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68 4 Hope, Blame, and Acceptance As the Rossi case progressed, Wald and her colleagues discussed what kind of patient they wanted to study next. Wald argued that she had put ten times as much effort into working with the Rossis as would have been required for an English-­ speaking family; she was determined not to have to struggle with a language barrier again. Others noted the importance of studying a patient with an illness like cancer,which typically followed a predictable trajectory. Because Nunzio had repeatedly outlived projections, it had been difficult to determine at what point he should be considered dying. The second major case fulfilled both criteria. By November 1969, when that case opened,Wald had begun to select study participants solely from Goldenberg’s roster of breast cancer patients. The ones she chose were women he believed had a three-­ month life expectancy. All had received their diagnoses in either the 1950s or—­ more commonly—­ the 1960s. During those decades, the reigning medical approach to breast cancer had two facets: early discovery of disease and radical surgery. Since its creation in 1913, the American Society for the Control of Cancer (later renamed the American Cancer Society) had tried to counter the fatalism surrounding the disease. Arguing that a breast cancer diagnosis was not a death sentence, the organization encouraged women to find breast lumps as soon as possible. By World War II,a massive health-­ education campaign had developed in the United States, promising that breast cancer would neither kill nor Hope, Blame, and Acceptance 69 maim any woman who remained vigilant, regularly examined her breasts, and reported all suspicious signs to her doctor.1 The early detection movement rested on a belief that the dominant treatment could cure breast cancer in its initial stages. Most doctors followed Johns Hopkins University surgeon William Stewart Halsted, who pioneered radical mastectomies. That operation had devastating consequences, causing serious chest deformities, including hollow areas under the collarbones and armpits, and, in some cases, lymphedema (arm or hand swelling), pain,and mobility problems.In the early 1970s,Goldenberg joined a growing chorus of surgeons who argued that breast cancer was a systemic rather than a local disease and that radical mastectomies were no more effective than less aggressive procedures.2 By the end of the decade, a combination of accumulating scientific evidence, patient dissatisfaction, and women’s health activism convinced the majority of surgeons to abandon the Halsted mastectomy. But as late as 1968, the year before Wald inaugurated her study, the great majority of women diagnosed with breast cancer underwent that operation.3 Although the feminist breast cancer movement did not emerge until the 1970s,earlier generations of patients were not entirely passive .In a 1954 magazine article titled “I Had Breast Cancer,”Terese Lasser declared, “A deplorable curtain of silence hangs about this subject and it is time we lift it.”4 Patients often failed to disclose their diagnoses, even to intimates, and doctors routinely listed other causes on death certificates. Lasser attempted to pierce that silence by founding Reach to Recovery. Long before the establishment of support groups for people confronting various afflictions, Reach to Recovery organized breast cancer survivors. Visiting other women immediately after diagnosis or surgery, volunteers discussed the aftereffects of radical mastectomies, explained how women could regain mobility in their arms, and provided fashion advice.Like advocates of both early detection and Halsted mastectomies , Reach to Recovery emphasized hope and optimism. The organization’s literature preached that prostheses could not only create a normal appearance but also facilitate healing and that any 70 Prelude to Hospice woman with sufficient willpower could rapidly return to health.5 By 1969, when Reach to Recovery became part of the American Cancer Society, it had grown into a massive organization, serving thousands of newly diagnosed women.6 The flip side of glorifying cure was denigrating those who either died or were seriously ill. Members of the second group were held responsible for their own misfortunes. Doctors who previously might have viewed advanced disease as inevitable or the result of their own incompetence could blame patients for having failed to recognize the first signs of cancer and take corrective action.A 1945 drug advertisement that appeared in numerous popular magazines contrasted “wise” and “foolish” women with breast cancer. The “wise”woman had quickly reported her breast lump to her doctor; as a result, she had no complications from surgery and “recovered completely.” The accompanying photograph depicted a healthy, smiling...


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