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

Barron H. Lerner (Author)

Book Description

Publication Date: May 1, 2003 | ISBN-10: 0195161068 | ISBN-13: 978-0195161069 | Edition: 1

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.

Editorial Reviews

From Publishers 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, Inc.

--This text refers to an out of print or unavailable edition of this title.

From 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 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 416 pages
• Publisher: Oxford University Press, USA; 1 edition (May 1, 2003)
• Language: English
• ISBN-10: 0195161068
• ISBN-13: 978-0195161069
• Product Dimensions: 8.2 x 5.3 x 0.8 inches
• Shipping Weight: 10.4 ounces (View shipping rates and policies)
• Average Customer Review: 4.6 out of 5 stars  See all reviews (10 customer reviews)
• Amazon Best Sellers Rank: #621,669 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

12 of 12 people found the following review helpful:

5.0 out of 5 stars FIRST-CLASS HIDDEN HISTORY, July 18, 2001

By 

Barbara Seaman - See all my reviews

This review is from: Breast Cancer Wars : Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (Hardcover)

Like many others who have discovered this treasure of a highly readable but profoundly illuminating book. I fully agree with Dr. Susan Love, who called it a "riveting" story and "one of the best books I have read in a long time." As someone who has long been active in the women's health movement I am sure that THE BREAST CANCER WARS will become a fixture on the short list of "must have" titles for any patient or advocate. Dr. Barron Lerner is a gifted writer, a caring clinician(Associate Professor of Medicine and Public Health at the Columbia University College of Physicians and Surgeons) a distinguished PhD medical historian, as well as the devoted son of a breast cancer survivor whose "quiet perseverance in the face of a terrifying disease has been an inspiration." Thus, he brings a thoroughly rounded perspective to the history of breast cancer diagnosis and treatment that (to my knowledge) no other male physician has ever attempted, much less achieved. His fascinating descriptions of the central role that activist patients have played in forcing doctors to treat breast cancer more humanely, and, yes, believe it or not- more scientifically, is a major contribution to modern social and science history. Dr. Lerner's title is well-chosen, as he escorts us through the maze of controversies and "wars" that mark breast cancer diagnosis, treatment and prevention, showing them to be dramatic, amazing, frustrating, sometimes ridiculous, and often highly unfair to patients. While THE BREAST CANCER WARS is not a "how to" book it provides women- and men-with a wealth of necessary background and information that will enable them to become far more savvy and sophisticated on every aspect of any breast cancer discussion.

9 of 9 people found the following review helpful:

5.0 out of 5 stars A Very Important Book, July 10, 2001

By 

Andrew Robinson (Brooklyn, New York) - See all my reviews

This review is from: Breast Cancer Wars : Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (Hardcover)

In trying to understand and have an appreciation for the larger perspective of Medicine, Doctors and the Medical/Cancer Establishment, I found "Breast Cancer Wars..." to be the most insightful and helpful book of its kind that I have read. And in seeking to understand my disease (Leukemia), and the process I have been going through, I have read dozens of books on Health, Healing, Cancer, Medicine, the Medical Establishment etc...

Dr. Lerner provides a comprehensive, readable and above all balanced book in which he examines all the factors which impact on the development of a cancer treatment in the U.S. And he maintains this sense of balance while examining what is one of the most emotional, sensitive and controversial areas in all of cancer diagnosis and treatment; Breast Cancer and the Radical Mastectomy.

What particularly distinguishes his writing is the way in which he is able to provide a clear, detailed history and narrative while exploring the human, cultural, political, societal and gender-related issues that have impacted on the development and treatment of Breast Cancer.

In this extremely controversial and politicized area, he does not look for, or find a villain; his is not an attempt to blame or demonize. And that is a great relief.

Instead, in discussing the individuals involved - the physicians who first espoused and continued to advocate the use of Radical Mastectomies and those who opposed it, the prominent women who elected this procedure for themselves, the women who began to oppose the Radical Mastectomy and who challenged the medical system, the women who used their influence and resources to initiate important cancer and support organizations - Dr. Lerner provides very human portraits which helped me to appreciate how and why these individuals developed their views, and how each one of them came to effect the course of the debate and the evolution of Breast Cancer treatment.

And he does not fail to convey the tremendous emotional, physical and psychological impact that these doctors, individuals and organizations have had on women coping with Breast Cancer.

I recommend this book to anyone who is trying to understand the context of an illness and treatment and the various forces, from individual to societal, which play a role in the treatment of disease in the U.S.

6 of 6 people found the following review helpful:

5.0 out of 5 stars A MUST READ for every woman, October 16, 2005

By 

greensleeves "greensleeves" (Maryland) - See all my reviews

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This review is from: Breast Cancer Wars : Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (Hardcover)

Barron Lerner's "Breast Cancer Wars" joins Ellen Leopold's "Darker Ribbon" as an eyeopening look backstage at the Breast Cancer Follies in America. They are both important books, and make many of the same points, but if you are of a mind to read only one history of this disease, make it this one.

Leopold's book, written from a frankly feminist (and that's OK)point of view is dry and academic. But as a frank feminist myself, I must say I much preferred Lerner's lively, even juicy, warts-and-all look at the nature of American surgeons and how they make their decisions. But be warned: like they say about watching sausage being made, it ain't pretty. In fact the chapter on super-radical surgery that was the fashion for a, thankfully short, period of time in the 1950's upset me so much that I couldn't sleep that night. Do NOT read that part at bedtime! The phrase "human remnant" used by one famous surgeon in referring to his patients - or what was left of them when he got through with them - still gives me nightmares.

Lerner is himself a doctor - he teaches internal medicine and medical history at Columbia, so he has an insider's knowledge and interpretive skills that Leopold lacks. In detailing why, exactly, it took nearly half a century for American surgeons to even agree to scientifically test the efficacy and safety of the radical Halsted mastectomy, Lerner exposes the thought processes that dominate the surgical profession. Trust me, you will never look at your doctors the same way.

His thoughts on the risk aversive, controling mentality of the American population, and how that is reflected in the kind of doctors and medical procedures we traditionally prefer - the mindset that allowed the Halsted and its horror chamber cousins to hold sway for so long - is particularly important.

Toward the end of the book, Lerner touches on chemotherapy - which is a case of poisoning the many in order to help a miniscule few. It is impossible not to see the similarities with the now discredited Halsted. Like the Halsted, chemotherapy is basically a sales job, with no studies that show it is very helpful at all to non-metastatic women. And yet, we risk averse, bigger is better, give it all to me Americans - and our doctors - are embracing it with the same mindless fervor as the radical mastectomy.

Wake up folks. Read this book - it is a must.