The Breast Cancer Wars Published

Why do the debates over mammography for women in their forties remain so rancorous? Why does the media characterize BRCA mutations as "time bombs"? In his new book, "The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in 20th-Century America" (Oxford, 2001), Columbia University internist and historian Barron H. Lerner argues that the answers to these questions can be found in a better understanding of American culture. Since the early twentieth century, Lerner contends, breast cancer prevention and treatment in the United States have been characterized by a "search and destroy" mentality. Americans have assumed that, as in actual war, earlier, more aggressive treatment of breast cancer would necessarily produce better outcomes. Yet, as Lerner describes, early detection technologies such as screening mammography have downsides, such as false-positive results. Among the colorful characters depicted in "The Breast Cancer Wars" are Arthur Holleb of the American Cancer Society, who aggressively championed mammography in the 1970s; John Bailar, who criticized screening despite working for the National Cancer Institute; and Judy Randal, a Washington, D.C. journalist who openly attacked ACS and NCI screening policies.

In its discussion of the evolution of treatment strategies, "The Breast Cancer Wars" focuses heavily on Columbia-Presbyterian Medical Center. In the 1940s and 1950s, Columbia surgeon Cushman D. Haagensen became America's first breast cancer specialist, writing the first edition of his renowned "Diseases of the Breast." Haagensen was known for his six-hour radical mastectomies, in which he tied off each individual blood vessel. He believed strongly that such "meticulous" surgery saved lives. By the 1970s, however, Haagensen found himself under fire from both surgeons and women as he steadfastly continued to advocate the extensive radical mastectomy. By this time, smaller operations had become much more commonplace.

Barron Lerner is the Angelica Berrie Gold Foundation Associate Professor of Medicine and Public Health at Columbia University. His previous book, "Contagion and Confinement," chronicled the forcible detention of noncompliant tuberculosis patients in the name of public health. He is currently studying the history of informed consent.