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

by Barron H. Lerner

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.

Product Details

ISBN-13:	9780195161069
Publisher:	Oxford University Press
Publication date:	05/01/2003
Pages:	416
Sales rank:	477,837
Product dimensions:	8.00(w) x 5.20(h) x 1.00(d)

About 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.

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

What People are Saying About This

Regina Morantz-Sanchez

Lively and readable, The Breast Cancer Wars combines the informed analytical perspective of a trained historian with the expertise of a scientist and the compassion of a good clinician. The result is a book sensitive to the perspective of both patient and practitioner.
—(Regina Morantz-Sanchez, Ph.D. Author of Conduct Unbecoming a Woman: Medicine on Trial in Turn-of-the-Century Brooklyn)

James T. Patterson

Barron Lerner has explored with brilliant even-handedness the century-long debates over the diagnosis and treatment of breast cancer. Authoritative and clear concerning scientific matters, The Breast Cancer Wars is also first-class social and cultural history.
—(James T. Patterson, Ph.D.,Bancroft Prize-winning author of Brown vs. Board of Education and The Dread Disease: Cancer in Modern American Culture)

Susan Love

This wonderful book illustrates beautifully the evolution of breast cancer treatment, demonstrating how science is far from the only driver of medical change. Barron Lerner tells a riveting story full of politics, personalities and patients, making this one of the best books I have read in a long time.
—(Susan Love, M.D., author of Dr. Susan Love's Breast Book)

Editorial Reviews

"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

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.

The Lancet

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.

Publishers Weekly - Publisher's Weekly

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.

Library Journal

"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

"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

"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

"This wonderful book illustrates beautifully the evolution of breast cancer treatment, demonstrating how science is far from the only driver of medical change. Barron Lerner tells a riveting story full of politics, personalities and patients, making this one of the best books I have read in a long time."—Dr. Susan Love

"Barron Lerner has explored with brilliant even-handedness the century-long debates over the diagnosis and treatment of breast cancer. Authoritative and clear concerning scientific matters, The Breast Cancer Wars is also first-class social and cultural history."—James Patterson, Bancroft Prize-winning author of Grand Expectations

"In The Breast Cancers Wars, Lerner presents a remarkably readable understanding of distinctly American attitudes toward the disease and the ways in which American culture and society have influence its treatment." — Library Journal

"(Lerner) describes the inner world of professional prestige and group conformity... he also gives a very clear account of the clinical and theoretical aspects of breast cancer... he resists the temptation to look back in self-righteous scorn on an earlier time when the concept of the patient's autonomy would not have occurred to even the most enlightened of physicians."—Sherwin Nuland, New York Review of Books

From the Publisher