Archive | January, 2013

Breast cancer comes to Downton Abbey

8 Jan

halsted radical mastIt’s always interesting to see how breast cancer comes across on television (less so during October, of course, when all of those creepy pink stereotypes are hauled out of the closet). 

BC has been the disease du jour everywhere from Murphy Brown (yes, I’m dating myself) to Sex and the City to Weeds to this season’s Parenthood. Now, we have a new TV character facing a breast cancer scare, although “new” may be the wrong word, since the show is set in 1920.

Yes, breast cancer has come to Downton Abbey (warning: spoilers ahead!).

In the two-hour premiere of season three, which aired this last Sunday night here in the U.S., kindly Mrs. Hughes, the estate’s housekeeper, finds a lump in her breast and, after a bit of persuasion from her friend Mrs. Patmore (the cook), goes in for a biopsy.

What did a breast cancer diagnosis mean in 1920? That was the question one of my editors at nbcnews.com posed to me in an email Monday morning. I did some research, interviewed breast cancer surgeon Dr. Deanna Attai and wrote this story. The bottom line: breast cancer in 1920 was probably a death sentence.

“I think most cancers were,” Dr. Attai told me when we chatted via phone. “Just because of the fact they were diagnosed so late. Most of the time, patients had metastatic disease. They had very advanced disease in the lymph nodes.”

At this point in time, we don’t know if Mrs. Hughes truly has breast cancer or not. She has to wait two months for the results of her biopsy (and I thought waiting three days was bad!). If she does have it, her treatment options might include radiation, which was in its infancy at the time.

More likely, though, she would be subjected to the Halsted radical mastectomy, named for the European-trained Johns Hopkins surgeon who performed and heavily promoted it in the U.S.

If you’ve ever been haunted by the stark image of a concave, surgery-ravaged chest (this is the first image that popped into my head when my surgeon told me I needed a double), that’s a Halsted radical mastectomy. Along with the breast (and the tumor), the surgeon would remove all of the underlying chest muscle and all of the lymph nodes. Scarring was extensive and side effects like lymphedema (aka “milk arm”) and even arm paralysis, were common.

Even worse, this debilitating and disfiguring surgery was often performed without the patient’s knowledge, i.e., a woman would go in for a “quick-section biopsy” and wake up “wrapped in bandages from midriff to neck — bound like a mummy in surgical gauze.” Not only did she not have her breast(s), she had little information as to how to deal with the pain, the swelling in her arms or even what she was supposed to stuff in her bra in lieu of boobs. 

Referred to in one breast cancer book as “the greatest standardized surgical error of the twentieth century,” the Halsted radical mastectomy is no longer practiced, although it took until the late 1970s for the barbaric surgery to be phased out (the book, The Breast Cancer Wars, does a good job of detailing the history — and persistence — of the radical mastectomy).

Today, most breast cancer surgeons practice breast conservation, a term that always makes me wonder if breasts are becoming an endangered species.

But I digress.

What does the future hold for Downton Abbey’s Mrs. Hughes? Like everyone else, I guess I’ll just have to wait and see (I’ve become pretty good at living a “wait and see” kind of life these last two years). Since it’s television, my guess is they’ll milk the cancer plot for all it’s worth then give her a magical reprieve, much like Matthew Crawley, who miraculously recovered from his paralyzing war wound. Or she’ll become the newest member of the BC club and will die — or become completely debilitated by her “life-saving” surgery.

Whatever the case, I suppose the good news is that medicine has moved on — a bit, anyway — when it comes to treatment for this crappy disease. Nearly a hundred years later, we have chemotherapy and targeted radiation and tamoxifen and mastectomies that don’t leave us hollowed out and housebound. Nearly a hundred years later, a breast cancer diagnosis doesn’t necessarily equate to a death sentence.

Although, as Dr. Attai put it, “having breast cancer today is still pretty barbaric.” 

Word.

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