cancer early. Colonoscopy can stop one from forming.

NCI explains that most colorectal cancers start as a growth in the lining of the colon or rectum. Some are raised polyps, some are flat. Polyps are common in people over 50 and most never become cancer, but one type, an adenoma, is more likely to. During a colonoscopy, any abnormal growth in the colon or rectum can be removed on the spot.

Our page on colorectal cancer screening walks through the other options, which include stool tests done at home.

Breast density, the part she pushed hardest

NCI defines breast density as the relative amounts of dense and fatty tissue, as they appear on a mammogram. It is a reading from an image, not something a clinician can feel and not something you can tell from a lumpy breast.

NCI states the consequence plainly: mammography is more likely to miss cancer in women with dense breasts.

Couric told NPR that women aged 40 and over should ask their doctor whether they have dense breasts, and then ask whether extra screening such as a breast ultrasound would help them. That is a conversation to have with your own clinician, since the answer depends on your risk.

Your mammogram report usually arrives within about two weeks and usually carries a BI-RADS category. That is a standard scale radiologists use to describe what they saw and what follow-up they advise. Our guide to mammograms explains the process.

When to get checked

These are the federal reference points, for people at average risk:

• Breast. The US Preventive Services Task Force recommends screening mammograms every 2 years between ages 40 and 74.
• Colorectal. Most expert groups now recommend starting at age 45 and continuing to 75. Between 76 and 85, the decision depends on life expectancy, health conditions, and past screening.
• Colonoscopy interval. Every 10 years at average risk.
• Stool tests. A fecal immunochemical test is generally advised every year or two. A multitarget stool DNA test is generally advised at least every 3 years.
• Sigmoidoscopy. Every 5 or 10 years.
• Virtual colonoscopy. Every 5 years.

Higher risk changes all of this. NCI names inherited conditions such as Lynch syndrome and familial adenomatous polyposis, a family history of colorectal cancer, a personal history of advanced polyps, and inflammatory bowel disease. People in those groups may be told to start earlier and screen more often.

What hormone therapy is for

About 80% of breast cancers are hormone receptor positive, meaning the cancer cells carry receptors for estrogen, progesterone, or both. Doctors test tumor tissue removed at surgery to find out.

Aromatase inhibitors block an enzyme the body uses to make estrogen. NCI lists three: anastrozole, letrozole, and exemestane. They are used mainly after menopause, because the ovaries in premenopausal women produce too much aromatase for the drugs to block well.

Given after surgery, this is called adjuvant therapy, and its job is to lower the chance the cancer returns.

The numbers, for a group

SEER, NCI's cancer surveillance program, carries an American Cancer Society projection of about 321,910 new female breast cancer diagnoses in the United States in 2026 and about 42,140 deaths. Five-year relative survival across all stages was 91.9% for people diagnosed from 2016 through 2022.

Stage matters enormously. SEER records 64% of cases found while still local, where five-year relative survival is 100.0%. Twenty-seven percent are found in nearby lymph nodes, at 87.5%. Six percent are found after spread to distant organs, at 33.8%.

Those are averages across a whole population over past years. They are not a forecast for any one person, including the person reading them.

What this does not mean

A screening test found one journalist's cancer early. That does not mean screening always works, or that a normal result rules cancer out. NCI's own material on dense breasts exists precisely because mammograms miss things.

It also does not mean the schedule above is right for you. Age ranges and intervals are built for people at average risk, and family history moves them.

And a public figure describing an early-stage cancer says nothing about anyone else's stage, treatment, or course.

Sources

• NPR: Journalist Katie Couric on her recent breast cancer diagnosis
• Cram P et al., "The Katie Couric effect," Arch Intern Med 2003 (NCBI E-utilities record)
• NCI: Mammograms fact sheet
• NCI: Screening Tests to Detect Colorectal Cancer and Polyps
• NCI: Hormone Therapy for Breast Cancer
• NCI SEER Cancer Stat Facts: Female Breast Cancer

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

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