What Hoda Kotb's Story Can Help Us Understand About Breast Cancer

"It can't be me. Why would it be me?"

Hoda Kotb was diagnosed with breast cancer in 2007, and TODAY reports that she has spoken about it often since. Newsweek, citing an interview she gave People, quotes her reaction to the phone call.

"There are people who are going to get breast cancer. I didn't think I was one. I mean, I ate apples and ran in Central Park. I was like me? When they called me, they were like, 'Oh, it's you.' I go, 'It can't be me. Why would it be me?'"

Newsweek reports that her treatment involved a mastectomy and reconstructive surgery, that she did not have chemotherapy because the cancer had not spread to her lymph nodes, and that she took tamoxifen for five years afterward. She has remained cancer free since.

She nearly said nothing at all. "I wasn't going to say anything about it and I wanted to forget about it, but someone encouraged me to say something," she told TODAY.

Her first reaction is the most instructive part, because it is the one nearly everyone has.

Doing everything right is not protective

Breast cancer is common enough that most people who get it have no dramatic risk factor to point to. The two strongest are being female and getting older, and neither is a choice.

That is worth stating clearly, because the alternative belief does damage. People who assume they are safe delay getting a lump checked, and people who are diagnosed spend energy searching for what they did wrong.

Risk factors do exist, and family history and inherited gene changes such as BRCA1 and BRCA2 genuinely change the picture. But their absence is not protection, and their presence is not a verdict.

What "it had not spread to my lymph nodes" means

Lymph nodes are the first place breast cancer tends to travel. Surgeons check them, usually starting with the sentinel node, the one the tumor is most likely to drain into.

Node status is one of the three anatomical facts that define stage, alongside tumor size and whether the cancer has reached distant organs. The National Cancer Institute stages breast cancer with the AJCC TNM system on exactly those inputs.

Node-negative disease means the cancer had not been found in those nodes, and it makes a considerable difference to what treatment is likely to add.

How the chemotherapy decision actually gets made now

For hormone receptor positive, HER2-negative, node-negative breast cancer, the modern question is not whether chemotherapy works. It is whether it adds anything on top of hormone therapy for a particular tumor.

NCI describes the tests used to answer that: gene profile assays including MammaPrint, Oncotype DX, and the Breast Cancer Index. The Oncotype DX 21-gene assay has the most extensive validation, and it produces a recurrence score.

NCI lays out how that score is used in node-negative disease. A score of 11 or lower is low risk, and chemotherapy "is not indicated for this group." A score above 25 is high risk, and chemotherapy is indicated. Between 11 and 25, NCI says the decision "is complex and personalized," weighing age, tumor features, and patient preference.

The evidence behind that middle band deserves precision. The TAILORx trial randomly assigned 6,907 women with scores of 11 to 25 to endocrine therapy alone or endocrine therapy plus chemotherapy. After a median follow-up of 90 months, the nine-year invasive disease-free survival rate was 83.3 percent with endocrine therapy alone and 84.3 percent with both, and the difference met the trial's noninferiority criterion.

Read the endpoint carefully. Invasive disease-free survival measures time without the cancer returning invasively, which is not the same as overall survival. NCI's conclusion is narrow and specific: chemotherapy "is unlikely to provide substantial benefit to patients older than 50 years with ER-PR-positive and node-negative disease and a recurrence score of 11 to 25."

If you are in that situation, ask whether a genomic assay applies to your tumor. It is the difference between chemotherapy and no chemotherapy for a large number of people.

Why five years of tamoxifen

Tamoxifen blocks estrogen's effect on breast tissue. For hormone receptor positive cancers, it is the workhorse of treatment after surgery, and aromatase inhibitors are the alternative in postmenopausal women.

The benefit is long-running rather than immediate. NCI notes that at 10 years after diagnosis, the risk of a new primary cancer in the opposite breast runs 3 to 5 percent, and that endocrine therapy lowers that risk. Finishing the course is where the benefit lives.

When to get checked

CDC lists these warning signs, and any one of them earns a prompt appointment.

• A new lump in the breast or armpit
• Thickening or swelling in part of the breast
• Dimpled, irritated, red, or flaky breast or nipple skin
• A nipple turning inward, or nipple pain
• Discharge other than breast milk, including blood
• A change in one breast's size or shape
• Breast pain unrelated to your cycle

CDC adds that non-cancerous conditions cause these too, which argues for checking rather than waiting.

On screening, CDC states the U.S. Preventive Services Task Force recommendation that women aged 40 to 74 at average risk have a mammogram every two years, with different schedules for those at higher risk. NCI notes that comparing a new mammogram against previous ones helps radiologists spot change, which is a reason to keep going to the same place or to bring your old images along.

The population figures

SEER, NCI's cancer surveillance program, carries an American Cancer Society projection of 321,910 new cases of female breast cancer and 42,140 deaths in the United States for 2026. NCI's own registry data put the median age at diagnosis at 64.

Five-year relative survival across all stages is 91.9 percent, from cases diagnosed between 2016 and 2022. By stage, SEER lists 100.0 percent for localized disease, 87.5 percent when nearby nodes are involved, and 33.8 percent once the cancer has reached distant organs. Sixty-four percent are found while still localized.

Those are group averages built from hundreds of thousands of records. They describe a population, and no individual's course was ever in them.

Sources

• https://www.newsweek.com/entertainment/celebrity-news/hoda-kotb-breast-cancer-update-2038255
• https://www.today.com/health/amanda-peet-hoda-kotb-surviving-breast-cancer-rcna265268
• https://www.cancer.gov/types/breast/hp/breast-treatment-pdq
• https://www.cancer.gov/types/breast/mammograms-fact-sheet
• https://seer.cancer.gov/statfacts/html/breast.html
• https://www.cdc.gov/breast-cancer/symptoms/index.html
• https://www.cdc.gov/breast-cancer/screening/index.html