Every spring, 32 multimillion-dollar corporations gather in one location to handpick the largest, strongest, fastest young men in America. Millions of people huddle around television sets to watch the proceedings on the television network ESPN.
The event known as the National Football League (NFL) Draft is one of the most testosterone-laden events in American television. If there is an ideal forum to become not just a public face for patients with breast cancer, but an indelible image of what survivorship looks like for hundreds of thousands of women each year, the NFL Draft seems an unlikely place for it.
Ms. Shelley Smith
“Because of the friends that I lost to cancer, I was proud to show that I was going through chemotherapy because I was doing something to beat this disease,” she said.
The story of diagnosis, treatment, and survivorship is a familiar one for ASCO members, most of whom have dedicated their lives to the treatment of cancer. However, the public nature of Ms. Smith’s profession gave voice to many of the issues often experienced in private by patients. For the last 2 years, Ms. Smith has conducted her treatment and recovery on television and on social media. Her openness provides a window on the hopes, fears, and feelings of many patients with cancer.
Like most patients, Ms. Smith’s experience was touched by ASCO members and by the research shared during Society meetings. In addition to her public battle, Ms. Smith’s story shows how ASCO and the cancer care community intersect.
Treatment Is a Marathon, Not a Sprint
The call came during the middle of the NBA Conference Finals in late May 2014, a particularly busy time of year for a sports reporter. LeBron James was gunning for back-to-back championships in the Eastern Conference, while in the Western Conference, the San Antonio Spurs tried to stave off the Oklahoma City Thunder for one more title run.
In the middle of those stories, Ms. Smith learned she might have breast cancer.
“My first thought was, ‘Ok, I’ll take care of it in July,’” she said. “I couldn’t figure out how to schedule it. How am I going to schedule cancer in the middle of the NBA playoffs? I deal with conflict pretty easily. I try to figure out a plan, but I didn’t have one right then.”
Results from an abnormal mammogram on her left breast led to a diagnostic exam at Torrance Memorial Medical Center near her home in Los Angeles. Days after the test, she received the results from her oncologist, David Chan, MD. Ms. Smith had an invasive lobular carcinoma that had spread to her lymph nodes.
It was her second cancer diagnosis in 5 years. Ms. Smith was previously diagnosed with uterine cancer, which was treated by a hysterectomy. Sitting in the doctor’s office after her latest diagnosis, Ms. Smith predicted another quick treatment cycle. The full scope of treatment only dawned on her after a meeting with Dr. Chan.
Patients newly diagnosed with breast cancer “are understandably panicked and want surgery immediately,” Dr. Chan said. “I explain that treatment is a long process; a marathon, not a sprint. The right decisions need to be made, and there are options on sequencing. Starting with surgery first isn’t always best.”
A mastectomy could have been quickly performed and would have assuaged Ms. Smith’s desire to begin treatment. But if her cancer could be made smaller, she could have effective treatment with lumpectomy and radiation without any compromise in her cure rate.
Ms. Smith previously witnessed a friend undergo an arduous reconstruction after mastectomy and did not want that experience. “I like my boobs,” she said. “I didn’t want to lose them.”
Dr. Chan, oncology director at Torrance Memorial Medical Center, recommended preoperative endocrine therapy before a lumpectomy. The treatment was based on the results of the American College of Surgeons Oncology Group Z1031 study comparing three aromatase inhibitors used neoadjuvantly.1 Results from the trial, which compared exemestane, letrozole, and anastrozole in postmenopausal women with stage II/III ER-positive breast cancer, were presented during the 2010 ASCO Annual Meeting. A total of 51% of patients who would have initially required mastectomy because of tumor size were able to have lumpectomy instead.
“Many patients with breast cancer initially feel that they want mastectomy instead of lumpectomy because doing more surgery seems intuitively better,” said Dr. Chan, an ASCO member since 1986. “But it’s clear that for certain patients, lumpectomy with radiation is at least as good, if not slightly better, compared mastectomy in controlling cancer.”2,3
Ms. Smith was prescribed anastrozole. Within a month of treatment, she could feel the tumor shrinking, and this was confirmed by ultrasound. Months later, when it was time for her lumpectomy, the margins were clear, and she was pleased that a smaller amount of breast tissue was removed compared to what would have been needed if she had had surgery first.
A Winnable Fight
The world of sports media, particularly within ESPN, can resemble a close-knit hospital staff. Employees work long hours in a high-stress environment, leading coworkers to form relationships akin to those of friends or family.
When Ms. Smith began chemotherapy, she carried with her the weight of some of her closest friends in sports. Bryan Burwell, a St. Louis-based sportswriter and former ESPN radio host, died in December 2014 after a battle with melanoma that spread to his liver. Stuart Scott, a popular television anchor and sports commentator, died one month later of appendiceal carcinoma.
The previous July at ESPN’s annual award show, Mr. Scott gave an impassioned speech about his experience.
“When you die, that does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live,” he told the audience. “So, live. Live. Fight like hell. And when you get too tired to fight, then lay down and rest and let somebody else fight for you.”
As she began chemotherapy, Ms. Smith was warned she would frequently become tired, often at unexpected times. She was never extremely nauseous (“they were giving me great anti-nausea drugs,” Ms. Smith said) but she once received a painful pegfilgrastim shot in order to boost her white blood cell count during an infection.
In some ways, Ms. Smith welcomed the pain and tiredness. It was her way of continuing the fight.
“I was scared of chemotherapy,” she said. “Stuart Scott died, and my other friend Bryan Burwell died. Bryan never had a fight; in 6 weeks he was gone. But I knew I had a winnable fight, and once I realized that, I wasn’t scared anymore.”
On the advice of friend and Good Morning America anchor Robin Roberts, herself a breast cancer survivor, Ms. Smith assembled a team of friends who would fly in from around the country during her chemotherapy. They, along with her daughter Dylann Tharp, drove Ms. Smith to her treatment, prepared meals, did laundry, and provided support.
“I didn’t know what I was going to need, but I had my best friends there,” Ms. Smith said. “The practical thing was that they drove me, but they would also just sit with me and talk. If I felt sick, I could just go to bed, and I knew that they would understand.”
Her doctors were an equally important part of the team. Ms. Smith met with Dr. Chan and his staff during her therapy to outline her symptoms and discuss her treatment. It was during these meetings that Ms. Smith discovered, and gave voice to, the issues that mattered to her. She learned, for example, that she hated waiting for test results.
“I understand the privacy rules, but when the person giving the mammogram gets a dark look on their face, not knowing is the worst fear you can ever have,” she said.
By comparison, Ms. Smith found herself understanding, even reassured, when Dr. Chan was late to appointments. Dr. Chan’s honesty (“I knew he was giving every patient as much time as they needed,” Ms. Smith said), as well as his willingness to stay until all her questions were answered, instilled a sense of confidence.
“I tell my patients that I am rarely on time,” Dr. Chan said. “The reason is that I am trying to take care of the problems that need to be dealt with during visits [with other patients]. Cancer and treatment–related problems often can’t wait for another appointment. Everybody understands why they are waiting. It’s not because I had a golf game and was late coming to the office. We’re taking care of people like them.”
Returning to Television
When Ms. Smith returned to ESPN with her Michael Jordan hairstyle, the experience was amplified because of millions of television viewers. But the decision to not wear a wig was a quieter one, reflective of the anxieties many women face after treatment.
“My biggest fear was that kids would be scared when they saw me,” she said. “There had never been a woman on ESPN, as far as I know, who had gone on TV bald. I was worried that when I was on TV, what I was saying would get lost because people would be distracted by a bald woman.”
On one of the first days of chemotherapy, Ms. Smith asked for a prescription for a wig. She wore the wig to her grocery store the day after visiting the same store with her shaved head. The experience surprised her.
“Someone was like, ‘Oh your hair looks so great.’ I said, ‘Did you not notice that I was bald yesterday and now I have hair?’” she said.
A wig, Dr. Chan said, is a personal choice. There is no right answer, as many women wish to regain their former appearance after surgery. A wig can also halt incessant questions from strangers, which is sometimes a welcome relief for patients with cancer.
As the NFL Draft inched closer, Ms. Smith and Dr. Chan began discussing her plans to return to television and what she would do about her hair. For Dr. Chan, the choice was made easier by Ms. Smith’s physical features (“Shelley has a great shaped head,” Dr. Chan said) and, more importantly, by her personality.
“For Shelley, I knew she had been very public about having breast cancer and going through breast cancer treatment. I knew this was something she was doing to promote awareness,” Dr. Chan said. “I thought if Shelley was comfortable with it, it would be empowering for her to go on air without a wig and show the world, ‘Hey, this is who I am, and this is what I do.’”
Ms. Smith continued appearing on ESPN after the NFL Draft and has returned to her normal role with the network. After her return, a colleague mentioned that his daughter had seen Ms. Smith on television.
“I was doing a media show and one of the guys’ daughter said, ‘Dad, that woman has no hair.’ My heart just stopped like, ‘Oh my god, it happened. Kids are scared,’” she said.
No, her colleague insisted, that wasn’t the case. She wasn’t scary. In fact, she was an inspiration.
“The father turned it into a teaching moment,” she said. “He told her there is cancer in the world and when people get medicine for cancer it causes their hair to fall out. It’s just what the medicine does.”