In this riveting narrative, Barron H. Lerner offers a superb medical and cultural history of our century-long battle with breast cancer. Revisiting the past, Lerner argues, can illuminate and clarify the dilemmas confronted by women with--and at risk for--the disease.
Writing with insight and compassion, Lerner tells a compelling story of influential surgeons, anxious patients and committed activists. There are colorful portraits of the leading figures, ranging from the acerbic Dr. William Halsted, who pioneered the disfiguring radical mastectomy at the turn of the century to George Crile, Jr., the Cleveland surgeon who shocked the medical establishment by "going public" with his doubts about mastectomy, to Rose Kushner, a brash journalist who relentlessly educated American women about breast cancer. Lerner offers a fascinating account of the breast cancer wars: the insistent efforts of physicians to vanquish the "enemy"; the fights waged by feminists and maverick doctors to combat a paternalistic legacy that discouraged decision-making by patients; and the struggles of statisticians and researchers to generate definitive data in the face of the great risks and uncertainties raised by the disease. As easy as it is to demonize male physicians, the persistence of the radical mastectomy and other invasive treatments has had as much to do with the complicated scientific understandings of breast cancer as with sexism.
In Lerner's hands, the fight against breast cancer opens a window on American medical practice over the last century: the pursuit of dramatic cures with sophisticated technologies, the emergence of patients' rights, the ethical and legal challenges raised by informed consent, and the limited ability of scientific knowledge to provide quick solutions for serious illnesses. A searching and profound work on an emotionally charged issue, The Breast Cancer Wars tells a story that remains of vital importance to modern breast cancer patients, their families and the clinicians who strive to treat and prevent this dreaded disease.
Sure to be controversial, this prodigiously researched medical and cultural history examines deeply held views on the treatment of breast cancer, particularly the societal embrace of a "war on cancer" rather than an emphasis on prevention. Lerner (a physician and medical historian at Columbia's College of Physicians and Surgeons), whose mother developed breast cancer, focuses, in large part, on the rise and fall of the radical mastectomy pioneered by surgeon William Halsted. To prevent what he theorized was the centrifugal spread of cancer to the lymph nodes, Halsted determined that it was necessary to remove not only the breast but also the nodes and two chest-wall muscles, leaving the patient feeling disfigured and with serious side effects. Lerner details the arguments that many in the scientific community made against this eventually discredited theory and against radical mastectomy, including those advanced by surgeon George Crile. Crile favored less aggressive operations and disagreed with the cancer establishment's relentless publicity campaign for early detection. He and others were convinced that it was the biology of the cancer, rather than how early it was diagnosed, that determined whether or not a tumor would metastasize. Barron also explores the strong impact the 1970s women's movement had on cancer treatment, with women demanding more information from physicians and input into their treatment options. Provocative and highly engaging, Lerner's book presents an important contribution to medical history; moreover, he offers insights into areas that most books about breast health and disease do not probe. Illus.