THE BREAST CANCER WARS: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America

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.