Medicine: Breast Cancer: Fear and Facts

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In examining breast lumps, doctors can quickly rule out growths that are not cancerous. If it hurts, according to gynecology texts, it is unlikely to be malignant. Manipulation can also help screen out the innocent lumps; if they seem unanchored and can be moved about under the skin, they are usually benign cysts. A needle biopsy, in which a needle is inserted into the lump and fluid or cells are withdrawn, can also be used to identify cysts. But some growths are too small or too well concealed behind other tissues for such procedures. In those cases, the only way a doctor can determine if a lump is cancerous is to have a biopsy performed, usually as a surgical procedure. A surgeon removes the lump and it is rushed to the hospital's pathology laboratory. There it is frozen with liquid nitrogen and then, with a device called a microtome, sliced into sections thinner than onion skin for examination under a microscope. If the cells are cancerous, the surgeon will usually know in minutes.

For the cases in which the tissue proves to be cancerous, immediate surgery is the only prudent remedy. How drastic that surgery must be, however, is a matter of considerable debate. For some years now, the standard treatment for breast cancer has been the radical mastectomy, a traumatic and disfiguring operation in which the surgeon removes not only the breast but other tissue that may have been invaded by cancerous cells: the pectoral muscles that support the breast and the lymph nodes under the affected arm. There is growing opposition to such extensive surgery, some of it from women's liberationists, who see it as a deliberate mutilation performed by male doctors who can neither understand nor appreciate its impact on their female patients.

Malignant Clusters. While most doctors believe that surgery is essential, there are those who insist that complete amputation is not necessary. Dr. Vera Peters of Toronto's Princess Margaret Hospital advocates a simple procedure called "lumpectomy," in which only the cancerous lump is removed. She says her research shows that in cancers that have not spread to the lymph nodes, lumpectomy is just as effective as the more radical operations and far less damaging psychologically. (The problem is how to determine that the lymph nodes are uninvolved; most doctors feel that the only sure way to tell is to remove the nodes and study them under a microscope.)

Dr. George Crile of the Cleveland Clinic considers the radical mastectomy a holdover from the 19th century. For many cases he advocates an operation called partial mastectomy, which, while more serious than a lumpectomy, still spares most of the breast. Crile's wife Helga, daughter of Poet Carl Sandburg, had the operation eight months ago, and Crile feels that its widespread use could make women more willing to face a diagnosis of breast cancer.

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