Word: breast
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Dates: during 1980-1989
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When Nancy Reagan entered Bethesda Naval Hospital two weeks ago, her plight, like that of Betty Ford 13 years ago, focused national attention on breast cancer. The affliction is the No. 3 killer of American women, after heart disease and lung cancer. The First Lady's case underscored the importance of early detection: her tumor was discovered during an annual mammogram, which is recommended for older women. But her choice of treatment caused some consternation and puzzlement in the medical community...
...Reagan's decision to have a modified radical mastectomy -- the removal of the entire breast and underarm lymph nodes -- struck some doctors as extreme. The reason: her tumor was just a quarter-inch in diameter -- small enough to have been safely excised by a less disfiguring operation called a lumpectomy, in which the tumor is removed along with a minimum of surrounding tissue. The First Lady also chose to have the surgery immediately after her breast was biopsied. According to prevailing medical wisdom, it is better to wait a few days so that the biopsied tissue can be thoroughly examined...
...opinion that she probably was overtreated," says Dr. I. Craig Henderson, director of the Breast Evaluation Center at Boston's Dana-Farber Cancer Institute. Henderson notes that several studies have shown that lumpectomy, followed by radiation treatment, is every bit as effective as mastectomy for even average-size breast tumors. In both procedures, women with early-stage cancers have a more than 90% chance of surviving at least five years after surgery. Modified radical mastectomy, however, remains the choice of most surgeons for women with large tumors...
Even so, there are good reasons why the First Lady may have proceeded as she did. For women with small breasts, lumpectomy may not offer a significant cosmetic advantage over mastectomy. And some women feel safer if the entire breast is removed. Says Goodman: "There are women who fear they will spend 23 hours a day worrying that the cancer may have returned if their breast is left intact...
Will other women be more inclined to choose mastectomy, following the First Lady's example? Dr. Bernard Fisher of the University of Pittsburgh, a leading proponent of lumpectomy, thinks not. Most women are aware of the alternatives, he says. Indeed, eleven states have laws requiring doctors to inform breast- cancer patients of all treatment options. Last week, as Mrs. Reagan convalesced, it was already apparent that her battle with cancer was having at least one positive effect: radiologists around the country reported that appointments for mammograms were up sharply...