We cannot verify your location
Browse Book and Journal Content on Project MUSE

Preventive Strikes

Women, Precancer, and Prophylactic Surgery

Ilana L

Publication Year: 2010

Modern scientific tools can identify a genetic predisposition to cancer before any disease is detectable. Some women will never develop breast or ovarian cancer, but they nevertheless must decide, as a result of genetic testing, whether to have their breasts and ovaries removed to avoid the possibility of disease. The striking contrast between the sophistication of diagnosis and the crudeness of preventive surgery forms the basis of historian Ilana Löwy’s important study. Löwy traces the history of prophylactic amputations through a century of preventive treatment and back to a long tradition of surgical management of gynecological problems. In the early twentieth century, surgeons came to believe that removing precancerous lesions—a term difficult to define even today—averted the danger of malignancy. This practice, Löwy finds, later led to surgical interventions for women with a hereditary predisposition to cancer but no detectable disease. Richly detailed stories of patients and surgeons in the United States, France, and the United Kingdom allow Löwy to compare the evolution of medical thought and practice—and personal choice—in these different cultures. Preventive Strikes aims to improve our understanding of professional, social, and cultural responses to cancer in the twenty-first century and to inform our reflections about how values are incorporated into routine medical practices.

Published by: The Johns Hopkins University Press


pdf iconDownload PDF


pdf iconDownload PDF


pdf iconDownload PDF
p. vii

read more


pdf iconDownload PDF
pp. ix-xi

My first debt is to the institutions that have made this research possible. INSERM— the French Institute of Health and Medical Research—has given continual support to my atypical investigations, while my research center, CERMES, has provided excellent intellectual and material conditions for my work, a rare privilege in a time of reduced support for “useless” studies, those devoid of economic ...

read more

Introduction: Embodied Risk

pdf iconDownload PDF
pp. 1-18

This study originated in a perplexing observation. For one year I observed the counseling that people with a hereditary risk of malignancies received in a major French cancer treatment center. The oncogenetics department providing this counseling combined innovative research in molecular biology with more traditional family studies and the performance of genetic tests. I was impressed by the ...

read more


pdf iconDownload PDF
pp. 19-39

The rise of the concept of precancer and of the aspiration to physically eliminate precancerous lesions is directly linked with the definition of cancer as “pathologist’s disease,” that is, an ailment diagnosed in the pathology laboratory. Even people who present symptoms that strongly indicate the presence of a malignant growth are “officially” classified as cancer patients only when their diagnosis is ...

read more

CHAPTER TWO: Classifications

pdf iconDownload PDF
pp. 40-54

As discussed in the previous chapter, the first element that shaped the concept of precancer was the generalization of cytological diagnosis of malignancy in the early decades of the twentieth century. The second, and equally important element, was the collection of epidemiological data on malignancies, coupled with attempts to correlate diagnoses and outcomes. Data that were collected ...

read more

CHAPTER THREE: Borderline Lesions

pdf iconDownload PDF
pp. 55-83

Until the last two decades of the twentieth century, the principle of early detection and surgical elimination of precancerous lesions was applied mainly to the detection and preventive treatment of female malignancies. Biopsies continued to be employed to diagnose other tumors (head and neck, lower digestive tract), and, in selected cases, surgeons asked for frozen sections of suspicious tissue during ...

read more

CHAPTER FOUR: In Situ Cancers

pdf iconDownload PDF
pp. 84-117

In the second half of the twentieth century, “carcinoma in situ” became the most visible and most often debated precancerous lesion. The term carcinoma in situ describes a cluster of cells that, when examined under the microscope, look exactly like cancer cells but do not invade surrounding tissues. In situ cancerlike lesions were first observed in cervical malignancies. Gynecologists who detected ...

read more

CHAPTER FIVE: The Origins of Screening

pdf iconDownload PDF
pp. 118-142

In the first half of the twentieth century preventive treatments of premalignant lesions was the exclusive domain of the clinician. Doctors detected suspicious changes in a person’s body and decided (sometimes together with individuals and their families) what to do about these changes. After the Second World War, with the development of mass screening campaigns, preventive treatments of ...

read more

CHAPTER SIX: The Generalization of Screening

pdf iconDownload PDF
pp. 143-165

The practical success of screening for cervical cancer validated the principle of physical elimination of premalignant lesions and legitimated the extension of this preventive approach to other tumors.1 The transformation of cervical cancer into a model malignancy was, however, made possible by selective emphasis on some aspects of this tumor. For example, experts brought to the foreground ...

read more


pdf iconDownload PDF
pp. 166-197

Screening for cancer is grounded in the principle that everybody is at risk of this disease. Search for the hereditary tendency to develop malignant tumors is grounded in the opposite supposition. It assumes that some people run much higher risk than others and that preventive interventions should selectively target these people. Precancerous lesions and hereditary predisposition to cancer ...

read more

CHAPTER EIGHT: The New Surgical Radicalism

pdf iconDownload PDF
pp. 198-225

The recent focus on dilemmas experienced by women diagnosed with BRCA mutations and facing decisions about prophylactic mastectomy have deflected attention from the peculiarity of a comeback of radical surgical solutions. For more than eighty years the accepted view on cancer surgery—and by extension, on surgical treatment of precancerous conditions—was that more is better. This view ...

read more

Conclusion: Uncertainty

pdf iconDownload PDF
pp. 225-238

Preventive treatment of precancerous lesions is a twentieth-century innovation. Three developments favored the rise of this approach: (a) the transformation of cancer into a “pathologists’ disease” in the 1910s and 1920s; (b) the introduction of mass screening for malignancies, which started in the 1940s with exfoliate cytology but expanded greatly in the 1970s and 1980s; and (c) the introduction, ...


pdf iconDownload PDF
pp. 239-322


pdf iconDownload PDF
pp. 323-328

E-ISBN-13: 9780801898693
E-ISBN-10: 0801898692
Print-ISBN-13: 9780801893643
Print-ISBN-10: 080189364X

Page Count: 344
Illustrations: 11 b&w illus.
Publication Year: 2010

OCLC Number: 647917326
MUSE Marc Record: Download for Preventive Strikes

Research Areas


UPCC logo

Subject Headings

  • Ovaries -- Cancer -- Surgery -- Social aspects.
  • Breast -- Cancer -- Surgery -- Social aspects.
  • Cancer in women -- Surgery -- Social aspects.
  • Precancerous conditions -- Surgery -- Social aspects.
  • Social medicine.
  • You have access to this content
  • Free sample
  • Open Access
  • Restricted Access