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The Radical Masectomy

20 Dec

Cancer is a unique disease. It is one of the great scourges of modern affluent nations and for most of our history it was quite untreatable. Ptolemy was one of the first to describe it and the advised treatment was simply “there is none”. Tumors were attributed to a mythical black bile, the melancholic humour. And, until the nineteenth century it was usually kinder and less destructive to simply let an internal tumor grow, rather than to take your chances with a surgeon. Surgery was dirty, unsanitary, and with the lack of anaesthetics, quite painful.

However, with the advent of modern sanitation, surgery blossomed and many types of tumors (including breast cancer) could now simply be removed (although early surgery was still as painful as ever). The exact science of cancer, however, was still elusive. Scientists knew that cancer could reoccur, but were not sure of the reason. Enter the year 1882 and a surgeon named John Halsted. Halsted understood that surgery of the tumor alone often wasn’t enough, surrounding tissues and vessels (especially the lymphatic system) could play a role in cancer’s return and were often the first sites of metastasis. To combat this phenomenon, he studied, developed, and promoted the radical masectomy.

The masectomy was not a new procedure. It was said to have been offered to the empress Theodora in the year 548. The prognosis was grim, however, with only a 10% survival rate over 20 years. Halsted, seeing that simply removing the breast was not enough, would remove a much larger selection of tissues, including both breasts, the lymph nodes, underlying musculature, and even ribs and clavicles in order to kill cancer. And it worked, in a way. The chance of regrowth dropped with every cut and many other surgeons started using this procedure. Until the 1950’s it was still the go-to operation for curing breast cancer in Europe and America.

However, the increased survival rates came at a price. Today masectomies, while sometimes drastic, can often be mollified with minimally invasive or plastic surgery. Radical masectomies, on the other hand, were, to put it bluntly, ruthless procedures that would often permanently disfigure or cripple the woman. The removal of musculature weakened the ability to move the arms. The removal of ribs could cause sunken chests. The removal of collarbones would swing the arms downward into a permanent slouch. Women often suffered for years afterwards and many shut themselves away from society. They lived where others had died, but paid a terrible price for it. We owe Halsted and his companion surgeons a great debt, but like many patients in the history of medicine, his women’s comfort and health was often sacrificed in the name of scientific advancement and fervor.

Sources: The Emperor of All Maladies, adairjones.wordpress.com, Wikipedia

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Posted by on December 20, 2011 in Medicine

 

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