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

In the 19th century, women with breast cancer were in a social sense considered to be lepers--it was a disgrace as well as a medical problem. As late as the 1960s breast cancer was not publicly discussed and women did not openly volunteer that they had the disease. (It was not until 1974 that by announcing her breast cancer diagnosis, First Lady Betty Ford pierced the public veil on the subject. President Ford did not hesitate to decide that she would have a mastectomy.)

Perhaps what Halsted meant when he promised to "cure" carcinoma of the breast was to remove the immediate and recurring misery, not the disease itself or its eventual outcome. In Halsted's paper, published in 1894, he acknowledges: "The efficiency of an operation is measured truer in terms of local recurrence than of ultimate cure."3(p302) But Halsted's zealous victory over local recurrence assumed a life of its own and later followers confused elimination of symptoms with a remedy for the disease. In the urgency to effect an absolute cure, progressively more and more tissue was expunged in an attempt to avert "recurrence." The concept that removing the breast would erase the disease was irresistibly seductive. It is useful to trace the intellectual origins of this theory.

A Short History of Ideas: Virchow's Influence
Tuberculosis, the sovereign disease of the 19th century, was the leading cause of death, as feared as it was widespread. In Europe, the work of the German physician Rudolph Virchow (1821-1902), the father of "cellular pathology," advanced medical knowledge. His contributions were substantial; for example, he identified leukemia in 1845 and in 1846 articulated the process by which blood clots become obstructive. At a time when medical focus was narrowed to the courses of particular diseases, Virchow both broadened and magnified the lens by gazing into the nature of specific pathophysiological processes. He mapped the tissue reactions of atrophy, hypertrophy, inflammation, embolism, necrosis, tuberculosis, cancer, fibrosis, and calcification. Many of Virchow's concepts have withstood the test of decades, but a few of his ideas were off course. Because of his immense stature, however, his faulty conclusions were also fully embraced and perhaps disproportionately influential.

Virchow proclaimed the tissue changes characteristic of tuberculosis as emblematic for the disease process in general, and cancer in particular. His revolutionary biological model of breast cancer professed that tumors arose within the skin, rather than as a systemic disorder, invading locally and centrifugally in all directions, spreading along the planes of muscles and through Iymphatic channels. Furthermore, Virchow thought that the lymph nodes under the arms acted like filters, blocking the spread of the disease to the organs and skeleton. If the tumor burden penetrated the Iymphatic defenses, then the disease progressed in an orderly manner from the center outward to the chest, trunk, upper arms, and thighs.

Virchow was not a clinician. He did not engage in the care of patients, instead focusing solely on tissue reactions in the lab. His positive disdain for clinical evidence became an intellectual trend. A tacit reverence for and acceptance of Virchow's theory that the lymph is the highway of the cancerous process persist today, though we know that metastases require blood supply (angiogenesis) and also travel through the circulatory system to distant (metastatic) sites.

(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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