Then writer and editor Babette Rosmond was diagnosed with breast cancer in 1971, the second wave of the Women’s Liberation Movement that began in the mid-1960s was in its infancy. Still, when told by her doctor that she would need a radical mastectomy—a procedure developed by William Stewart Halsted in 1882—to remove her cancerous left breast, plus underarm lymph nodes and her chest wall muscles, Ms. Rosmond rebelled and said she wanted 3 weeks to think it over. “In 3 weeks you may be dead,” said her doctor.1
Second Opinion
Undeterred, Ms. Rosmond, then 49, sought a second opinion with George Crile, Jr, MD, a surgeon at the Cleveland Clinic and a pioneer in breast-conserving surgery. Seven years earlier, at the Annual Scientific Assembly of the American Academy of General Practice (later renamed the American Academy of Family Physicians), Dr. Crile told physicians that too much tissue was being removed in the surgical treatment of many women with malignant and benign breast tumors.
He cited results from a study of nearly 200 patients with breast cancer. While 75% of the cancers in the study were operable, half of the patients were treated by a form of radical mastectomy and the other half were treated with a simple mastectomy, in which the cancerous breast is removed but lymph nodes and chest muscles are left intact. Most of the study participants received no adjuvant radiation therapy. The 5- and 6-year survival rates of patients treated with the less invasive procedure, Dr. Crile said, were “a little higher” than those for patients given radical mastectomies. And, he noted, the survival rate was higher for patients of surgeons who chiefly performed simple mastectomies than for surgeons performing radical mastectomies.2
Because Ms. Rosmond’s tumor was small and localized, Dr. Crile suggested she have an even less invasive procedure than the simple mastectomy—a partial mastectomy, now known as a lumpectomy, in which only small amounts of tissue are removed. He also offered her adjuvant radiation therapy, which she refused.
Happy with the results of her surgery, Ms. Rosmond wrote about her experience in The Invisible Worm: A Woman’s Right to Choose an Alternate to Radical Surgery,3 under the pseudonym Rosamond Campion. “I think what I did was the highest level of women’s liberation,” she wrote. “I said ‘no’ to a group of doctors who told me, ‘You must sign this paper, you don’t have to know what it’s all about.’” However, Ms. Rosmond was quick to point out in articles she wrote for women’s magazines such as McCall’s that while the choice she made was right for her, “I did not, do not, cannot recommend it for every woman.”
Speaking Out
An outspoken critic of radical mastectomies not just within the medical establishment but in the public arena as well, Dr. Crile joined Ms. Rosmond on a 1973 episode of The David Susskind Show. Along with breast surgeon Jerome A. Urban, MD, a developer of the extended radical mastectomy for advanced breast cancer, and oncologist Ezra Greenspan, MD, founder of The Chemotherapy Foundation, they debated the merits of breast-sparing surgery vs the more conventional radical mastectomy in the treatment of breast cancer.
Because the safety and efficacy of breast-conservation surgeries were not yet known, Dr. Urban and Dr. Greenspan voiced their concern that Ms. Rosmond’s decision would lead other women to choose similar procedures, resulting in more women needlessly dying from breast cancer. The discussion became heated, with Ms. Rosmond fiercely defending her decision. Ultimately, the show’s host felt compelled to support Dr. Urban and Dr. Greenspan, at one point referring to Ms. Rosmond as “Mrs. Civilian.”
A New Era of Care
As the 1970s wore on and the feminist movement grew—and buoyed by Ms. Rosmond’s public activism—more women began writing magazine articles and books encouraging women with breast cancer and other conditions to become more proactive in their treatment decisions and challenge their doctors to inform them of their best options.
In 1985, the results of randomized clinical trials comparing surgical strategies for primary breast cancer were published in The New England Journal of Medicine.4 Led by University of Pittsburgh surgeon Bernard Fisher, MD, the investigators found that lumpectomy—at this point called segmental mastectomy—plus radiotherapy is equivalent to mastectomy in breast cancer survival. (The findings were challenged nearly a decade later when one of the researchers involved in the studies was found to have falsified data. However, subsequent analysis of the data found no change in outcomes.) Today, lumpectomy and adjuvant radiation therapy is standard of care for early-stage breast cancers.
Ms. Rosmond’s breast cancer never recurred. She died in 1997 at the age of 75. ■
References
1. Lerner B: The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. New York, Oxford University Press USA, 2003.
2. Too much tissue often removed in mastectomy, general practitioners told (medical news). JAMA 188:35-35, 1964.
3. Campion R: The Invisible Worm: A Woman’s Right to Choose an Alternate to Radical Surgery. New York, Macmillan, 1972.
4. Fisher B, Bauer M, Margolese R, et al: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312:665-673, 1985.
