Doctors Find Small Tumor, Remove First Lady’s Breast

Surgeons removed First Lady Nancy Reagan’s left breast Saturday, after discovering a pea-sized tumor that appeared not to have spread to the lymph nodes or surrounding tissue, the White House said.

A breast cancer specialist not associated with the case said that Mrs. Reagan’s chances for cure--without additional therapy--appear to be excellent. But he cautioned that firm conclusions about her prognosis must await the results of additional laboratory tests to be completed today.

“I would view this as a success story of cancer screening,” said Dr. John Glaspy, a medical oncologist at UCLA Medical Center in Los Angeles. “The tumor was caught very early. Based on what we know now, this tumor poses no threat to the First Lady’s survival or life style.”

Mrs. Reagan was “awake and resting comfortably” in her room at Bethesda Naval Medical Center following a breast biopsy and the uncomplicated 50-minute surgery, according to a statement released by Dr. John E. Hutton Jr., the White House physician. The First Lady is expected to remain in the hospital for five to seven days.

President Describes Condition

“She’s feeling just fine,” President Reagan said as he returned to the White House about four hours after his wife’s surgery. “Everything’s just . . .” he said, completing his sentence by making an “OK” sign with his hand.

Earlier, in the recovery room, the President was quoted as telling his wife: “Honey, I know you don’t feel like dancing, so let’s hold hands.”

Doctors told Mrs. Reagan that they had removed her left breast. They were uncertain, however, if the information registered because she remained groggy from the general anesthetic used for the surgery, according to Elaine Crispen, the First Lady’s press secretary.

Mrs. Reagan, 66, entered the hospital Friday, 11 days after her routine annual mammogram detected a “suspicious lesion” on her left breast. The lesion was so small that it caused no symptoms and could not be felt by physical examination.

Suspicious Area Removed

Saturday morning, a team of surgeons, led by Dr. Donald McIlrath of the Mayo Clinic in Rochester, Minn., removed the suspicious area and found preliminary microscopic evidence of a “non-invasive intraductal adenocarcinoma of approximately seven millimeters (5/16ths of an inch) in size,” the White House said.

Such a tumor is one of the earliest stages of breast cancer, because it remains confined to the channels within the breast that make and transmit breast milk. It differs from most breast cancers, which are not diagnosed until after they have spread through the lining of these channels and infiltrated the surrounding tissue.

Subsequently, the surgeons performed a modified radical mastectomy, in which Mrs. Reagan’s left breast and the lymph nodes from beneath her left armpit were removed. Preliminary microscopic examinations of the lymph nodes and surrounding tissue were negative for malignancy as well.

No Additional Treatment

“This is a very positive report,” White House spokesman Marlin Fitzwater told reporters. He added that Mrs. Reagan’s physicians had “no plans” for any additional treatment, such as chemotherapy, radiation therapy or breast reconstruction surgery.

But Fitzwater provided few medical details of the biopsy and mastectomy, citing the First Lady’s desire to keep publicity “as low-key and dignified as possible.”

As Mrs. Reagan began her recuperation, pathologists from Mayo Clinic and the Naval Medical Center were preparing to slice her breast tissue and lymph nodes into the thin sections that will be stained with dyes and scrutinized under the microscope. This careful examination is necessary to be sure that all of her tumor is in the early stage, which was the initial diagnosis.

According to UCLA’s Glaspy, intraductal breast cancers “never spread to the lymph nodes” and are “100% cured by removal (of the tumor).”

Infiltration Increases Risks

By comparison, once the breast tumor begins to infiltrate the surrounding breast tissue, there is about a 20% risk the cancer will recur within 10 years, he said. If the lymph nodes are diseased as well, the risk is considerably higher.

Prior to the surgery, some tumor specialists had expressed surprise that Mrs. Reagan chose to have her entire left breast removed, when it might have been possible to only remove the part of the breast containing the cancer, a procedure known as lumpectomy.

But Crispen said that Mrs. Reagan had discussed the various treatment options with her doctors and then chose to have the mastectomy because “it was the most positive way to get it all over with.”

The American Cancer Society estimates that about 130,000 women develop breast cancer each year and that about 40,000 die annually from the disease. Despite advances in detection and treatment, the age-adjusted death rate from breast cancer has remained relatively constant over the last 50 years.