Vera Peters, the Doctor Who Helped Spare Women from Radical Mastectomy

Vera Peters, the Doctor Who Helped Spare Women from Radical Mastectomy

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Amy Scharf: I'm Amy Scharf, and this is Lost Women of Science: From Our Inbox, a series of mini episodes featuring forgotten female scientists that we first learned about from you, our listeners.

On today’s episode, we hear from two daughters about their remarkable mother: Dr. Vera Peters, who helped revolutionize treatment for two potentially fatal diseases.

Producer Johanna Mayer brings us her story.

Johanna Mayer: In 1975, a Canadian oncologist named Dr. Vera Peters took the podium at the Royal College of Physicians and Surgeons of Canada meeting in Winnipeg.

Jenny Ingram:  I as a recent graduate, now a resident in medicine, attended that meeting. 

Johanna Mayer: This is Jenny Ingram – she’s Vera’s daughter, and a physician herself.      

Jenny Ingram:  I  watched her present her results to probably 400 men sitting in a huge auditorium, all wearing suits, telling the surgeons that their bread and butter surgery, the radical mastectomy, did not need to be done in early breast cancer and that the results were just as good with a lumpectomy. And it's fair to say that it was a hush silence there.

Johanna Mayer: I’m Johanna Mayer, and this is Lost Women of Science: From Our Inbox. Today, we’re talking about Dr. Vera Peters, and how, nearly half a century ago, her one brave act in front of a roomful of men helped revolutionize treatment for breast cancer.  

Vera Peters was always a driven person. 

Sandy Clark: I have memories of her working at the dining room table doing research. 

Johanna Mayer: That’s Sandy Clark – she’s Vera's other daughter. She’s a retired schoolteacher. Together, Sandy and Jenny wrote to us about their mother.

Sandy has childhood memories of going upstairs to bed while her mother was at work at that table, then coming down in the morning…

Sandy Clark: …and she was still there because she got so involved in it that when she looked up it was daylight.

Johanna Mayer: Vera grew up in a small town near Toronto.

Sandy Clark: She went to one-room school, and followed that with high school and then onto the University of Toronto Medical School.

Johanna Mayer: She graduated from medical school in 1934…which is pretty remarkable, considering that in the early 20s, 98% of doctors in Canada were men.

Jenny Ingram: And it's fair to say that they were a unique group of women to graduate from medicine at such an early year in the century. And I think there was great camaraderie for them all. 

Johanna Mayer: Sandy and Jenny credit two things with sparking their mother’s ambition in medicine. First, Vera grew up with two strong women at the head of the household – her mother and her aunt. Second, Vera’s mother would die of breast cancer while Vera was at the tail end of med school. And it was during her mother’s cancer treatment that Vera met Dr. Gordon Richards,  a pioneering radiation oncologist . Before Gordon arrived at Toronto General Hospital, physicians and surgeons would interpret images from diagnostic radiology. But Gordon changed the process so that trained radiologists would interpret the film. He also took on Vera and others as apprentices  – even though there was no formal training program in radiotherapy at the time.

During Vera’s residency, she and Gordon studied Hodgkin lymphoma, and the effects of radiation. Hodgkin lymphoma, also known as Hodgkin’s disease, is a form of cancer that affects the lymphatic system. When this type of cancer begins, white blood cells grow out of control and cause swollen lymph nodes and growths all across the body.

Jenny Ingram: And the two of them recognized the pattern of Hodgkin's disease spreading throughout the body and recognized that if you have Hodgkin's disease, let's say in your arm, under your arm, you can feel the swollen glands. But if you only treat that area, people didn't survive.

Johanna Mayer: Together, Vera and Gordon took the approach of looking ahead – towards the areas where the disease was going to spread next, and treated those areas. 

Jenny Ingram: This made a disease that was normally viewed as a killer, an incurable disease of young people, into a curable disease. So this came as a result of her intense focus with Dr. Richards on the patterns of the disease and getting ahead of it rather than chasing it.

Johanna Mayer: Vera published a paper about their findings in 1950 – and it eventually cemented her reputation as an authority on Hodgkin lymphoma.

Jenny Ingram: It was unusual to have such a high profile woman doing such high profile research and impacting women's lives in such a high profile way. I think that is a legacy that is perceived by people across the globe.

Johanna Mayer: After Vera’s work on Hodgkin lymphoma, doctors began reaching out to her, asking her to treat “incurable” people who had breast cancer. 

Jenny Ingram: These were treated as, kind of individuals who were given a second chance because they had been told by others, often surgeons, that they were too unwell to have curative treatment, so they would shuffle off to see Dr. Peters to get the next best thing.

Johanna Mayer: The treatment of the day for breast cancer was radical mastectomy, an extremely invasive surgery that removes the entire breast, the underlying muscles, and all the lymph nodes underneath the arm and shoulder. The idea was that by removing it all, you stripped away the opportunity for the disease to spread. Radical mastectomy was the standard of care for much of the 20th century, even for tumors detected in the early stages. But the disfiguring results of radical mastectomy can give rise to emotional distress. And it’s a MAJOR surgery, requiring lengthy recovery and a great deal of physical stamina. 

Jenny Ingram: And so in the early days, I think Dr. Peters was receiving patients who were viewed as too old or too ill or having too many other complexities to allow them to have such extensive surgery. 

Johanna Mayer: So Vera thought back to her work on Hodgkin lymphoma, and her knowledge of how disease spreads.

Jenny Ingram: She treated them by taking the lump out of the breast, and then if they had evidence of nodes in the axilla or elsewhere, she would radiate those areas kind of in the same way that she treated Hodgkin's disease to try to get ahead of it rather than always chasing it.

Johanna Mayer: The treatment was called lumpectomy – and it was a new and somewhat revolutionary approach. Years later, Vera had accumulated thousands of breast cancer patients – many of whom received lumpectomy instead of the radical mastectomy. And she began to notice something.     

Jenny Ingram: Many of them had lived longer than 10 years and would've been considered a cure, even though upon referral they were considered getting a second best treatment. And the question she asked herself at this point was, how long did people live if they had a lump removed and postoperative radiation if needed? She then speculated, could I find age and disease matched patients who had had a radical mastectomy? So she set about to investigate.  

Johanna Mayer: Remember – this was before everything was digitized, computers weren’t common yet. Vera had to track down individual patient information, then plot the data on a grid by the stage of disease, their age, and other medical factors. She looked at this for patients who’d gotten radical mastectomy, and those who got the lumpectomy. And she did this for two decades.

Jenny Ingram: And lo and behold the results showed that they had parallel lifespans, that people treated with the Halsted mastectomy and the people treated with lumpectomy and postoperative I radiation as needed, was indeed a curative treatment in the early stages of breast cancer.

Now, if you can imagine the impact of this in society, this meant that women who were being managed largely by surgeons for their breast cancer were suddenly hearing that a noninvasive treatment, a breast-conserving treatment, was available. And for many people, this was a choice that they had never been given.

Johanna Mayer: In 1975, Vera published the first controlled study to show that this less invasive treatment – lumpectomy and radiation as needed – worked. She argued that the radical mastectomy should not be the go-to, first resort treatment. 

And that’s how Vera – and her daughter Jenny – found themselves at that conference in 1975, in front of a room of very skeptical surgeons.

There was a hush in the room, as Jenny described earlier. But there was also curiosity. It’s tough to overstate how revolutionary this was – it took until 2002 for Vera’s idea to gain widespread acceptance in the medical community.

Jenny Ingram: That impact of breast-conserving surgery in the psyche of couples and women was huge. Her mother had been treated with a radical mastectomy, and subsequent to the radical mastectomy, she had a iron vest full of radiation in it, that caused burning of her skin. So the devastating effects of the treatment as it used to be done, were well known and well understood by our mother, Dr. Peters. 

Johanna Mayer: Here’s Sandy again, Vera’s other daughter: 

Sandy Clark: She was a wonderful mom. I had great respect and admiration for her and love as well because she worked so hard seeing patients all day and doing her research at night, and yet she always, always had time for us. 

But I have always felt that her legacy, what she has left behind, has been a benefit for everybody in this world.  Breast cancer patients, Hodgkin's disease patients because of the work she did, and I believe the world is a better place for us as a result.

Amy Scharf: Thanks to Jenny Ingram and Sandy Clark for writing to us about their mother, Vera Peters.

This episode of Lost Women of Science: From Our Inbox was produced by Johanna Mayer and engineered by Hans Hsu. Our executive producers are Katie Hafner and myself, Amy Scharf. Lizzy Younan composes our music. We get our funding from the Alfred P. Sloan Foundation and the Anne Wojcicki foundation. PRX distributes us and our publishing partner is Scientific American.

Here at Lost Women of Science, it is our goal to rescue female scientists from the jaws of obscurity, but we need your help! If you know of a female scientist who's been lost to history, let us know! You can go to our website to send us an email at lost women of science dot org. You'll also find the phone number to our tip line. We love getting calls to the tip line.

Thanks for listening.

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