Long before there was an Awareness Month, there were women with breast cancer.
One well-known case is that of Abigail (“Nabby”) Smith, the much-loved daughter of former US President John Adams. In 1811, Nabby was 46 years old when she first discovered a lump in her breast. Her physician, Benjamin Rush (for whom Rush University Medical Center in Chicago is named), recommended immediate treatment, advising her family that “tumors such as hers tend much more rapidly to cancer after 45 than in more early life” and that “the knife” was the only known curative. During a time when a wine cordial spiked with laudanum (tincture of opium) served as the only anesthetic, Nabby endured the incredible agony of a mastectomy performed while she was fully conscious. Dr Rush later reported to President Adams that he had never before seen a patient demonstrate such fortitude. But while Nabby’s will to live was obviously tremendously strong, her reprieve from the cancer was brief. As her mother, Abigail Adams, recalled: “[the cancer] soon communicated itself through the whole mass of the Blood [sic], and after severe sufferings, terminated her existence.” Nabby Smith died within 2 years after the removal of her breast. John Adams, it has been said, was permanently changed and humbled by Nabby’s ordeal. A man whom we would in today’s parlance call a “difficult person,” Adams had always been notorious for short-temperedness; after witnessing the grace and determination with which his daughter confronted her cancer, the former president became noticeably gentler, more accepting of life, and more forgiving.
The legacy of courage displayed by women like Nabby Smith is carried on today by breast cancer survivors everywhere. Now, as then, these brave women are all around us: they are our co-workers, our friends, our sisters, and our daughters.
Unlike Nabby Smith and her contemporaries, however, women with breast cancer today stand a very good chance of survival after treatment. For patients with breast cancer that is detected in the localized stage (stage I, before the disease has spread to surrounding breast tissue), the 5-year survival rate is approximately 98%. For patients with stage III breast cancer, it is 72%.
Survival rates for women with breast cancer are not merely better than they were in the 18th century—they have improved dramatically in just the last 24 years. Mortality rates associated with breast cancer have decreased 34% since 1990. This is heartening news, and is certainly a testament to improved treatment as well as to earlier-stage detection and diagnosis.
It is worth pointing out that these advances in screening and detection coincide almost precisely with the initiation of Breast Cancer Awareness month, which was launched in 1985. Each year, as we are reminded to “think pink,” women older than 40 years are encouraged to get their yearly mammograms, and young women are learning early on about the importance of vigilance against this deadly disease.
Breast cancer is the second leading cause of cancer among women. And its risk factors are, for the most part, unavoidable. Major risk factors include issues related to parity—ie, at what age and how often a woman becomes pregnant and undergoes childbirth. When it comes to breast cancer, the fact is, lifelong exposure to estrogen—or, in other words, simply being a woman—is the greatest risk factor of all.