Fighting Breast Cancer

Perhaps no diagnosis is more feared by women than breast cancer. Medicine's efforts to cut the death rate from breast cancer have been far less successful than with other malignancies to which women are vulnerable. This year alone, 71,000 American women will learn that they have breast cancer, and some 30,000 will die of it. At least 1,000 a week are undergoing surgery. The operation usually involves radical mastectomy, a disfiguring procedure that includes removal of the breast and surrounding tissue. Though surgery can save their lives, many women feel that the price is their femininity. Doctors report a common reaction: "I feel like half a woman."

Medical science is a long way from keeping all these women whole, but reports at two medical meetings last week indicate progress in two important aspects of breast cancer: controlling recurrence and providing an alternative to radical mastectomy in certain cases. Meanwhile doctors are also working on ways to reduce the psychic misery of those who must undergo full-scale surgery.

Five Successes. The most dramatic announcement, made at a session sponsored by the National Cancer Institute at Gatlinburg, Tenn., concerned immunotherapy, or use of the body's own defense mechanisms to protect itself against cancer. Dr. Edmund Klein of Roswell Park Memorial Institute in Buffalo, N.Y., who has already had some success treating skin cancer, tried a variation of the treatment on five women. The patients had all undergone breast surgery already and were suffering recurrences of cancer. Klein injected a serum containing tuberculin--a substance that rouses the body to counterattack--directly into the women's cancerous lesions. Then, as the cancers showed signs of healing, he switched from the painful shots to regular applications of a tuberculin skin cream. Most people at some time in their lives have had tuberculosis antibodies naturally activated in their system, and tuberculin awoke the women's immunological "memories," triggering the production of more antibodies. The treatment induced an immune response to cancer as well.

Though much study and testing remain to be done before immunotherapy can become an anticancer weapon, Klein's results indicate that the effort is likely to prove worthwhile. All five of the women are still alive two years after treatment began and have shown improvement in varying degrees.

More controversial was the report of Dr. M. Vera Peters, of Toronto's Princess Margaret Rose Hospital, on simpler surgery for early breast cancer. Dr. Peters told a meeting at the Indiana School of Medicine that doctors should attempt the most conservative procedures possible "in order to preserve the patient's morale." Thus, for certain of her patients in whom early diagnosis has been made, she favors "lumpectomy," the removal of the cancer alone rather than the entire breast. She claims that the operation, which is followed by radiation therapy, offers selected patients essentially the same survival rate as radical mastectomy.

Other doctors doubt the long-term results of this method. Last week Dr. Peters offered figures that tend to support her case. Of 81 women who had radical mastectomies between 1955 and 1965, 70.4% were alive five years after the operations. Peters paired each of these patients by age and other factors with 81 women who had only lumpectomies, then compared the two groups' survival rates. There were only slight differences each year, and after five years, 71.6% of the lumpectomy patients were still alive.

Many surgeons still question Dr. Peters' procedure and take issue with women's magazine articles that advocate it as an alternative. "Deciding about treatments for breast cancer shouldn't be like choosing a brand of toothpaste," says Dr. Guy Robbins, acting chief of the breast service at New York's Memorial Hospital for Cancer and Allied Diseases. Dr. Robbins cautions that lumpectomy may fail to locate or remove all the cells and he maintains that only radical mastectomy offers the physician and the patient a semblance of certainty that all malignancy has been removed. He also warns that half of all lumpectomy patients eventually have local recurrences of cancer and says that many end up paying for their respite with a subsequent--and more serious--operation.

Cosmetic Job. But Robbins acknowledges that male doctors are often insensitive to women's psychological problems. He and his colleagues support efforts to ease the shock of breast removal. Many doctors are spending more time acquainting their patients with the necessity for radical surgery. Reach for Recovery, a program run by former mastectomy patients, is helping women through the convalescent period with exercise drills and counseling.

Nothing has done more to relieve postoperative depression than development of techniques for reconstructing the breast after surgery. Dr. Reuven Snyderman, a plastic surgeon at Memorial, has found that explaining the possibilities of reconstruction has helped many women to accept mastectomy calmly. The cosmetic job involves implantation of a silicon form and substantial surgery to restore the breast to a near-normal contour. But according to Snyderman, most women are so pleased by the initial implant, which makes the breast look normal under clothing, that they do not even bother with the later stages necessary to complete the process.

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