Feminism in the War on Cancer
In a conference room in New Orleans, the 1898 convention of the American Surgical Association caught a glimpse of the newest piece of artillery in the War on Cancer. William Halsted stood on the podium explaining the then unmatched success rate of a new surgery he had developed to employ against Breast Cancer: the Radical Mastectomy.
The God of Surgery:
The creator of the tradition of using anesthesia in surgery, founder of the still famous surgical residency program at Johns Hopkins University, and the teacher of the founders of Neurosurgery and Urology (among his other achievements), Halsted was a veritable God in the medical community. His ambitious but meticulous character made him an iconoclast in surgical medicine. The radical mastectomy, however, seemed uncharacteristically reckless for him. To cure the cancer of the breast, Halsted believed, you would have to cut away as much of the nearby tissue as possible. He based it on a theory he dramatically named the “Centrifugal Theory” of cancer: that the disease spread in an outward spiral from the origin, through the blood and lymph. Surgery, he claimed, would have to cut as much away from near the site of the tumor as possible, so as to ensure that as little of the cancer could remain in the body.
The procedure spread like wildfire in the 1950s and 60s, with surgeons going as far as cutting away the entire pectoralis major (the chest muscle), the lymph nodes in the armpits and collarbone, and even, in some cases, a few of the ribs. The surgery was horribly disfiguring, involving the loss of one or both breasts and often far more, with Halsted himself noting, “The patient was a young lady whom I was loath to disfigure.” It gained a cult following among surgeons of all degrees of prominence, eventually evolving into superradical and ultraradical mastectomies. Many patients never knew they had an option of rejecting the procedure. The few that did still often chose to do it. The argument was simple and typically one-sided: lose the breast or die.
Of course, death was not actually inevitable. In fact, death from a radical mastectomy was quite likely. The massive wounds most certainly resulted in scars, but only for those that actually survived the surgery. The wounds were often so large that healing them alone proved to be a herculean feat. Many women were too frail for the surgery and did not live long after. But to the patient, the surgeon was a God, and to the surgeon, Halsted and his theory. Tradition created an imbalance of power, and asymmetry of information kept it that way. The procedure of course, was proven to be markedly superior to no intervention at all (with around twice the survival rate after five years), but one key piece of analysis was missing. It had not been compared to non-radical surgery.
The Embers of Resistance:
In 1924, Geoffrey Keynes successfully deployed a combination of radiation and non-radical surgery against breast cancer. He then repeated the procedure several times and realized to his great surprise that he was finding a rate of success similar to Halsted. The findings, however, did not go down well with other surgeons. They were ‘loath to disfigure’ Halsted’s legacy, and the craft they had so carefully honed. Nearly half a century later, George Barney Crile, inspired by Keynes’ work, decided he would investigate himself. He noticed clear patterns of cancers reappearing at sites distant to the tumor in which they originated, a violation of Halsted’s Centrifugal Theory. But getting surgeons to conduct trials proved to be impossible. No one was willing to challenge the powerful image of Halsted. And more pressingly, protecting the bodies of women was not a priority in their minds.
The Winds of Change:
The 1960s saw something new in the field of science and medicine. The second wave of the feminist movement, focussed on reclaiming women's bodies, was making new inroads into the medical profession — and radical mastectomy became a target. As waves of awareness spread, women began to realize two things they should have been informed of before: that the radical mastectomy had never been tested for efficacy, and that their bodies were unquestionably theirs; they could refuse to undergo it if they so choose. Popular support for clinical trials of the procedure ballooned. Newspapers and magazines were used by feminists to seek clarity and transparency about the treatment of female bodies. Crile also became a vocal supporter of the growing movement to reject the surgery.
Emboldened by the support for trials and empowered by public pressure to act, Bernard Fisher, the Director of the National Surgical Adjuvant Breast and Bowel Project (NSABP), proposed randomized clinical trials on radical mastectomies in 1971. In 1981, the results were published: The terrible, disfiguring procedure, and less radical, simpler procedures, were no different by any statistically significant amount, concluding that the trials “fail to demonstrate an advantage for those who had a radical mastectomy.” Further research done in light of the findings found the success of surgery to be more dependent on the spread of the cancer before the operation than the amount of tissue removed during. The Centrifugal Theory of Cancer was finally put to rest, changing the course of cancer research for everyone.
The radical mastectomy is no longer used to treat breast cancer.
- The Emperor of All Maladies — Siddhartha Mukherjee
- Halsted, W. S. (1894). The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June 1889, to January 1894. Annals of Surgery, 20, 497–555
- Fisher, B., Montague, E., Redmond, C., Barton, B., Borland, D., Fisher, E. R., … Investigators, O. N. (1977). Comparison of radical mastectomy with alternative treatments for primary breast cancer:A first report of results from a prospective randomized clinical trial. Cancer, 39(6), 2827–2839