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In Charge of Her Medical Fate
 I
will be 89 years old next August; I was born in Berlin, Germany
at the beginning of First World War. My father died when I was 2
years old during the war and my mother had to raise me alone. Living
in Germany, not being rich and without the "right" contacts,
I was brought up on the strictest McDougall diet possible - if I
was fortunate, my daily food was maybe potatoes, rye bread, and
some veggies. We had occasionally meat on a Sunday. This went on
throughout all my childhood. In spite of periods of general unemployment
and monetary turmoil, I was a happy child because I knew no better.
I also somehow made it through the political nightmare of the 1930s
and early 1940s and through WW 2. I met my husband, Paul, during
the Berlin Airlift - the beginning of the Cold War between the U.S
and Russia. Paul had come as a civilian meteorologist from California
to guide the U.S planes which brought food to Berlin, and I was
the secretary/interpreter/translator at the U.S Weather Station.
In l949, after the blockade of Berlin was lifted, Paul and I got
married and left Germany.
We went directly to Honolulu – it was a dream-come-true. Here
I raised my family of one son and my husband. I was in good health
back then. Soon I learned that Americans needed meat with their
meals. Women in Hawaii showed me how to make roasts, meat loaf and
chickens – the American dream. This was an ideal eating-style
that most Europeans envied. I was so eager to fill in with all those
foods I had missed during my youth living in Germany. Even though
I tried to eat more meat, our meals still had lots of potatoes and
much less meat than most people. So, I don't think it was my
diet that gave me breast cancer – I think it was the Premarin
(estrogen) my doctors put me on.
As a dutiful patient, I had my yearly medical check-ups. On one
of these, my doctor told me he wanted to keep me young, so I should
take estrogen. I happily started the Premarin at age 50 years and
stayed on it until age 67 when I discovered a lump in my breast
– they did a biopsy which showed cancer. Then without any apparent
question or thought about alternatives they told me I had to have
a mastectomy.
I was devastated. How could this be? I was retiring. I wanted a
reward for all my hard work my whole life; instead, what I got was
a diagnosis of breast cancer. Because of all of my overwhelming
experiences as a young woman living in Nazi Germany, I had become
hardened to bad news. I initially thought this cannot be possible.
Then I thought I will fight back.
Fortunately, the week before my diagnosis I heard Dr. McDougall
talk about breast cancer and the fact that a mastectomy was not
necessary and did not prolong lives. This was 22 years ago in 1980.
I made an appointment with him, and Paul and I listened to information
I desperately wanted to hear. I didn't want my breast amputated.
As a result, I did nothing more than the initial biopsy. Dr. McDougall
wanted me to get the margins of the tumor removed so the cancer
did not come back in the breast – but I had had enough of the
medical business. Then, as Dr. McDougall had predicted, 4 years
later the cancer came back in my breast. I saw Dr. McDougall. He
reassured me that the reappearance of the cancer was not necessarily
a bad sign and that this was probably tumor left behind from the
first biopsy. I decided to have a more careful lumpectomy to get
the entire tumor in the breast and then some radiation.
This was a wake-up call. After my diagnosis I returned to my old
German diet, which was now known as the "McDougall diet,"
but a lot more interesting and tastier. Since then I have enjoyed
excellent health, and I have had no recurrence of the cancer. I
will always be grateful that Dr. McDougall supported me in not having
a mastectomy, when no one else would (except my husband, Paul).
 Every
summer I have been returning to Europe for my yearly vacation. This
past summer I decided to take my vacation in Santa Rosa with the
McDougalls instead. September 11, 2001 somehow took the fun out
of going to Europe for me. I read that Dr. McDougall had changed
his location from the hospital to a spa – I was curious, plus
I felt I needed a little booster. Rather than spending money on
a long airplane ticket to Europe I decided to take a shorter trip
to Santa Rosa. I loved seeing John and Mary again, and I just loved
the cooking demonstrations and the outings -- especially the visits
to supermarkets and health food stores under Mary McDougall's professional
guidance. Cooking is fun again. Though an old hand at exercising,
I learned new ways, and renewed my interest in yoga. This was a
great vacation for me since everything was served beautifully and
it was so delicious, and I didn't have to cook for a change.
Even though I was eating well before I came to the program, in 10
days my cholesterol went from 150 to 116 mg/dl. And I made some
great friends.
My life now is spent with many retired people. I share with them
all the recipes and great meals I learned at the Program. Some listen
and some don't – but I still recommend the diet, because
people are so interested. They say, "That is what you are doing
and you are 88 and living by yourself – and you look so good."
I think I will keep doing this same Program for another 10 or 20
years, and I am planning already another refresher course in Santa
Rosa in a couple of years.
Although the failure to improve survival by cutting a woman's
breast off was well recognized by the early 1950s1, this practice
continues today. A New England Journal of Medicine article published
in 1996 found 65% of women from 1983 through 1990 were still undergoing
breast amputation for breast cancer.2 I estimate that over seven
million women have had their breast(s) removed unnecessarily over
the past 50 years in the United States alone (50 years times 150,000
women/year undergoing mastectomy). And well informed doctors have
known the truth and have continued to let this happen without
lifting a hand to stop the death and disfigurement.
This past month, October of 2002, the New
England Journal of Medicine published two, twenty-year follow-up
studies on breast cancer treatment. Their unquestionable conclusion
was the aggressive treatment of breast cancer does no good and
much harm. The first study from Italy of 701 women with breast
cancer found no survival benefit for radical mastectomy compared
to breast conserving surgery (a quadrantectomy – a section
of breast removed). Approximately 42% of women had died of all
causes by 20 years. The second study in the same journal from
the USA of 1851 women with invasive breast cancer compared women
treated with lumpectomy (with and without radiation) and total
mastectomy. The death rate after 20 years was the same for all
3 approaches (about 46% were alive at 20 years from the time of
diagnosis). An accompanying editorial concluded, "It is time
to declare the case against breast-conserving therapy closed and
focus our efforts on new strategies for the prevention and cure
of breast cancer." 5
The reason that treatment of the breast
area with any amount of surgery or radiation has no effect on
the ultimate outcome of this disease is that by the time of diagnosis
the course of the disease has already been determined. If it is
an aggressive tumor then it has already spread to other parts
of the body – beyond the reach of surgery or radiation. If
it is not an aggressive tumor, then it is unlikely to affect a
woman's life regardless of what medical actions she takes.
Will practices change now that the New
England Journal of Medicine has published these two large studies
showing again that this aggressive therapy (a mastectomy) is unnecessary
and harmful? I doubt it. In the late 1970s I listened to a well-respected
surgeon's presentation at a noon-time doctor's conference.
I asked, "Doctor, I have just listened to you talk for the
past hour on the failure of surgery, including the time-honored
mastectomy, to cure cancer or prolong life. Why do you still perform
mastectomies when you fully realize the ineffectiveness of this
approach in saving lives?" His answer was to the point. "This
is the way I was trained." I pursued the matter by asking
what would change this common practice in our healthcare system.
He replied, "A whole new generation of surgeons trained differently."
So why add insult to injury? It is bad
enough to be told you have a potentially fatal disease, but then
to be told you have to be disfigured for the rest of your life
is an unforgivable and unnecessary catastrophe. Don't wait
for your doctor to bring his or her skills into the 21st century
(or even the 20th century). Become well-informed and practice
saying "NO" for at least an hour before each doctor's
visit.
Anneliese may have been right about her
feelings that estrogen was at the root of her breast cancer. This
year a extensive review of hormone replacement therapy came to
the conclusion that the risks, including the risk of breast cancer,
outweigh any benefits, including reducing the risk of osteoporosis.6
Anneliese had one more important advantage over the average woman
facing breast cancer – she knew the importance of a good
diet. The result is at 88 she can run circles around most women
(and men) half her age – and she will probably outlive a
fair share of them too.
You can read much more about breast cancer
– prevention, mammography, standard treatments, and the advantage
of diet therapy in the McDougall Program for Women book –
found in your local book stores, libraries, and on my web site
at www.drmcdougall.com.
References:
1) Mustakallio S. Treatment of breast cancer by tumor extirpation
and roentgen treatment instead of radical operation. J Fac Radiol
6:23, 1954.
2) Nattinger AB. The effect of legislative
requirements on the use of breast-conserving surgery. N Engl J
Med. 1996 Oct 3;335(14):1035-40.
3) Veronesi U. Twenty-year follow-up of
a randomized study comparing breast-conserving surgery with radical
mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227-32.
4) Fisher B. Twenty-year follow-up of a
randomized trial comparing total mastectomy, lumpectomy, and lumpectomy
plus irradiation for the treatment of invasive breast cancer.
N Engl J Med. 2002 Oct 17;347(16):1233-41
5) Morrow M. Rational local therapy for
breast cancer. N Engl J Med. 2002 Oct 17;347(16):1270-1.
6) Nelson HD. Postmenopausal hormone replacement
therapy: scientific review. JAMA. 2002 Aug 21;288(7):872-81.
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