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

Outmoded Ideas and Practices
It is becoming clear that the Halsted mastectomy was based on an outdated model of breast cancer. Fisher27 revised the model after years of clinical trials, concluding that

"cancer is a systemic disease involving a complex spectrum of host-tumor interrelations and that variations in local-regional therapy are unlikely to substantially affect survival. All of the findings ... did not conform to the concepts that served as the basis for the principles of the Halstedian hypothesis but, rather, provided a matrix for the formulation of an alternative thesis, which is biologic, rather than anatomic and mechanistic, in concept. Its components are completely antithetical to those of the Halstedian thesis."

Fisher further clarified some misconceptions regarding u ho is eligible for lumpectomy. Tumor size or location does not preclude saving the breast by use of lumpectomy. Large tumors can often be shrunk by preoperative chemotherapy. Women with lymph nodes that are found to have (positive) or not have (negative) cancerous cells are equally eligible. Age is also not a factor--lumpectomy is equally appropriate for older and younger women. Finally, there is the issue of patient choice, and a woman's preference for mastectomy. To this Fisher27 says, "Patient autonomy will not be compromised and paternalism will not be resurrected if physicians firmly inform patients that, in almost all cases based on current knowledge, mastectomy is no longer justifiable, and lumpectomy followed by breast irradiation will not put them at greater risk of developing systemic disease or of dying than mastectomy would." Fisher's reanalysis and results were published in a 1995 report. He found that upon evaluation of three treatments (simple mastectomy, lumpectomy with irradiation, and lumpectomy alone), an average of 60% of patients were alive after 12 years and about 50% had no tangible signs of disease.26

To account for the discrepancy between the research supporting lumpectomy and the persistence of its l lack of use, Harvard professor of surgery William Silen28 laments the replacement of data by dogma. "One of the best examples of this," Silen says, "is the use of the Halsted radical mastectomy for breast cancer.~ He identifies several problems, beginning with residency training when the young doctor is indoctrinated into managing situations in the "usual manner because that's the way we've always done it. Such normative behavior is expected to occur automatically and without question." He continues: "Beyond the period of training, surgical practice is strongly influenced by the leaders of the profession who are not always meticulously scrupulous in attention to the validity of the material they publish." He chastises the profession to more accurately assess the outcomes of what it does.28

Although remuneration for mastectomy is more than triple that of lumpectomy, financial motives do not account for the hegemony of this procedure. Habits and tradition assume an authority of their own. Is it reasonable to liken surgeons, men or women, to the tribal Africans who perform clitorectomies with the unshakable conviction that they are acting in the best interest of the woman? In both instances, what is best for the woman is associated with maintaining conformity with an outmoded belief. It is neither the women nor the doctors who are to blame; both come to the matter with honorable intentions. Cultural forces conspire: professional recommendations conflict, an irrational fear of keeping the breast is planted in women, and mastectomy constitutes a conclusive sacrificial act that permits women to feel as though they are doing everything they can.

(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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