Edwards to Stay in Race Despite Return of Wife’s Cancer
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JUDY WOODRUFF: Democratic presidential hopeful John Edwards and his wife, Elizabeth, delivered their news today in Chapel Hill, North Carolina.
JOHN EDWARDS: The biopsy showed that the cancer had returned. It was malignant. And, so, the net result of all the tests is that she has — her cancer is back. It’s largely confined in bone.
JUDY WOODRUFF: Elizabeth Edwards was first diagnosed with breast cancer in the final weeks of the 2004 presidential campaign. John Edwards was the vice presidential nominee, sharing the Democratic ticket with Senator John Kerry.
Today, the Edwards explained how concern over a broken rib quickly led to the discovery this week of malignant cancer in Elizabeth’s right rib.
JOHN EDWARDS: when the cancer goes from breast and shows in bone, which it’s doing now, it’s no longer curable. It is completely treatable. The thing that is true is that her cancer will not be cured now.
JUDY WOODRUFF: For her part, the 57-year-old Elizabeth Edwards said she and her family were very hopeful.
ELIZABETH EDWARDS: And we’re blessed to have such an extraordinary doctor in whose care I have been and will continue to be.
But the other thing you do is keep — keep a positive attitude that we had actually before. You know, John was saying that, last week, people asked him how I was doing, and he said, she’s cancer-free. It turned out not to be the truth.
But it was that attitude of, you know, we’re going to always look for the silver lining. It is who we are as people, and we will continue to do it.
I do want to say something. And that is, this is what happens to every cancer survivor, not that you ultimately get a bad diagnosis, but, every time you get something suspicious, you go into alarm mode.
And that’s all — every cancer survivor that you know personally has exactly that experience of knowing that the pain they feel in their side, the ache they feel someplace could be the sign of something worse. This turned out to be.
There were times yesterday that we thought it might be a lot worse than it is, and we wouldn’t be having the same conference we’re having right now with the same hopeful tone. We were actually encouraged as we got more and more test results. And, right now, we feel incredibly optimistic.
I expect to do next week all the things I did last week, and the week after that, and next year at the same time, all the same things I did last week. I do not expect — except that I will be seeing Dr. Carey a lot more often — I don’t expect my life to be significantly different.
One of the things — one of the hopeful signs, besides the fact that this is, as Lisa will say, low volume, in terms of how much cancer I have in me — in my bones — is, I’m also completely asymptomatic. And I’m actually very lucky that I cracked this rib, because, if I hadn’t cracked it, I wouldn’t have gotten the chest X-ray that identified the suspicious place.
JUDY WOODRUFF: Elizabeth Edwards, a lawyer, has played a major role advising her husband in 2003 and ’04, as well as in the current campaign. She was asked today if she felt ready to accompany him on another presidential run.
ELIZABETH EDWARDS: I’m absolutely ready for this. I’m ready for that. Honestly, I have all the energy. I mean, one of the reasons to do a press conference, as opposed to a press release is that you can see, I mean, I don’t look sickly; I don’t feel sickly. And, you know, I’m as ready as any person can be for that. I mean, you know how grueling it is in general.
There is a likelihood that some of the medications that I will be taking will at some times make me tired. I have, as you all well know — and a lot of you know — actually know that my children — my younger children, a 6- and an 8-year-old. If I get tired, I actually expect they’re going to be the reason, as opposed to the medications that Dr. Carey is going to be giving me.
But there’s a chance the both of them will make me tired sometimes. And, so, sometimes I will step back to sort of regain my — my energy.
But I’m also 57, you know, and so I might get a little tired. But, right now, I don’t feel any of that.
JUDY WOODRUFF: Edwards’ physician, Dr. Lisa Carey, spoke to reporters afterwards.
DR. LISA CAREY, Elizabeth Edwards’ Doctor: This is a very variable thing. I don’t have a crystal ball about how she’s going to do.
I can tell you that many patients with exactly the circumstances that she has do very well for a number of years. And the fact that she is a healthy person, and that there isn’t a lot of the cancer, and that she doesn’t have symptoms, all work in her favor.
JUDY WOODRUFF: Dr. Carey added that Edwards’ cancer may have spread to other sites, including her lungs.
Stage four breast cancer
JUDY WOODRUFF: For more about treating and dealing with breast cancer, we turn to Dr. Julie Gralow. She's associate director of the Fred Hutchinson Cancer Research Center. She's an oncologist at the University of Washington School of Medicine and a spokesperson for the American Society of Clinical Oncology. Dr. Gralow, first of all, tell us, what is stage four breast cancer?
[Editor's Note: This segment misidentified Dr. Gralow's title and medical affiliation. Dr. Julie Gralow is an associate professor of medical oncology at the University of Washington and Seattle Cancer Care Alliance. She also is an associate head of the breast cancer program at Fred Hutchinson Cancer Research Center.]
DR. JULIE GRALOW, Associate Director, Fred Hutchinson Cancer Research Center: Stage four breast cancer is when breast cancer comes back outside the general area of the breast and the chest wall. The most common places that stage four breast cancer occurs are the bones, the liver and the lungs.
JUDY WOODRUFF: And we heard the Edwards, we heard their doctor say today it's treatable, but it's not curable. Why not?
DR. JULIE GRALOW: Well, I think that's a very accurate way of looking at it.
At this point, there's really no reasonable expectation, when any woman has breast cancer in the bones, that the cancer will go away entirely without any therapy, and then never return. But diabetes, for the most part, is incurable. Hypertension, high blood pressure, is incurable. Those are also examples of highly treatable diseases, where you expect to be on therapy for the remainder of your life.
You might have to adjust those therapies, but hopefully will have a long life.
Cancer in the bone
JUDY WOODRUFF: Help us understand. Two-and-a-half years ago, Mrs. Edwards was diagnosed with breast cancer. She was treated for that. It -- we were told it went into remission. Now she has what is described as cancer in the bone. What happened to cause this?
DR. JULIE GRALOW: It's quite clear that, when cancer comes back in the bone or the liver or the lungs, that it was there all along. It didn't regenerate anew. It was there even during all of the prior treatments.
Cancer can go through the blood, through the lymphatic system. And bone seems to be a site that has a particular affinity for breast cancer cells. There's an interaction between the bone cells and the breast cancer cells that allow it to survive. You can't see it at the time. It's a few cells. It won't show up on scans. Unfortunately, in this case, it appears to have survived all of the prior treatment and the chemotherapy.
JUDY WOODRUFF: And, so, to be perfectly accurate, this is breast cancer in the bone, not bone cancer?
DR. JULIE GRALOW: Absolutely, two very different diseases, treated very different ways.
JUDY WOODRUFF: And, when we understand -- when we hear them say that this is breast cancer, is it in one bone? Is it in bone tissue in more than one place? Or we don't know the answer to that?
DR. JULIE GRALOW: Even if we only see it in one site, we know that, once breast cancer is in the bone, it's generally spread much more widely throughout the bone.
The bone is highly connected to the blood. The marrow is constantly bathed by blood. So, even if -- and I don't know this in Mrs. Edwards' case -- it's only seen in one spot, it is undoubtedly in other spots, which is why, in general, we would be using a systemic therapy, a therapy that floats through the blood, as opposed to a highly local therapy.
Possible cancer in the lungs
JUDY WOODRUFF: So -- and, again, on -- on where it is, we also heard that the doctor, Mrs. Edwards' doctor -- I believe her name is Dr. Carey -- say today that -- that she ought -- that it's possible this cancer is also in the lungs.
Now, what difference would it make if it were isolated in the bone, or if it had already spread to the lungs?
DR. JULIE GRALOW: Patients whose disease comes back in the bone only or in the bone predominantly tend to have much longer survivals, tend to have slower-growing, less aggressive disease.
The lungs, and in particular the liver, are organs where, if the cancer gets out of control, it can lead to a more rapid demise. So, although a little bit of cancer in the lungs can be still a reasonable prognosis, we can expect years of survival, if the lungs or the liver become filled with cancer, those organs stop functioning. And that is what leads to death in most of our breast cancer patients who ultimately die of their breast cancer.
JUDY WOODRUFF: So -- so, based on what you know right now, Dr. Gralow, what is Mrs. Edwards' prognosis? And, again, we know they're still doing tests about this -- on this cancer.
DR. JULIE GRALOW: Well, without knowing the full details, I would have to say there's a lot of reason for her optimism and her hope. It's very appropriate. I think that I -- she gives hope to all of our patients around the country who are fighting metastatic breast cancer.
We don't have a crystal ball, as Dr. Carey said. Averages are just that, averages in terms of survival. They're wrong for almost everybody. If the disease is predominantly in the bones, then, we can expect years of survival. That's very realistic.
And the treatment options are changing so much. We have got so many terrific new therapies that are available, even since Mrs. Edwards was originally diagnosed, that we can expect more treatments to become available that will hopefully allow all women with metastatic breast cancer, and cancer in general, to live out long lives.
Cancer treatment options
JUDY WOODRUFF: And, just quickly, what are those -- the options of treatments?
DR. JULIE GRALOW: It's important to individualize the cancer, to know what genes are turned on and off, estrogen receptors important. About three-quarters of breast cancer express estrogen receptor. We have drugs that target that receptor and turn the cell off.
HER2 is another very important gene that we would need to know about. We have therapies that target that. And we're entering an era of -- of personalized cancer therapy, where we understand the handful, maybe the dozen genes and proteins that are unique to that cancer, and then we can devise therapies, formulate treatment plans to target those -- those genes.
JUDY WOODRUFF: And we did hear the doctor, her doctor, today say that she does expect that there wouldn't be surgery.
DR. JULIE GRALOW: That's right. That would not be performed, given we would expect this disease, even if we can't see it, has spread much farther than one site.
JUDY WOODRUFF: And Mrs. Edwards' quality of life, Dr. Gralow, what would you expect going forward? She said she expects to have -- her next week to look like last week, to carry on as much as possible. Her husband, obviously, has a busy schedule. She does. Can she carry on?
DR. JULIE GRALOW: It depends entirely on the treatment.
But there are great treatments available now that -- that don't cause a lot of symptoms. She right now is feeling relatively asymptomatic, except for pain in that rib. And that's a really good sign. There are therapies where she might have fatigue as the main side effect.
And I think we do much better with nausea drugs, if she needs chemotherapy. And we do -- we do better in general with quality of life in metastatic breast cancer. We don't do well enough, but I also think there's reason for optimism that -- that she can lead a busy, active life.
I think her -- her biggest issue is, she has a couple young kids to raise. And, of course, we're all hoping that she -- she lives to raise those kids and see her grandchildren.
JUDY WOODRUFF: Well, we certainly all -- we, all of us, wish her the very best.
Dr. Julie Gralow, thank you very much.
DR. JULIE GRALOW: Thank you.