Challenging Myths in Physical Therapy

Abstract

As a young, hospital-based physical therapist in the early 1970s, I vividly recall a middle-aged patient who had undergone a radical mastectomy for treatment of breast cancer. Her chest was sunken and hollow following removal of the pectoral muscles, overlying skin, and supraclavicular lymph nodes. She had a gaping wound in her axilla where the lymph nodes had been cleared, making the range-of-motion exercises that I provided extremely painful. For almost 80 years, the Halsted radical mastectomy was the standard treatment for breast cancer in North America, a procedure that was both physically and psychologically debilitating. An American surgeon named Bernard Fisher chose to challenge the myth that radical mastectomy was the only viable treatment for breast cancer. Through a series of large randomized controlled trials conducted in the 1970s and 1980s, Fisher's research team demonstrated that a much less invasive surgery—the partial mastectomy (lumpectomy), combined with radiation to the breast—was as effective as the radical mastectomy in prolonging lives of women with early-stage breast cancer.1,2 As a result, almost 75% of the more than 200,000 women diagnosed with breast cancer in North America each year can opt for a lumpectomy.3 For those who still require removal of the breast, much less invasive procedures—such as the total mastectomy or modified radical mastectomy—are now standard practice. A few years after my experience with the patient who had undergone the radical mastectomy, I switched gears and became a pediatric physical therapist. In 1973, I was thrilled to take part in an 8-week course on the neurodevelopmental treatment approach …