May 6, 1994

1.Breast Cancer

A child said, what is grass? fetching it to me with full hands. How could I answer the child? I do not know what it is any more than he.

Walt Whitman(1819-1892)

The swan song of my career as a cancer research scientist was a book, The Topic of Cancer. Published in 1974, it explained what we knew and didn't know about cancer. It discussed the biology of cancer, its treatment and cancer politics. Prior to its publication, it was read and criticized by several of the most knowledgeable cancer scientists and physicians in the country. I corrected the errors that they found. Reviews of the book were uniformly favorable. One reviewer called it "one of the finest books on cancer for the general reader to date." It was chosen as a selection for the Nurse's Book Society. It wasn't reviewed by the New York Times, Good Housekeeping nor the San Francisco Chronicle. As a consequence, it didn't sell worth a darn. It was translated and revised in Dutch and translated into Chinese. Aside from some copies that are still circulating in libraries, the book died a quiet death. After it was published I was persona non grata in certain circles in Washington and Buffalo. Part of the problem was resentment that a person without a medical degree would have the audacity to write such a book. Much of the praise for the book came from cancer patients and from people in the medical profession who thought that what was said was true and needed saying. A major problem was that it said a number of things that many people just didn't want to hear. Cancer books that promise miracle cures have a much better sale. I would like to think that the book was a factor in what was subsequently done to evaluate cancer treatment. What I and others recommended were controlled studies of all forms of cancer treatment. This is now being done. As a consequence, it is now possible to say which treatment is the best for several different kinds of cancer. I would like to think that the book was also a factor in the abandonment of radical mastectomy for breast cancer.

This is the first of a series of six articles on breast cancer. I would ordinarily be reluctant to discuss the treatment of cancer in a newspaper column if it wasn't for the fact that there is such a massive amount of misinformation about the subject out there.

Everyone knows what a breast is -or do they? Those two protuberances that are praised in poetry and prose are mostly fat. Yes, one major difference between Marilyn Monroe and Joe DiMaggio is the distribution of the same fat that thickens the thighs, buttocks and belly. The part of the breast that produces milk doesn't take up much space, which accounts for the fact that women with small breasts are often able to produce as much milk as those with large ones. The milk producing part of the breast, the gland, is the part that is usually involved in breast cancer. For a variety of reasons that we do not completely understand, some gland cells change their behavior and become tumors. The change to cancer appears to occur in the genetics of the cells and it is passed on to the next generation of cancer cells with each cell division. In the process, the cancer cells change still further.

Tumors are simply swellings, or lumps. People used to refer to the tumor of pregnancy. Some tumors of the breast will grow and then stop, or they will grow very slowly. They will also stay where they are, and will not spread into other tissues or into other parts of the body. These tumors are called benign, or good tumors. If you left such a tumor alone, your life would not be threatened, unless the tumor was in an inaccessible part of the brain. The problem is that a physician usually can't tell by looking or feeling them whether they are benign tumors or malignant(bad) tumors, which we usually refer to as cancer.

Next week I will talk about how physicians can tell malignant from benign tumors.

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