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 Breast Cancer: Revisiting Accepted Wisdom in the Management of Breast Cancer - Part 1 

It was my father's medical school roommate, Nathaniel Berlin, clinical director of the National Cancer Institute (NCI) through the 1960s and chairman of the NCI Breast Cancer Task Force until 1975, who secured funding for Fisher's studies after Congress passed the National Cancer Act of 1971. The climate was such that Fisher was unable to recruit enough American surgeons into the study--they were unwilling to venture beyond the conformity of ideas and established standards of practice, though Canadian physicians were willing. The atmosphere surrounding the clinical selection of lumpectomy over mastectomy remained charged well into the '80s.

My father performed his first lumpectomy in 1978, but not without derision from his colleagues. On occasion, the women he treated would request a second opinion from another surgeon. If a woman had metastatic disease--sometimes years following a lumpectomy--one colleague of my father's insinuated that had the woman come to him (rather than my father), he would have done the proper operation (mastectomy) and cured her, thus proving he was able to "get it all."

By modern standards, Halsted's studies were sloppy and unkempt. This is not completely incomprehensible, though, because his landmark paper proclaiming "operations for the cure of cancer of the breast" was based on research between 1889 and 1894, the same period that his addiction plagued him so heavily. For the bulk of 1889 he was even hospitalized in Providence. Although Halsted's study covered the period between June 1889 and January 1894, he mistakenly included women in his report from March 1894, three months after the study was closed. Halsted3 stated: "Local recurrence is a return of the disease in the field of operation in the apparent or buried scar." Yet under the heading of women without local recurrence, he included those who recurred on their scar, contradicting himself. He focused on local recurrence, not survival, and tracked the women he saw for 3 years or less. Out of 50 cases, only 3 women were followed and found to be alive 3 years later. Eighteen were followed for less than 2 years, and 43 were followed for less than 3 years. If lumpectomy studies showed anything less than a 5-year survival, they would have been regarded as statistically laughable. But due to Halsted's authority and the ideological loyalty he inspired, his research methodology and results, though poor, never seemed to deter multitudes of followers.

One hundred years later, a double standard still remains. Lumpectomies are held to rigorous standards of efficacy, whereas mastectomies have never been subjected to anything close to the same requirements. A recent scandal has also clouded clear thinking. In 1994 Bernard Fisher, professor of surgery at the University of Pittsburgh, was ousted from his chair of the National Surgical Adjuvant Breast and Bowel Project (NSABP) because an investigator from Montreal, Roger Poisson, committed acts of scientific misconduct on Fisher's watch. Poisson altered surgical biopsy dates for 6 patients so they would be eligible within the Protocol B-06 requirements. His actions, irresponsible because of the deceit involved, did not, however, affect the end results. All 354 patients at his hospital were eliminated from the total group of 2163 women by subsequent auditors, and adequate numbers remained to assure overall credibility for the study, which covered the period between 1976 and 1984.24,25

There were, however, public alarm and breech of trust over this incident. Even though no patient's welfare was compromised, and no research outcomes were altered, the safety of lumpectomies was thrown into question by newspaper headlines that did not fully explain the nature of the error, possibly setting back use of this breast-conserving procedure. Now extensive reviews of Fisher's data have been published, confirming the original conclusions-namely, that mastectomy, lumpectomy, and lumpectomy with radiation provide comparable survival advantage.26

(Excerpted from Alternative Therapies in Health and Medicine)
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 About The Author
Harriet Beinfield LAcHarriet Beinfield, L.Ac. and Efrem Korngold, L.Ac., O.M.D. have pioneered the practice of Chinese medicine in America for the last 28 years as educators, writers, and practitioners. They are the co-authors of the......more
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