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 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.” 


14 Responses to “Breast cancer comes to Downton Abbey”

  1. Renn January 8, 2013 at 6:26 pm #

    I just watched the episode last night after hearing rumors of a cancer scare. I have to give the show (and the actress!) props for showing the terror of waiting for results and how the anxiety messes with your head. Thanks for a great post!

    • singleshot1 January 9, 2013 at 9:11 am #

      I thought the writers/actors did a good job of relaying the terror, as well. I also appreciated some of the comments Mrs. Hughes made to her friend during the doctor’s appointments, re Mrs. Patmore’s patronizing attitude, her histrionics and later, her assurances that “everything will be all right.” “You don’t know that,” Mrs. Hughes told her, “you don’t know that everything will be all right.” That’s definitely something I’ve felt like telling the people who blithely assured me everything would be just fine while I was waiting for my biopsy results, etc. Obviously, people tell us things (or tell themselves things), trying to make us all feel better — I’ve been guilty of this, too. But sometimes you just have to own up to the fact that you don’t know what’s coming down the road and you’re scared shitless about it.

      • Bev January 9, 2013 at 4:32 pm #

        I agree wholeheartedly. I did not like my genuine fear and terror to be minimized with platitudes. I do understand that others are not likely to feel the same or get it unless they are in the same predicament.

  2. Trixie Lane January 8, 2013 at 7:07 pm #

    Word. Indeed. It is truly a no fun barbaric thing to suffer through.

    • singleshot1 January 9, 2013 at 9:12 am #

      It sucks. But good definitely friends help.

  3. chemobrainfog January 8, 2013 at 9:06 pm #

    My gosh, you’ve dropped off the face of the planet and I can only hope it’s for more than boxing…. I’d prefer to hear about a nice wrestling match…

    Love Love Love this and LOVE Dr Deanna Attai, too.

    I suppose it’s time for me to start watching this Downton Abbey show that everyone is talking about!

    Miss you madly..


    • singleshot1 January 9, 2013 at 9:17 am #

      Haven’t totally dropped off the face of the earth, AnneMarie. Just turned into an “every blue moon” blogger, I guess. ; ) Still working, still boxing, still running, still trying to date, and, yes, still working towards reconstruction (slowly). I’m wondering now if I need to spend less time watching PBS and more time keeping in touch with my #BC buds! Great to hear from you. So excited about your new association with the Army of Love!

  4. Catherine ~ Facing Cancer Together January 9, 2013 at 8:39 am #

    I’m agreeing with AnneMarie – it might be time to start watching this show. 🙂 As for going in for a biopsy and coming out with much of your torso removed . . . that is a nightmare. And on top of the barbaric surgery option, back then women didn’t talk about the disease. Thank goodness we’re breaking past that taboo (though there’s still a ways to go for all types of cancer).

    • singleshot1 January 9, 2013 at 9:23 am #

      That was the one bit from Downton Abbey that I had trouble buying, the fact that Mrs. Hughes would confide in her friend immediately about finding a lump in her breast. Seems like her character would have suffered in silence for a while, maybe forever. BUT … she’s a smart, independent woman and 1920 was a time of change. I’m thankful we’re past the taboo as well (don’t know what I would have done without my friends, family and BC buddies). Now if we can just kick this crappy disease to the curb, we can all go out for a drink together and celebrate. ; |

  5. Scorchy January 9, 2013 at 11:05 am #

    Wonderful post. Awesome!! You may enjoy this:

    • singleshot1 January 9, 2013 at 11:09 am #

      Ha! Just squirted tea out of my nose (which is truly the highest praise for humor). Thanks for sending!

  6. Lisa January 11, 2013 at 10:51 am #

    Check out Breast Cancer comes to beauty pageant at

    Contestant plans to remove both breat because of family predisposition to cancer. She is only 24.

    • singleshot1 January 11, 2013 at 11:01 am #

      Thanks for the note, Lisa. I just read and tweeted that story! Very tough decision made even tougher by 2.5 million people sharing their (mostly uninformed) opinion. Cannot wait until somebody figures this crap out so women do not have to make those kinds of decisions/choices. Mastectomy is a very poor workaround. We need a real cure/preventative.


  1. Weekly Round-Up « Journeying Beyond Breast Cancer - January 11, 2013

    […] now to Downton Abbey, where this season breast cancer – as Double Whammied calls it the disease du jour – has arrived and many of you felt moved to comment on the […]

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