INFORMED CONSENT

Given adequate mental preparation, accurate technical and medical information about the types of mastectomy now available to women--radical; modified radical; partial; lumpectomy--and a choice of biopsy procedure (one-stage or two-stage), cancer of the breast can be made significantly less traumatic for women who are afflicted by it. Two case histories, of a fortunate woman and an unfortunate one, are used to make the author's point: that women ought to be given more control over the sort of treatment they receive. The unfortunate case is typical. The woman enters the hospital for a biopsy, and signs a surgical consent form that gives her doctor the right to remove her breast at his discretion. A twenty-minute analysis of the tissue is made while she is unconscious (room for error in such a short procedure, says the author), and if the results indicate cancer, a mastectomy--usually radical--is performed on the spot. Lymph nodes under the arm are removed, as well as pectoral muscles in the chest wall, causing horrifying disfigurement and permanent discomfort. The fortunate woman, on the other hand, is given the option of a two-stage biopsy, and the analysis of breast tissue is made in a procedure totally separate from the one in which her breast would be removed, should the outcome of the biopsy indicate cancer. Even if the results do indicate cancer, the patient is given a little time to get used to the idea. Time, at least, to weight the options, and a chance to arrange for a plastic surgeon to perform reconstructive surgery immediately after the breast has been removed. In the same operation, in fact. A sane and apparently safe alternative, very much worth consideration.