Marcia Strassman, the actress best known for her roles in “Welcome Back Kotter” and “Honey, I Shrunk the Kids” died from metastatic breast cancer this month at age 66. My condolences to her friends and family.
Strassman was something of a hero to me because she was the only famous living person I knew with metastatic breast cancer. I have been on the same drugs as Strassman, so of course I took inspiration that she lived with the disease for seven years.
The actress was one of very few high profile people to talk about having metastatic breast cancer–see this Stand Up 2 Cancer video. Elizabeth Edwards was the last national figure in recent years to share her metastatic breast cancer diagnosis. When Marcia Wallace (the actress who voiced Mrs. Krabapple on “The Simpsons”) died last year, a close friend of hers said she died of breast cancer, but Wallace’s family initially denied this was the case. Understandably, Wallace’s family may not have known what happened.
Although Strassman freely acknowledged her Stage IV diagnosis, not a single news report used the phrases “Stage IV” or “metastatic” breast cancer. I hope I don’t sound petty–to her grieving friends and family I am sure this is is a small point and one that unfortunately does nothing to alleviate their loss.
But it is so important.
Two weeks ago, I participated in a meeting for Chicago-area people living with metastatic breast cancer. Attendees could put on different colored necklaces signifying their breast cancer subtypes: hormone-receptor positive, HER2 positive or triple negative. I was surprised that several women did not know this basic piece of information–one that is the road map to their care and treatment making decisions.
Had these people’s doctors told them the specifics of their disease? Had they asked? Do they understand their treatment plans? We will never make any progress against metastatic breast cancer if we pretend it is all one disease.
Saying that Marcia Strassman died of breast cancer after living with it for seven years somehow implies she died because she let her guard down and WHAM! breast cancer got her.
This is not what happened. When someone dies from breast cancer, they died because the cancer spread beyond the breast and eventually overwhelmed the body.
From published interviews, we know Marcia Strassman was a denovo metastatic breast cancer presentation. This means she was Stage IV from her first diagnosis–when her breast cancer was found, it had already spread to her bones–this is unusual, the majority of those diagnosed with metastatic breast cancer had early stage disease.
Strassman shared that she had lobular breast cancer–i.e., the cancer began in the milk-producing lobules. About 10% of all invasive breast cancers are invasive lobular carcinomas (ILC). (For reference, about 80% are invasive ductal carcinomas (IDC.) Lobular breast cancer grows in sheets–not lumps–and therefore doesn’t show up on mammograms well. (Strassman did in fact have regular mammograms, was a non-smoker and maintained a healthy lifestyle.)
With ILC, for any given stage or grade, the prognosis is similar to that of IDC. The pattern of metastases is slightly different vs. IDC–lobular carcinoma can metastasize to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa (refers to uterus/ovary). Invasive lobular carcinoma is more likely to occur in both breasts compared with other types of breast cancer. ILC tends to occur later in life than IDC — the early 60s as opposed to the mid- to late 50s.
Strassman had a lumpectomy and then began standard of care for hormone-receptor positive breast cancer. According to a 2009 magazine article: “One drug, Femara, an aromatase inhibitor in pill form that Strassman takes every morning, starves tumors of the estrogen they need to grow. The other, Zometa, which is administered in monthly infusions in her doctor’s office, is a bone-building bisphosphonate that can slow deterioration in people with bone metastases.”
Strassman “endorsed” Zometa early on, but either she or the drug company chose to quietly drop the partnership. (The late Barbara Brenner, then the head of Breast Cancer Action, was critical of a 2010 SABCS luncheon featuring Strassman.)
People can do well with bone-only metastatic disease for a long time, often well surpassing the median survival time for Stage IV breast cancer which is two to three years. Although one source reported Strassman had been given 2.5 years to live upon her initial diagnosis, it’s unlikely any oncologist would have offered such a prognosis–they just don’t know. Strassman, with no visceral organ involvement at her diagnosis, would have been on the “good” end of a metastatic diagnosis.
Strassman did so well that, two years after diagnosis, a writer marveled at how good she looked: “Strassman doesn’t look like someone who’s battling a grave illness,” Linda Marsa observed.”Once her condition was stabilized by the combination drug therapy, she had surgery to remove remaining cancerous cells and several lymph nodes. Since then, bone scans have revealed no further deterioration, which is excellent news. She will take some form of therapy for the rest of her life. ‘This is cancer—but it’s a speed bump,’ Strassman insists. ‘You slow down, but once you pass it, you keep going.'”
Although bone mets can be painful and in some cases disabling, generally speaking, from what I understand, they are not immediately life threatening. When breast cancer spreads to a visceral organ–like lungs, liver or brain–that is a different kettle of fish. It should be stressed that some people can and do live with mets to these areas for a long time–but we are all different.
We don’t know exactly what course Strassman’s disease took–only that it almost certainly spread beyond her bones. But we do know one thing for certain: Marcia Strassman died from metastatic breast cancer.