Leaders in the Fight Against Breast Cancer

The benefits of challenging conventional wisdom are on full display in this thorough historical account of breast cancer treatment in 20th century America. Indeed, it becomes clear after just a few chapters that it was a mere handful of pioneers--doctors and patients--who refused to settle for the status quo and demanded scientific advances in the detection, treatment and prevention of breast cancer. These leaders, not surprisingly, often met great resistance to push forward new ideas. Change isn't easy.

But change has greatly benefited American women who have breast cancer. "The Breast Cancer Wars," written by Dr. Barron H. Lerner, a professor at Columbia University College of Physicians & Surgeons, is a detailed, colorful account of the people and events that shaped breast cancer treatment, mostly in the last half of the century.

This book may be of lesser interest to women in the throes of breast cancer treatment who are seeking more practical advice. But the story of the quest to improve treatment is captivating and should interest students of medical history, consumer advocates and health professionals, among others. Most interesting is Lerner's determination to show how social and cultural forces shaped trends in treatment. For example, he explains how physicians in mid-century regarded the breast as a "nonvital and functionless gland," but were finally swayed by women's outrage at radical surgeries that removed the breast and resulted in disfigurement.

Consumer groups also played a large role in guiding cancer treatment. The American Cancer Society, Lerner notes, was founded in 1913 as the American Society for the Control of Cancer by 10 doctors and five nonphysicians. Early in its history, the organization established a set of axioms that guided cancer researcher for the remainder of the century: 1) Cancer is at first a local disease; 2) With early recognition and prompt treatment, the patient's life can often be saved; 3) Through ignorance and delay, thousands of lives are needlessly sacrificed. The first major fund-raising effort for cancer was led by Mary Lasker, a New York socialite whose housekeeper developed uterine cancer.

Years later, mass organizing by women in the U.S. led to increased funding for breast cancer and a greater role for patients in treatment decisions. And it was pressure from women, and a few doctors, that led to the development of lumpectomy for removal of some tumors in place of mastectomy.

Lerner cautions that the metaphor for breast cancer research--from which he draws the title of his book--of a war to be waged against a conquerable foe is too simplistic. He is concerned that it led, and may continue to lead, to overtreatment and unrealistic expectations about the effectiveness of treatment.

Future treatments, many of which will depend on genetics, may not yield the straightforward benefits for which consumers yearn. At the end of the book, Lerner offers this important message: "Rather than feeling compelled to reach decisions that are objectively 'right,' women should choose what is right for themselves."

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