All the publicity in the world, all the public-service TV spots, all the articles about why every woman should examine her breast for lumps every month -- and how she should do it -- all those things (and all the money they cost) just won't work, says Rose Kushner.
And she'll tell you why.
Kushner, who used to work for the Pavlovian Center at the Johns Hopkins University in Baltimore, says it's all a matter of conditioning.
"Here you are asking a woman to engage in a complicated sort of behavior every month to look for something she doesn't want to find.
"Then, if she is a good girl, and examines her breasts, and finds a lump, what does she get for a reward?
"And then they wonder why women don't examine themselves."
Rose Kushner doesn't mince words. She never has. Not when she was one of the very earliest voices against the Vietnam war -- and who covered it herself -- and not when she took on the cancer establishment five years ago. First, when she refused a radical mastectomy for her own breast cancer, and then, afterward, to work a sort of revolution among breast-cancer patients. a
This culminated (but did not end) last June in an official concensus opinion from the National Cancer Institute recommending the use of a two-step procedure -- biopsy first, decision about surgery later -- in most cases, as well as their recommendation of virtual abandonment (after nearly a century) of the so-called Halsted radical mastectomy as the treatment of choice for local breast cancers.
(This particularly disfiguring procedure from which recovery is often arduous and painful, involves surgically removing the entire breast, the underarm lymph nodes and the underlying pectoral muscles. Modified radicals and simple mastectomies leave the muscles, which are used in arm movements, intact. Studies indicate that in many, perhaps most cases of early detection, the less extensive surgery is just as efficacious.)
Kushner wrote a book about her experience and the results of her own quest for knowledge of the subject and used the proceeds to establish a hotline for breast-cancer information.
She developed a list of breast-cancer specialists across the country to whom she referred potential patients, and made sure they were well briefed to ask the right questions.
Hers was a shoulder to cry on, an ear for terrors which could not be expressed to anyone else, a source of encouragement, common-sense advice and hard facts.
She is now a member of the President's National Cancer Advisory Board and was a lay member of the NCI concensus panel which reached its June opinion only after hours of debate in which she was a lively participant.
She has written a useful brochure on breast cancer which may be obtained at no cost by calling the national cancer hotline: 800-638-6694. (in Maryland, the number is 800-492-6600.)
She is, at 51, a warm and witty woman whose often pesky persistence and penchant for toe-stomping has left her a reputation for abrasiveness -- or worse -- in some quarters.
If the 12,000 or so women who have sought her help regard her as something akin to saint, elements of the cancer establishment even now see her, as she herself has regretfully characterized it, as "an angry, hateful witch."
Now her 5-year-old counseling service is in jeopardy. She and her family can no longer cope with the midnight phone calls, the unceasing flood of mail, and although a few of the National Cancer Institute's regional hotlines are useful, even helpful, in some parts of the country, most of them, as she has testified before Congress, are neither. She knows. She spot-checks them all the time. (She has called one at Howard University so many times that they know her voice. Now she has volunteers do the checking.)
Kushner has a small grant from the Public Welfare Foundation and she'd like her Women's Breast Cancer Advisory Center to be adopted or endowed so that she could rent an office, furnish it, and hire a staff including a fulltime oncology nurse or social worker, a secretary and a professional fund raiser.
She still answers calls, although she is no longer listed under her own name, and with only word-of mouth publicity, her Post Office box (Box 224, Kensington, Md., 20795) still fills with mail. She's tried having volunteers help her at home, "but then you have to feed them . . . I was always making coffee . . ."
Her husband and son and daughter have helped, but she's promised them now to let up, at home anyway. And her duties as a member of the advisory board keep her busy -- lecturing, traveling, reviewing grant applications.
Saks-Jandel, a fashionable suburban Washington store has offered to put on a fashion show, and several diplomatic wives have agreed to lend their names, she says, but she has no one to help her with the hotel arrangements, nor to provide the "upfront" funds needed. ("Besides, the biggest thing I ever put on was a bar mitzvah.")
In her direct way she says this: "I need money. Big money. Contributions are tax deductible.
"People will give anything to any children's thing," she sighs, "or for seals or whales or dogs or cats . . . but not to breast cancer. Of course, I don't want to take a penny away from the children, and I love animals. Yet it is estimated that this year, in this country, 108,000 women will have confirmed diagnoses of breast cancer.
"And that means some 600,000 women will have biopsies.
"And," she says, hinting perhaps at campaigns to come, "until we can tell women that if they find something smaller than 1 centimeter in their breasts, they can be sure they won't lose the breast, when we can guarantee that, you better believe, women will stand in line to examine themselves."
Rose Kushner subscrubes to the World Book Encylopedia's annual updates. This year's science book came last week.
"It has two pages about options for women with breast cancer," she reports with some delight. "Now you can't get any more grassroots than the World Book, can you?"