There is a curious story in the New York Times about "the complicated legacy of Betty Ford's breast cancer story." As someone considered high risk for breast cancer due to family history of the disease, I have some thoughts on Betty Ford's legacy.
Betty Ford was diagnosed with breast cancer in 1974 and was one of the first women to openly talk about her diagnosis and subsequent mastectomy. At that time, her role as First Lady gave her an enormous platform to raise awareness about the disease.
I was curious about this New York Times essay because of the impact breast cancer has had on my family. In 1970, my mother was diagnosed with breast cancer. She was 37 years old, a mother with three young daughters. When this happened, she was sedated for a biopsy and knew that if the cancer was found, they'd perform a mastectomy before she woke up.
She woke up without a breast.
In later years, when I thought about the brutality of this medical approach, I thought I perhaps misremembered what my father had told me. I brought this up with my father-in-law, a radiologist, who told me that this was indeed the state-of-the-art treatment for breast cancer at that time.
That's an incredible approach to cancer - biopsy & mastectomy at the same time if cancer is found. 54 years later, I still feel enormous sorrow for my mother for the emotional broadside of waking up without a breast as the way to find out she had breast cancer.
In 1974, my mother died, four years after her mastectomy. She had just turned 41. By then, cancer had ravaged all of her body. She had endured the loss of one breast and lymph nodes; her uterus and ovaries were later removed to get rid of estrogen, thought to be food for cancer. She lost her hair, her looks, and then her life.I was a child - it was very difficult to witness.When she was first diagnosed, cancer was considered a taboo topic. Even in 1970, there were some people thought they might "catch" cancer from the person who was dealing with this disease. The idea of being disfigured by a mastectomy was something to be kept secret from everyone.
Betty Ford's openness about her diagnosis and surgery was a gift. She talked publicly about a taboo subject. She let people know she'd had a mastectomy. She provided other women with the confidence to talk openly about their breast cancer diagnosis and treatment.
And that changed a lot of things. Ford's willingness to talk about breast cancer put much more attention on researching treatments for this insidious disease. No woman today is put under for a biopsy with the fear she may wake up without a breast. And since Betty Ford brought attention to the issue of breast cancer, more resources were devoted to researching treatments for this disease.
Here is a link to a Journal of American Medical Association study on the improvements in breast cancer treatments over time. The study showed a dramatic decrease in deaths from breast cancer since 1975: "Improvements in treatment and screening after 1975 were associated with a 58% reduction in breast cancer mortality in 2019...."
As someone who has spent my entire adulthood as being considered high risk for breast cancer due to my mother's pre-menopausal diagnosis and death, I still very much appreciate Betty Ford's openness about her diagnosis and treatment. It opened the floodgates for researching treatments for this disease. And, as the study above shows, deaths from breast cancer have been reduced significantly since 1975, thanks to new treatments.
The New York Times article oddly focuses on the perils of Betty Ford's breast cancer story.
"Mrs. Ford’s tumor, a lump in her right breast, was detected by her doctor during a routine physical examination on Sept. 26, 1974. She was 56 years old. The consulting surgeon at Bethesda Naval Hospital, William Fouty, recommended a traditional radical mastectomy — a disfiguring operation in which a surgeon removed the affected breast as well as the underarm lymph nodes and chest wall muscles on the side of the cancer.
"A few renegade surgeons and some women with breast cancer had recently begun to question the logic behind this standard of care, arguing that for more localized cancers, smaller operations, especially ones that left the chest wall muscles in place, were equally good. The right to choose one’s own treatment was becoming a cause among a growing number of feminist breast cancer activists. Although Dr. Fouty mentioned the other options to Mrs. Ford, he also discouraged them. She believed him and later said that she did not seriously consider any alternative."
As you read the New York Times story, remember that there was NO early detection in 1974. A mastectomy WAS the standard of care in 1974. Betty Ford's lymph nodes WERE found to have cancer. Removing cancerous lymph nodes WAS the right decision. It is unclear what "alternative" was available to women back when biopsy and breast removal happened as part of the same procedure were the standard of care.Betty Ford was responsible for bringing attention to the importance of early detection, though, as the article notes, since her cancer had already spread to the lymph nodes, she was NOT a case study in finding cancer early.She was a case study in the importance of bringing attention to breast cancer. From the National Archives:"In late September 1974, during a routine physical examination, Mrs. Ford’s doctor discovered a lump in her right breast. Within days, the First Lady underwent a surgical biopsy which determined that the lump was malignant, and a radical mastectomy was performed. Mrs. Ford chose to go public with her plight early on, destigmatizing breast cancer during a time when the word “breast” was little used in social settings....
"Shortly afterward, there was an uptick in the number of check ups women sought across the country – accredited to Mrs. Ford. It was even called the “Betty Ford Blip.” Sane E. Brady reported in the New York Times on October 6, 1974, that “The publicity surrounding Betty Ford’s surgery for breast cancer has motivated thousands of women around the country to seek appointments at free breast cancer detection centers.”
The National Archives post includes the news release issued to inform the public of Ford's diagnosis:
In reading the New York Times article on the "complicated legacy of Betty Ford's cancer diagnosis," it seems as if the author wants to diminish the importance of early detection because some women who detect breast cancer early still die."And while it might seem counterintuitive, searching for earlier cancers may not always be beneficial, particularly in women under 50. For one thing, one must screen 750 to 1,000 women throughout their 40s to save just one life from breast cancer. These other women are much more likely to have false positive results, which lead to unnecessary worry and biopsies. There are also growing calls for other, potentially more precise screening methods like ultrasounds and M.R.I.s for certain women. Thus, while the U.S. Preventive Services Task Force recently recommended regular mammograms for women in their 40s, some breast cancer experts remain concerned that calls for early detection may promise too much.
Mrs. Ford’s bravery and influence remain commendable. But her experience also demonstrates the challenges of celebrity health stories, which can both inform and give false hope. This is especially true for diseases such as breast cancer, for which our understanding continues to evolve. Accounts of famous women with breast cancer appear all over the internet, especially in October, which is Breast Cancer Awareness Month. So do versions from everyday women. Among the most common stories are those in which women report that mammograms saved their lives. While this claim is surely true in some instances, it is probably not in others. The nuances of diagnosis and treatment may be lost as people try to create coherent stories after the fact."
And yet, the fact remains – though ignored in the New York Times article – that over time, the mortality rate for breast cancer has dropped by nearly 60 percent since 1975. Early detection can help save lives. Waiting until lymph nodes are infected is not an appropriate solution. I don't think ANY woman I've ever known who's been diagnosed with breast cancer has the "false hope" that they will without a doubt be cured. Regardless of how old or young a woman is when diagnosed with breast cancer, it is a terrifying diagnosis; the treatments usually result in hair loss (mostly temporary), aggressive chemotherapies and surgery. So I puzzle about the objective of this article, which seems slanted against early detection measures.
Betty Ford's story is an example of a public figure using her platform to bring awareness to a disease that was barbarically treated back in the 1970s. To use her story as a means to cast doubt on the usefulness of mammograms and early detection is an odd choice, in my opinion as the daughter of a woman who died far too young of this disease. I will ALWAYS appreciate Betty Ford's openness about her breast cancer diagnosis and mastectomy. Early detection DOES matter, even if it cannot help to every woman who is diagnosed with this horrible disease.
Since 1975, deaths from breast cancer have been significantly reduced - and Betty Ford's public discussion of her diagnosis helped greatly to open the doors to more research going to help treat women diagnosed with this disease. For that, she is one of my heroes.
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