NCI Director Monica Bertagnolli remembers when Betty Ford and Nancy Reagan went public with their breast cancer diagnoses—and the profound impact those decisions had on oncology.
“First Ladies Betty Ford’s and Nancy Reagan’s public sharing of their breast cancer diagnoses had a tremendous effect on how our society views cancer,” Bertagnolli said during her introduction of a panel convened by the Cancer History Project, “How Betty Ford and Nancy Reagan’s cancer diagnoses impacted a nation.”
“Their courage in sharing information about their personal health, at a time when the subject of cancer was taboo, provided much needed support to so many women at a time when social support was so much less than it is today,” Bertagnolli said.
Bertagnolli was diagnosed with breast cancer only eight weeks after becoming NCI director (The Cancer Letter, Dec. 14, 2022). Like Ford and Reagan, Bertagnolli was forthcoming about her diagnosis.
“It was important to me to be open about my diagnosis. What I want to share is that my prognosis is very favorable,” she said. “My cancer was diagnosed by mammogram, and the care that I am receiving is a result of decades of research funded by the National Cancer Institute.
“I am so grateful to the many women, and researchers supporting them, who’ve made my care possible. It was also important to me to participate in a clinical trial, to give back in that way, and I am doing so in honor of all the other women who did the same for me.”
The panel was moderated by Stacy Wentworth, assistant professor of radiation oncology at Wake Forest University School of Medicine and medical director of cancer survivorship at Atrium Wake Forest Baptist Health Comprehensive Cancer Center.
A guest editorial by Wentworth on the subject of First Ladies with breast cancer appears on the Cancer History Project.
On a panel March 7, Wentworth was joined by panelists Mirelle Luecke, supervisory museum curator at the Gerald R. Ford Presidential Library and Museum, and Karen Tumulty, deputy editorial page editor and columnist of The Washington Post. Tumulty is also the author of “The Triumph of Nancy Reagan.”
Six weeks after Gerald Ford became president, Betty Ford was diagnosed with breast cancer.
“Right from the beginning, Betty was really adamant that she would be open about this,” Luecke said. “When she first became First Lady, she talked about how she was going into this office as Betty and as the woman that she had always been.
“She said, ‘If they don’t like me, they can kick me out.’”
Making the decision to go public with her diagnosis made sense for Betty Ford. She then used her role as the First Lady to educate women in America to get screened for breast cancer.
“She hadn’t planned to go get a breast exam, and then all of a sudden, they found a lump,” Luecke said. “That really shook her up and made her think about all the other women in the country who might be in that same position.”
Ford received a radical mastectomy just as the science was changing. While she was under the knife, cancer researcher Bernard Fisher was giving a presentation at NCI about how the radical mastectomy—which removes the breast, lymph nodes under the arm, and chest wall muscles—was no more effective than a modified radical mastectomy followedby radiation (The Cancer Letter, Oct. 4, 1974).
The Cancer Letter’s founding editor Jerry Boyd, who started this publication not quite a year earlier, recognized that fate had dealt him one hell of a story—and he nailed it, writing big:
The timing was ironic, with overtones of tragedy for yet another of the Nation’s first families.
Nathaniel Berlin, director of NCI’s Div. of Biology & Diagnosis and chairman of the Breast Cancer Task Force, had for months planned a “state of the art” report to the scientific community on detection and treatment of breast cancer.
Date for the report Monday, Sept. 30-was scheduled weeks ago.
Then Betty Ford, the wife of President Gerald Ford, underwent a radical mastectomy two days before the meeting, after a lump in her right breast was found to be malignant. Suddenly Berlin’s report took on an aura of major national significance.
Reporters and other nonscientists jostled for seats with the professional observers in the NIH clinical center auditorium, with the overflow watching on closed-circuit TV in a smaller theater.
Berlin told The Cancer Newsletter last spring that he felt it was too early for the Task Force’s tentative findings to receive public recognition, and that the various studies should have another year or more first. But the results were already being widely circulated and NCI decided that an official report was necessary.
Any chance that the report would be limited to the profession with little public awareness disappeared with Betty Ford’s illness. The result may be that the dramatic, although tentative, findings of the Task Force will be forced by public pressure into medical practice-prematurely, some feel.
The two most important conclusions involved treatment :
- Radical mastectomy, involving removal of the breast, underlying pectoral muscles and axillary lymph nodes, is no more effective than total mastectomy (removal of the breast alone) for patients with operable disease limited to the breast.
- For patients whose cancer has spread to the axillary nodes, radical mastectomy was no more effective than total mastectomy combined with postoperative radiotherapy.
- Chemotherapy, involving the drug L-phenylalanine mustard (L-PAM), administered to patients with positive axillary nodes, resulted in recurrence in premenopausal women for only one of 30, whereas 1 1 of 37 recurred after surgery alone. The normal recurrence rate for patient
At the CHP First Ladies panel, Wentworth said Ford underwent surgery at the exact time when approaches to the treatment of breast cancer were shifting.
“She was really at the edge and at the precipice of the change in surgery,” Wentworth said. “I can’t imagine how much pain she was in, and even after a modified radical mastectomy, many women will find that it takes a while to get their strength and that range of motion back.”
While Betty Ford was recovering in the hospital the week after her surgery, President Ford brought her a get-well gift—a football from the Washington Redskins, a team now renamed the Washington Commanders.
“She decided she was going to surprise him. Show him, her doctors, and the American public how well she was recovering,” Luecke said. “She throws this football to him, which is really incredible when you think about it… She’d never talk about how painful it was to do that. She always had a very positive spin on it, but I imagine it was quite a determined act to push through the pain there and throw that football.”
Ford’s diagnosis and treatment resulted in something called the “Betty bump.”
“There was an increase in breast cancer diagnoses by about 15%,” Luecke said. “She received over 50,000 pieces of mail sent to the White House during and after her ordeal. Many of these letters were from women thanking her for being so open about her experience.”
Ten percent of the letters were from women who had experienced breast cancer. Others shared that Ford had prompted them to get breast exams.
First Lady Nancy Reagan was diagnosed with breast cancer more than a decade later—in 1987. By then, Reagan was already familiar with what it took to tell the world about a cancer diagnosis (The Cancer Letter, July 19, 1985).
“They had been through something like this only two years before, which was Ronald Reagan’s diagnosis and subsequent surgery for colon cancer. He had also been diagnosed with skin cancer,” Tumulty said. “They had already been through the sort of scrutiny that a president and a president’s family are going to get in this situation.”
Nancy Reagan was savvy about medical issues because her father was a surgeon, Tumulty said. Reagan knew she could be a candidate for a lumpectomy, but opted for a modified radical mastectomy.
Like Ford, the Reagan White House decided to be open about the First Lady’s diagnosis and treatment.
“There was some public second-guessing to her decision to go with surgery,” Tumulty said. “Again, it wasn’t like she didn’t know her options. It wasn’t like she didn’t weigh her options, but she also knew herself, and she knew what would make her feel most comfortable.”
Rose Kushner, a prominent breast cancer activist at the time, “told The New York Times that Nancy Reagan ‘set us back 10 years. I’m not recommending that anyone do it her way,’” Tumulty said. “Second-guessing someone’s choice like that in public adds a lot of pain and scrutiny to what she was already going through, but she was comfortable with her choice.”
Reagan took on the role of advocate—recommending that women get mammograms so their cancers could be detected earlier.
“She was very aggressive in promoting early detection, and making people talk about it, and making people think about it,” Tumulty said.
Reagan made the decision not to have reconstructive surgery.
In one of her diaries, she wrote: “I still haven’t shown Ronnie me—even though he says it doesn’t make any difference, and I believe him, I somehow can’t bring myself to do it yet. I’ll know when the time is right.”
Ford, too, wrote about her recovery from surgery. “In her autobiography, she writes about sneaking looks under her bandage so she can see the scars herself because, of course, she’s still trying to come to terms with those,” Luecke said. “The way that she writes about her own self-image and what she thinks about the surgery is very much tied with her concerns about how Jerry is going to respond to her now that she’s lost a breast.
“She was really invested in sharing these concerns about the physical toll and the emotional toll of the surgery with the public in her autobiographies, because she, again, wanted to try to show other women in the country that it was okay and that these were things that she was feeling, that everyone was feeling,” Luecke said.
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