PROLOGUE
“Most surgeons in this country, no longer do the radical mastectomy, the removal of the breast and the underlying pectoral muscle. Unnecessarily mutilating, it is thought.” It was March 18, 1985. The not quite 50 year-old Phil Donahue propped his leg up on the edge of the stage, a casual, yet purposeful pose he had perfected in hosting The Donahue Show for nearly two decades.
“Now, the modified radical is used most often,” Donahue continued. “And now steps forward another very important study suggesting the lumpectomy might be enough for many, many women. Think of the consequences of this!” He paused dramatically.
“Who had their breast removed and didn’t need to? Who’s reading all those pictures, and do those guys – and they almost always are male – know what they’re doing?” The audience snickered.
A graphic popped onto the screen, entitled “Breast Cancer Facts.” The five bullets spelled out the current state of affairs: 1) One in eleven women will develop breast cancer; 2) It is the leading cancer killer in women, and the leading cause of death for women ages 30 – 40; 3) The five-year survival rate is 74%. For women whose tumors are small and localized, it is 96%.
“Can you imagine if the guys had this?” Donahue asked rhetorically, suggesting that perhaps society would take notice if as many men as would fill a Boeing 747 were diagnosed with a deadly disease every day of the year.
Another graphic appeared with a list of risk factors for breast cancer. They included early onset of menstruation, late menopause, late child bearing, increased height and weight, and family history. “Incidentally,” Donahue inserted, “if you have a baby at 16, it reduces the incidence of breast cancer.”
“Now you tell me!” shouted a woman in the audience, and laughter follows.
It’s the perfect segue for Donahue to turn toward the stage, where a sober-faced Dr. Marc Lippman, head of the breast cancer section of the National Cancer Institute (NCI), and a smiling Rose Kushner sat side by side. Perhaps it was that Rose could speak about breast cancer from personal experience; perhaps it was confidence from her vast knowledge of the disease, its detection and its treatment; or perhaps it was just her natural demeanor, but for the entire hour, that smile never left her face. At a time when newspapers were loathe to even print the word cancer – calling it instead “the Big C” – Rose was shockingly willing to share the details of her own breast cancer treatment, live and on national television.
Cancer had terrified humans for millennia. When a 1980 National Institutes of Health (NIH) survey asked women to list their most serious health concerns, a total of 76 percent put cancer at number one (44 percent specifying breast cancer). Stress, high blood pressure and heart disease troubled only 16 percent of those surveyed. Although strides had been made against cancer since President Nixon had signed the 1971 National Cancer Act, the disease still evoked specters of slow and agonizing death, spouseless mourners and parentless children. In some circles, cancer was still thought to be contagious. It was spoken of in hushed tones, and rarely discussed in public. Consequently, it was a risk to focus an entire television show on such a scourge.
And yet Donahue had. Deftly steering the discussion like a North Atlantic sea captain, he navigated the icebergs of the era’s breast cancer controversies: mammography, lumpectomy, chemotherapy, and the mother of all controversies, radical mastectomy. The standard of treatment for a century, the surgery was pioneered by Dr. William Halstead at Johns Hopkins Hospital. Halstead amputated breasts, scraped away muscles, and hacked out bone, leaving his women patients debilitated for life. He stubbornly believed that, if he got to the root of the cancer, survival chances would increase. Although the term radical is the Latin word for root, it also accurately described the surgery’s extreme nature. And it was a procedure Rose had flat out refused when her breast cancer was diagnosed in 1974.
“I had a modified radical,” Rose explained to the audience, “the removal of the breast and axillary lymph nodes, but no muscles or bone.” Smiling, she finished. “In 1974, that was as hard to get as a lumpectomy is today. And I had to go to Buffalo to get it.”
She had met with and rejected eight different surgeons in her home town of Baltimore, at the NCI, and in New York City, all of whom refused her request to leave her muscles and bones intact. She finally found Dr. Thomas Dao, 370 miles away at Buffalo’s Roswell Cancer Institute. Dao was practicing exactly what Rose sought, and their medical relationship would become a lifelong friendship. He fully supported Rose’s surgical wishes, while many of his colleagues found her as radical as members of the ongoing Women’s Movement, who marched in the streets protesting employment inequalities.
“Radical” Rose would not be silenced. She was certainly not the first woman who wanted to take charge of her own body and what could be done to it. Nor would she be the last. But it was a steep hill to climb. For centuries, women had been expected to be passive recipients of their medical care. They were frequently not told about the severity of any life-threatening illnesses, as it was assumed the news would be more than their fragility could handle. Any hormonal changes and the emotions associated with them were addressed with mind- and personality-numbing depressants.
Simply put, society dictated that it was a woman’s duty to do what her doctors told her. Discussions of her health, illness, or treatments were not necessary, in the doctor’s office or anywhere else. Research was not a woman’s friend either. With the exception of female-specific drugs and procedures, medical trials completely excluded women.
Still discussing the battle between doctors doing radical mastectomies and those who were taking a more conservative approach, Donahue again employed drama. “If the guy with the white coat … says to me, ‘Look …, you’re going in. Let’s get it all.’” He continued, “And if we take just a little bit of your breast, and you die, your husband will sue us!”
Rose interrupted him emphatically. “The younger women aren’t buying that any longer. The older women, yes. ‘Doctor, I’ll put my hand in yours, do whatever you want.’ The younger women – and by that I mean women under 50 – aren’t putting up with that anymore.”
In 1985, there was a great deal that women weren’t putting up with anymore. Despite what many voices claimed, these women weren’t fanatics, they weren’t communists, and they weren’t crazy. Making up more than half of the country’s population, they simply wanted to be treated in the same manner as the other half – the male half.
Change was in the wind. That was evident by Rose’s smiling confidence in her convictions, and by the nods and murmurs from the all-female audience. Women were demanding to be seen and heard (accompanied in their demands by brave men who were secure enough to join them). Equally important was more awareness and understanding of breast cancer. Better treatment options – dare they even hope for a cure? – needed to be researched. And given the ever-climbing number of new diagnoses every year, funding for breast cancer research needed to become a priority.
Today, it is hard to imagine a time when women’s health was marginalized, when breast cancer wasn’t discussed, when October wasn’t pink. And yet, those were the norm in 1985. Clearly, the time had come for a change, but first it is crucial to understand the role that women in general, and their health in particular, have been assigned over the years. The new dawn in breast cancer would be a long time in coming.
