What Martina Navratilova's Story Can Teach Us About Breast and Throat Cancer

A swollen neck node at a tennis tournament

BBC Sport reported the sequence in detail. Martina Navratilova noticed an enlarged lymph node in her neck during the WTA Finals in Fort Worth, Texas, in November 2022. A biopsy showed stage one throat cancer, and during those tests a lump was also found in her breast, which turned out to be a separate and unrelated cancer.

She was 66. On January 2, 2023, she said both had been caught early. "The double whammy is serious, but fixable, and I'm hoping for a favourable outcome," she said. "It's going to stink for a while, but I'll fight with all I have got."

On March 21, 2023, she told an interviewer: "As far as they know I'm cancer-free." She had first spoken publicly about breast cancer in 2010.

Two things in that account are worth pulling out. A neck lump can be the first sign of throat cancer, and two cancers found at once are usually two separate diseases rather than one that has spread.

Two primaries are not a metastasis

This distinction changes everything about treatment. A metastasis is the original cancer in a new location, keeping the original cancer's name and its drugs, whereas two separate primary cancers are two independent diseases. Each gets its own staging, its own plan, and its own team.

BBC Sport reported that the breast lump was diagnosed as an unrelated cancer. That word carries weight, because it means her breast cancer was staged as breast cancer while her throat cancer was staged as throat cancer.

The neck lump nobody expects

Throat cancers sit in the head and neck group, which the National Cancer Institute says usually begins in the squamous cells lining the mouth, throat, voice box, sinuses, and nose.

The oropharynx is the middle part of the throat. NCI describes it as running from the soft palate down to the hyoid bone, taking in the base of the tongue, the tonsils, the soft palate, and the throat walls. Cancers arising there often announce themselves through an enlarged lymph node rather than through any pain.

NCI names smoking and heavy alcohol use as "the two most important risk factors for head and neck cancers," and notes that using both is worse than either alone. It also reports that "about three-quarters of all oropharyngeal cancers are caused by chronic HPV infection," usually type 16. That is a statement about the disease in general, not about any individual patient.

HPV status is not a detail, and NCI reports that the AJCC eighth edition "separates oropharyngeal staging by HPV status," so the two versions are staged on entirely different scales. A p16 test on the biopsy tissue is what sorts them.

When to get checked

Neck and throat symptoms get blamed on colds and allergies for months. Three weeks is the cutoff.

• A neck lump lasting over three weeks, even a painless one
• A sore throat over three weeks, especially on one side
• Trouble or pain swallowing that is not improving
• Hoarseness for more than three weeks
• A mouth patch, white or red, that will not heal
• One-sided ear pain with a normal ear exam
• Unexplained weight loss, or coughing up blood

For the breast, CDC lists a new lump in the breast or armpit, thickening or swelling, dimpled or red or flaky skin, a nipple turning inward, discharge that is not milk, a change in size or shape, and breast pain. CDC notes that non-cancerous conditions cause these too, which is a reason to be checked rather than to wait.

What "early stage" actually means

Stage describes how far a cancer has travelled rather than how serious it feels, and NCI stages breast cancer using the AJCC TNM system, which records tumor size, lymph node involvement, and distant spread.

Early breast cancer is usually treated with surgery, and NCI notes that "breast cancer is commonly treated by various combinations of surgery, radiation therapy, chemotherapy, and hormone therapy." Radiation often follows breast-conserving surgery, and it can be given to lower the chance of the cancer returning rather than to treat cancer that is still present.

For early oropharyngeal cancer, NCI describes stage I and II disease as generally treated with one method, either radiation therapy or surgery. Stage III and IV disease usually means chemoradiation, or surgery followed by radiation, or chemotherapy given first.

What decides the breast treatment plan

Three test results on the pathology report drive it. NCI lists estrogen receptor status, progesterone receptor status, and HER2 status alongside stage, tumor grade, and menopausal status.

Receptors are docking sites on the cancer cell, and NCI states that estrogen receptor status is measured mainly by immunohistochemistry, a stain applied to the tissue, where "any staining of 1% of cells or more is considered positive for ER." HER2 is a growth-signaling protein, measured by that same stain or by counting gene copies. Hormone receptor positive cancers can be treated with drugs that block estrogen, while HER2 positive cancers respond to drugs built against HER2.

The survival picture for each

SEER, the National Cancer Institute's surveillance program, gives separate numbers for these two diseases.

For female breast cancer, the American Cancer Society projects 321,910 new cases and 42,140 deaths in the United States for 2026. Five-year relative survival is 91.9 percent overall, using cases from 2016 through 2022. By stage, in that same cohort, it is 100.0 percent for localized disease, 87.5 percent when nearby nodes are involved, and 33.8 percent once it has reached distant organs. Sixty-four percent are found while localized.

For oral cavity and pharynx cancer, the same society projects 60,480 new cases and 13,150 deaths for 2026. Five-year relative survival is 69.9 percent overall, again for 2016 through 2022. By stage it is 88.7 percent for localized disease, 69.7 percent for regional spread, and 36.0 percent for distant spread. Only about 26 percent are found while still localized.

The gap between those two stage-distribution figures is the whole story. Breast cancer has a screening test, while throat cancer does not, so it depends on someone noticing a lump and acting on it.

Prevention that exists now

For head and neck cancer, NCI names two levers. Avoiding tobacco and limiting alcohol addresses the risk factors it ranks highest. The second is vaccination, and NCI notes the FDA has approved Gardasil 9 to prevent cancers caused by HPV in people aged 9 through 45. Vaccination works best before exposure, which is why it is offered during early adolescence.

For breast cancer, CDC states the U.S. Preventive Services Task Force recommendation that women aged 40 to 74 at average risk get a mammogram every two years, with different schedules for women at higher risk.

Sources

• https://www.npr.org/2023/01/02/1146569305/martina-navratilova-cancer
• https://www.bbc.co.uk/sport/tennis/64146656
• https://www.bbc.co.uk/sport/tennis/65021842
• https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• https://www.cancer.gov/types/head-and-neck/hp/adult/oropharyngeal-treatment-pdq
• https://www.cancer.gov/types/breast/hp/breast-treatment-pdq
• https://seer.cancer.gov/statfacts/html/breast.html
• https://seer.cancer.gov/statfacts/html/oralcav.html
• https://www.cdc.gov/breast-cancer/symptoms/index.html
• https://www.cdc.gov/breast-cancer/screening/index.html