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Before signing the consent forms for my lumpectomy, I asked my surgeon if there was a possibility that I might wake up from my operation without a breast. "No," he said, "we don't do that any longer."
Ah, but they used to. In fact, according to "The Breast Cancer Wars" it was standard procedure during most of the twentieth century for a woman to go under the knife for a biopsy and wake up without her breast, axillary nodes, and her chest wall muscles. If she were unlucky enough to be operated on in the fifties, she might also be minus an arm and part of her rib cage.
Chapter 4, "The Scalpel Triumphant: Radical Surgery in the 1950s" is truly grotesque to someone who had her own surgery in December, 2001. One surgeon of that middle decade even accused a colleague of "having performed a 'humanectomy.'" People who went in to the operating room with breast cancer might lose a whole forequarter (clavicle, scapula, and an arm). For reproductive cancers, there was an operation called the hemipelvectomy, "which required removal of the 'hind-quarter': a leg and an adjacent bone from the pelvis." A surgeon named Pack performed over 200 hemipelvectomies on men and women, acquiring the nickname 'Pack the Knife' from his admiring colleagues.
How did the war against cancer come to involve such radical surgeries? According to the author, surgeons gained experience with extreme operations during World War II, where they also learned about the life-saving qualities of blood transfusions and penicillin: "Indeed, the Surgeon General had reported a remarkable 96 percent survival rate among injured World War II military personnel."
When the surgeons returned from the battlefields, they were prepared to take extreme measures against an enemy more ancient than the Nazis. Cancer researcher Michael Shimkin later noted, "'surgeons went radical and then superrradical' during the decade following World War II."
I started reading this book fully prepared to despise William Halsted, the surgeon who invented the radical mastectomy and performed it first in 1882. However that was not to be the case. Halstead was a great surgeon and "believed that his operation, if performed early enough in the course of the disease, could substantially prolong the survival of patients"--as did generations of surgeons following his training and example, even though 75% of their patients were dead five years after surgery.
Even after statistics like the above, randomized controlled trials involving lumpectomies and follow-up radiation, womens' activism, better mammography, and a new theory on how breast cancer metastasized, older surgeons performed radical and modified radical mastectomies well into the 1980s--a century after Halstead performed his first. When speaking of one of the old-school surgeons who turned 80 in 1980, Dr. Susan Love, herself a notable breast surgeon, remarked: "It was sad. He had lived too long. He just couldn't make that critical jump."
Dr. Lerner has written a superb medical and cultural history of America's war against breast cancer. Women who are considering treatment options for breast cancer should, at the very least read Chapter 11: "The Past as Prologue--What Can the History of Breast Cancer Teach Us?"
2 FIRST-CLASS HIDDEN HISTORY
Like many others who have discovered this treasure of a highly readable but profoundly illuminating book. I fully agree with Dr. Susan Love, who called it a "riveting" story and "one of the best books I have read in a long time." As someone who has long been active in the women's health movement I am sure that THE BREAST CANCER WARS will become a fixture on the short list of "must have" titles for any patient or advocate. Dr. Barron Lerner is a gifted writer, a caring clinician(Associate Professor of Medicine and Public Health at the Columbia University College of Physicians and Surgeons) a distinguished PhD medical historian, as well as the devoted son of a breast cancer survivor whose "quiet perseverance in the face of a terrifying disease has been an inspiration." Thus, he brings a thoroughly rounded perspective to the history of breast cancer diagnosis and treatment that (to my knowledge) no other male physician has ever attempted, much less achieved. His fascinating descriptions of the central role that activist patients have played in forcing doctors to treat breast cancer more humanely, and, yes, believe it or not- more scientifically, is a major contribution to modern social and science history. Dr. Lerner's title is well-chosen, as he escorts us through the maze of controversies and "wars" that mark breast cancer diagnosis, treatment and prevention, showing them to be dramatic, amazing, frustrating, sometimes ridiculous, and often highly unfair to patients. While THE BREAST CANCER WARS is not a "how to" book it provides women- and men-with a wealth of necessary background and information that will enable them to become far more savvy and sophisticated on every aspect of any breast cancer discussion.
3 A Very Important Book
In trying to understand and have an appreciation for the larger perspective of Medicine, Doctors and the Medical/Cancer Establishment, I found "Breast Cancer Wars..." to be the most insightful and helpful book of its kind that I have read. And in seeking to understand my disease (Leukemia), and the process I have been going through, I have read dozens of books on Health, Healing, Cancer, Medicine, the Medical Establishment etc...
Dr. Lerner provides a comprehensive, readable and above all balanced book in which he examines all the factors which impact on the development of a cancer treatment in the U.S. And he maintains this sense of balance while examining what is one of the most emotional, sensitive and controversial areas in all of cancer diagnosis and treatment; Breast Cancer and the Radical Mastectomy.
What particularly distinguishes his writing is the way in which he is able to provide a clear, detailed history and narrative while exploring the human, cultural, political, societal and gender-related issues that have impacted on the development and treatment of Breast Cancer.
In this extremely controversial and politicized area, he does not look for, or find a villain; his is not an attempt to blame or demonize. And that is a great relief.
Instead, in discussing the individuals involved - the physicians who first espoused and continued to advocate the use of Radical Mastectomies and those who opposed it, the prominent women who elected this procedure for themselves, the women who began to oppose the Radical Mastectomy and who challenged the medical system, the women who used their influence and resources to initiate important cancer and support organizations - Dr. Lerner provides very human portraits which helped me to appreciate how and why these individuals developed their views, and how each one of them came to effect the course of the debate and the evolution of Breast Cancer treatment.
And he does not fail to convey the tremendous emotional, physical and psychological impact that these doctors, individuals and organizations have had on women coping with Breast Cancer.
I recommend this book to anyone who is trying to understand the context of an illness and treatment and the various forces, from individual to societal, which play a role in the treatment of disease in the U.S.
4 An important addition to an important subject
...From his book I learned about a number of feminist heroes who brought breast cancer to the spotlight. Nor does Lerner hesitate ot criticize physicians, when appropriate. In sum, the "Breast Cancer Wars" describes a series of troubling controversies with a great deal of even-handedness. Breast cancer patients and others concerned with this fearsome disease will surely benefit from Lerner's insights.
5 Great Book
This is a fascinating story about breast cancer treatment in the U.S. Actually, it's the story of overtreatment that lasted 80 years--of surgeons who ignored the evidence that their operations were unnecessarily drastic--of a few courageous doctors and women who pushed against the tide.
The take-home message: just because all doctors are doing it, doesn't mean it's the best treatment for breast cancer. This book provides an excellent context for anyone who must make a decision about today's cancer treatments.
6 Rip-off!!!
Regrettably, Lerner has "covered" the impressive original research and intellectual synthesis of Ellen Leopold's book "A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the 20th Century." Leopold's is the first book ever written on the social history of the radical mastectomy and breast cancer in this century, including previously unpublished correspondence and new information. Lerner makes a passing reference to Leopold's book, mistakenly dismissing her as a "journalist" and "radical feminist." Neither appellation is accurate. She is an architect and economic historian. Alas, she is not an M.D. For readers who want the insights of the intelligent female discoverer of this 20th century terrain rather than the sanitized medical perspective, I recommend "A Darker Ribbon."
7 THE BREAST CANCER WARS
This is a great read. It is a must for women of all ages and the men in their lives. Don't miss this one! It's unforgettable.