Knife, Rays and Women: Controversies about the Uses of Surgery versus Radiotherapy in the Treatment of Female Cancers in France and in the US, 1920–1960

Abstract

In 1960, François Baclesse and two of his colleagues at the Curie Institute published a paper entitled ‘Should one be authorized to do a simple tumourectomy followed by radiotherapy in a case of a mammary tumour’. Baclesse, the head of the Curie’s radiotherapy department, argued that the ablation of a malignant tumour of the breast followed by radiotherapy could be as effective as the standard therapy for breast malignancies, the radical mastectomy.¹ Baclesse’s conclusion was grounded in more than 20 years worth of observations, of 100 women with stage I and II breast cancer who had been treated with surgical removal of the tumour alone followed by radiotherapy.² Half of the patients remained symptom free for ten years or more, and 17 additional women did not show any signs of breast cancer for at least five years after treatment. The women treated with this conservative approach had slightly higher rates of local recurrence than those who underwent radical surgery, but the five years survival rate was similar in both groups.³ Tumourectomy (the surgical excision of the tumour) with radiation was less effective than mastectomy in young women (under 35), and those whose tumours were of high histological grade. However, women whose cancers had spread to axillary lymph nodes but not to more distant sites fared relatively well: 55 per cent of the patients with stage II breast tumours (26 out of 47) were stabilised with tumourectomy and radiation alone, as compared to 71 per cent (38 out of 53) of those with stage I breast tumours (small, localised growths without lymph node involvement). Baclesse and his colleagues counted women who had local