The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America

Overview


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...
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The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America

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Overview


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 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 to combat a paternalistic legacy that silenced 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. And for this new paperback edition, Lerner has included a postscript in which he discusses the most recent breast cancer controversy: do mammograms truly lower mortality rates or do they lead to unnecessary mastectomies?
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 ethical and legal challenges raised by informed consent, and the limited ability of scientific knowledge to provide quick solutions for serious illnesses. The Breast Cancer Wars tells a story that is of vital importance to modern breast cancer patients, their families and the clinicians who strive to treat and prevent this dreaded disease.
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Editorial Reviews

From the Publisher

"Lerner, who teaches internal medicine, medical history and bioethics at the Columbia University College of Physicians and Surgeons, presents a thoroughly researched and deeply reflective history of breast cancer and the methods that have been employed to treat it."--Scientific American

"A detailed, colorful account of the people and events that shaped breast cancer treatment, mostly in the last half of the century.... 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."--Los Angeles Times

"A fascinating, well-told tale with important lessons for scientists, clinicians, politicians, and patients."--The Lancet

"Will be of great interest to medical professionals, advocates of breast-cancer research and awareness, and lay readers. Lerner has written an engaging narrative that is meticulously researched, well organized in its presentation, and immensely readable.... This book will be particularly valuable in the education of medical students."--The New England Journal of Medicine

"Sure to be controversial, this prodigiously researched medical and cultural history examines deeply held views on the treatment of breast cancer.... 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."--Publishers Weekly

Scientific American
"Lerner, who teaches internal medicine, medical history and bioethics at the Columbia University College of Physicians and Surgeons, presents a thoroughly researched and deeply reflective history of breast cancer and the methods that have been employed to treat it."
The Lancet
Lerner invokes US cultural attributes as part of his explanation and alludes to different histories in other countries, but does not pursue the question of national styles in depth. To do so would be a topic for another book. What we have now is a fascinating, well-told tale with important lessons for scientists, clinicians, politicians, and patients.
Publishers Weekly - Publisher's Weekly
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. Agent, Michele Rubin. (May) Forecast: A controversial book on a hot-button issue, this may not be widely read, but it will be widely discussed. Copyright 2001 Cahners Business Information.
Library Journal
Military metaphors have long been used in promoting breast cancer awareness, prevention, and treatment. In The Breast Cancer Wars, Lerner (medicine, Columbia Univ.) presents a remarkably readable understanding of distinctly American attitudes toward the disease and the ways in which American culture and society have influenced its treatment. Restricting his history to the 20th century, with a focus on the years from 1945 to 1980, Lerner begins by describing surgical pioneer William Halsted's radical mastectomy in a medical and historical context. Halsted's treatment was considered by some to be not radical enough and later, as the century progressed, was thought far too extensive. Lerner deftly profiles breast cancer survivors, celebrity spokeswomen, surgeons, and researchers and even makes the concept of randomized controlled trials (RCTs), first introduced in the United States in 1971, understandable to the lay reader. There are a few minor problems in this extensively researched and annotated book some medical terminology, which could be more extensively defined in the glossary, is explained in parentheses, and concerns over the environmental causes of breast cancer are mentioned only in passing. Ellen Leopold's A Darker Ribbon (LJ 10/1/99) covered a similar time period using a feminist, activist approach. Lerner's book is essential for women's studies and history of medicine collections, but no public or academic library could go wrong in adding it to its collection. (Index not seen.) Martha E. Stone, Treadwell Lib., Boston Copyright 2001 Cahners Business Information.
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Product Details

  • ISBN-13: 9780195161069
  • Publisher: Oxford University Press
  • Publication date: 5/28/2003
  • Pages: 416
  • Sales rank: 840,581
  • Product dimensions: 8.00 (w) x 5.30 (h) x 0.80 (d)

Meet the Author

Barron H. Lerner, M.D. is Angelica Berrie Gold Foundation Associate Professor of Medicine and Public Health at the Columbia University College of Physicians & Surgeons, where he teaches internal medicine, medical history, and bioethics. He is the author of Contagion and Confinement: Controlling Tuberculosis Along the Skid Road as well as articles in professional journals and publications such as The Washington Post. He lives with his wife and two children in Westchester County, New York.

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Table of Contents

Preface xi
Abbreviations 2
1 Introduction 3
2 Establishing a Tradition: William Halsted and the Radical Mastectomy 15
3 Inventing a Curable Disease: Breast Cancer Control after WorldWar II 41
4 The Scalpel Triumphant: Radical Surgery in the 1950s 69
5 A Heretical Interlude: Biology as Fate 92
6 Reality Check: Breast Cancer Treatment and Randomized Controlled Trials 115
7 "I Alone Am in Charge of My Body": Breast Cancer Patients in Revolt 141
8 No Shrinking Violet: Rose Kushner and the Maturation of Breast Cancer Activism 170
9 Seek and Ye Shall Find: Mammography Praised and Scorned 196
10 "The World Has Passed Us By": Science, Activism, and the Fall of the Radical Mastectomy 223
11 The Past as Prologue: What Can the History of Breast Cancer Teach Us? 241
12 Risky Business: Breast Cancer and Genetics 276
13 Epilogue 291
14 Postscript 297
Glossary of Breast Cancer Operations 303
Sources 305
Notes 309
Index 379
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