Remembering Kelly Preston and Breast Cancer

What was said, and what was not

John Travolta announced on Instagram in July 2020 that his wife, the actress Kelly Preston, had died. CNN reported it that day. She was 57, and she had been living with breast cancer for two years.

Travolta said she "fought a courageous fight with the love and support of so many," and thanked her doctors and nurses at MD Anderson Cancer Center. A family representative told PEOPLE that Preston had chosen to keep her fight private, and had been undergoing treatment for some time with the support of close family and friends.

Nothing else about her diagnosis was made public. No stage, no subtype, no treatment plan. This article makes no guesses.

What is worth explaining is the thing that privacy hides from public view: what two years of breast cancer treatment can actually consist of, and why two people with the same words on a pathology report can end up on entirely different regimens.

Not one disease

"Breast cancer" is a category, in the way that "car" is a category.

The National Cancer Institute reports that invasive ductal carcinoma, which starts in a milk duct and grows into surrounding tissue, is the most common type at 70% to 80% of cases. Invasive lobular carcinoma, which starts in the milk-producing lobules, accounts for 10% to 15% and grows in a more scattered, single-file pattern.

The histologic type is only half the picture. NCI states that all breast cancers are tested for hormone receptors, meaning estrogen and progesterone receptors, and for HER2, a growth-signaling protein. Those results split breast cancer into biologically different diseases:

• Hormone receptor positive. The tumor cells carry receptors that estrogen or progesterone can plug into, and the cancer uses those signals to grow.
• HER2 positive. The tumor makes too much HER2, which drives growth. Drugs designed against HER2 work here and nowhere else.
• Triple negative. No estrogen receptors, no progesterone receptors, no HER2 excess, which removes the targets that the other groups aim at.

The biopsy report also gives a grade from 1 to 3, where 1 looks closest to normal tissue. Multigene tests such as Oncotype DX and MammaPrint can estimate recurrence risk and help decide whether chemotherapy is likely to add anything.

What the stages actually mean

NCI describes them in plain terms.

Stage 0 is noninvasive, such as ductal carcinoma in situ. Stage I is a small cancer in breast tissue, possibly with nearby nodes involved. Stage II is cancer in the breast or nearby nodes or both. Stage III has reached nodes close to the breast, the skin, or the chest wall.

Stage IV means it has spread to other parts of the body, such as the bones, liver, or lungs. That is also called metastatic breast cancer. Breast cancer that has traveled to the liver is still breast cancer, and it is treated with breast cancer drugs, not liver cancer drugs.

What treatment involves over months and years

NCI divides treatment into two kinds. Local treatments, meaning surgery and radiation, are aimed at the area where the cancer is. Systemic treatments are drugs that travel through the bloodstream and reach cells anywhere: chemotherapy, hormone therapy, targeted therapy, and immunotherapy.

Hormone therapy is where the length of treatment surprises people. It only works for hormone receptor positive cancer. NCI lists tamoxifen and toremifene, aromatase inhibitors such as anastrozole, letrozole, and exemestane, the receptor degrader fulvestrant, and ovarian suppression drugs including goserelin and leuprolide.

The duration is the point. NCI states that hormone therapy taken for five years or more can greatly reduce the risk of a new breast cancer, of recurrence, and of dying from breast cancer. That is five years of daily pills after surgery and radiation are long finished. NCI lists the common side effects as hot flashes, night sweats, and loss of interest in sex, and notes it can disrupt the menstrual cycle in premenopausal women.

When to get checked

NCI lists these breast changes as reasons to contact a doctor:

• A lump, or a thick or firm area, in or near the breast or under the arm.
• A change in the size or shape of one breast.
• Nipple discharge that is not breast milk.
• A nipple that flattens, inverts, or changes the direction it points.
• Skin that is scaly, swollen, red, or darkened on the breast, nipple, or areola.
• Dimpling or puckering of the skin, or a rash.
• Swelling of the whole breast with no distinct lump.

Two rules attached to that list matter more than the list itself. NCI states that breast cancer does not usually cause pain, so waiting for something to hurt is not a safe strategy. And NCI says to follow up on a breast change even if you had a recent normal mammogram.

For screening, the U.S. Preventive Services Task Force recommends mammography every two years for women aged 40 to 74. That is a grade B recommendation, issued April 30, 2024.

Symptoms that suggest spread need their own attention. NCI lists back pain, bone pain or fractures, shortness of breath, a constant dry cough, abdominal pain or swelling, jaundice, severe headaches, seizures, and vision changes. In someone with a history of breast cancer, any of those means calling the oncology team now.

The survival picture, for populations

These are group figures. They describe hundreds of thousands of women and predict nothing for any one of them.

SEER, the cancer surveillance program at NCI, publishes an American Cancer Society projection of 321,910 new female breast cancers in the United States in 2026, about 15.2% of all new cancer diagnoses, and 42,140 deaths. Five-year relative survival across all stages is 91.9% for women diagnosed from 2016 to 2022, and the median age at diagnosis is 64.

Stage separates those outcomes sharply. SEER reports five-year relative survival of 100.0% for localized disease, 87.5% for regional disease, and 33.8% once the cancer has spread to distant organs. About 64% of cases are found while still localized, and about 6% are distant at diagnosis.

The part worth keeping

Preston's family asked for privacy and got it. That was theirs to decide, and it carries no lesson for anyone else.

The part that does travel is smaller. A breast cancer diagnosis is not one thing. A pathology report answers three questions about receptors and one about grade, and those answers shape everything that follows.

Sources

• NCI: Breast Cancer Treatment (PDQ) — Health Professional Version
• NCI: How Is Breast Cancer Diagnosed?
• NCI: Breast Cancer Stages
• NCI: Treatment for Breast Cancer
• NCI: Hormone Therapy for Breast Cancer
• NCI: Signs and Symptoms of Breast Cancer
• SEER Cancer Stat Facts: Female Breast Cancer
• USPSTF: Breast Cancer Screening, final recommendation, April 30, 2024
• CNN: Kelly Preston, actress and wife of John Travolta, has died following a two-year battle with breast cancer