In the early days, she pictured the cancer as bulky, solid and black, weighing heavily in her chest.

In her mind's eye, the immune system she was trying mobilize against the cancer was like an ax or a chisel.

The cancer was gaining.

Today, the cancer is still in her lung -- "right here," she will say and tap the left side of her chest with a graceful finger.

But today in Penny Cummings' visualization, the cancer is "more like coal dust." And her immune system, she says, "I see as like those scrubbing bubbles you see in the TV commercials. They're scrubbing that coal dust out of my lungs."

Cummings, who is public relations director of the Sheraton hotel chain in Washington, was 33 when her breast cancer was diagnosed in 1981. She had a modified radical mastectomy with no radiation or chemotherapy. There were no affected lymph nodes, usually a good sign that the cancer has been caught in time. Yet the cancer returned.

Today, Cummings' oncologists have evidence that the cancer is responding to her current course of chemotherapy. What role, if any, visualization might have played, she can't be sure. But she knows the images changed on their own. Cummings translated the images into sketches and drawings as soon as they came into her mind, she said. Only in retrospect did she realize that in her pictures, the cancer was "dissolving" into dust. ::

The use of visual imagery to fight cancer was first widely popularized in the early 1970s by oncologist Carl Simonton and his psychologist wife, Stephanie. Despite numbers of anecdotal reports of remarkable cures and remissions, no scientific studies have ever demonstrated that it is of any use.

Penny Cummings is another anecdote. Her fight against the cancer has been almost full-time since its recurrence. One difficult chemotherapy course proved useless, as did a six-month trial with a hormonal therapy. She is almost through an experimental protocol that seems to be helping, and although she is once again wearing a wig and has periods of fatigue and nausea, she is generally in good spirits, working almost full-time and feeling "in control." She attributes much of her current strength and a great deal of her visualization skills to a group of area scientists whose work may eventually help settle the controversy over the effect (or lack of effect) of psychological state, guided imagery, stress management, mood and behavior on the course of a disease like cancer.

About the time in 1984 that Penny Cummings' breast cancer was reaching ominous tentacles into her lung, a team of specialists at the Medical Illness Counseling Center in Chevy Chase was setting out to test the effects of relaxation and guided imagery on the immune systems of seriously ill cancer patients. Working with a psychoimmunologist at George Washington University, they taught 10 patients with metastatic (spreading) cancer, how to relax and imagination techniques that they hoped would strengthen their immune systems.

Independent blood tests of their immune systems -- particularly T-cells and natural killer cells, believed part of the body's natural defenses against cancers -- were promising. The study was small and preliminary, and although the results are still awaiting publication, they have been discussed at conferences and the word is out that the immune systems of these patients showed statistically significant, measurable changes.

At the end of the study, the individual oncologists treating the patients for their cancers were queried. About 25 percent said they believed their patients' survival had been enhanced. All the oncologists found a distinct improvement in the quality of the lives of their patients.

Now, Drs. Stephen P. Hersh, Lucy R. Waletzky, Sharlene Weiss and Barry L. Gruber at the Medical Illness Counseling Center are preparing to begin a second study, involving breast cancer patients. The experimental design of this second group is more rigorous than that of the pilot study and will be restricted to 20 premenopausal breast cancer patients who show no evidence of spread to lymph nodes. These patients will have been treated with modified mastectomies (without radiation or chemotherapy) at least four months before entering the study.

Results, over a period of at least one year, could provide some of the first genuinely controlled measures of relaxation and guided imagery on the course of a specific cancer. ::

But as important as the biochemical or psychoimmunological findings may eventually prove to be, the psychological effects of imaging therapy may be equally significant.

"There is," said Weiss, "often accompanying the cancer experience the feeling on the part of the patients that they are totally out of control. One of the things that came through loud and clear was that {in the group} they finally felt they were taking charge, that they were actually doing something."

Ability to visualize is greatly aided by being able to attain a genuine state of relaxation, yet Gruber, the center's biofeedback specialist, found that although several of the patients said they felt perfectly relaxed, the biofeedback measurements showed they were not. Training enhanced the relaxation techniques, leading to more effective visualizations (as measured by the immune system tests.)

The cancer counselors also found that contrary to recommendations of many "specialists" in the new field of guided imagery, the most effective techniques -- at least psychologically -- were those the patients devised themselves. Some patients, said Weiss, like Penny Cummings, a member of one of the treatment groups, are naturally adept. Some need to "feel" or even "hear" the immune system. One woman imagines an opera in which hero (her immune system) and villain (the cancer cells) sing arias in which the hero conquers. "Another woman feels the immune system as a rushing stream."

"We found that it doesn't seem to matter how they see them as long as they could develop the imagery and use it. One woman," said Waletzky, "said she saw her immune cells as sitting on the beach under little umbrellas. I said to her, 'Don't you think it's time for them to get a little more active?' and she agreed."

Some people, she said, "want so much to believe that the cancer has been totally removed by the initial surgery, that they are unable to visualize any cancer cells in their body." For these, she said, she has borrowed a technique described in a recent book by Steven Locke and Douglas Colligan, "The Healer Within," in which the immune cells are perceived as "guides or scouts who go out every day to find the cells who might be misbehaving, disobeying the normal laws -- who are, you might say, 'having a temper tantrum.' " ::

Studies on the role of psychological and social factors in breast cancer continue to conflict. According to a recent report of the Mind Body Health Digest of the Institute for the Advancement of Health, small scattered studies in the United States and England suggest that these factors do affect length of survival. New findings from Dr. Sandra Levy at the University of Pittsburgh suggest that in a study of 36 patients followed for seven years, a high rating in a category called "the joy factor" was more predictive of survival than the number of sites to which the cancer had spread.

However, a new large study at Sloan-Kettering Cancer Center in New York is showing "no significant differences" in attitude and mood between those who survived and those who did not.

The story is far from ended.More Information

Volunteers for the breast cancer visualization study may write Medical Illness Counseling Center, Two Wisconsin Circle, Suite 530, Chevy Chase, Md. 20815. Phone: 654-3638.