March 18, 2015 • 27 mins
Dr. Peters helped revolutionize the treatment of both breast cancer and Hodgkin's lymphoma. But, at the time, her work was largely dismissed. Read the show notes here.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Frying. So we've
mentioned quite a number of times that we have an
extensively long list of two dudes on the podcast. There
(00:24):
are hundreds and hundreds and hundreds of listeners submitted suggestions,
and then we have our own to do lists, and
they're both very long and sometimes sort of like when
you're uh you have access to hundreds of channels on
the television, it just feels like nothing's on. I scrolled
through all those things, and there are so many great
(00:44):
ideas on there, but none of them are quite catching
my attention that day. And you and I both know
from experience that the best episodes come from when we're
really engaged with what we're talking about. Yeah, if you're
just not in the mood for a topic, even if
it's an awesome topic, it just won't turn out as
well as if you wait a little while all and
let it become the thing that catches your mood. Right,
And some of the things I was in the mood
(01:04):
to talk about, we're on hold until uh Stuff could
come in from the library. So I was browsing around
the Internet and found a post on Rejected Princesses about
Dr Vera Peters, who was one of the foremost oncologists
in the world in her time. Not only was she
one of the only female oncologists in the world, she
(01:25):
completely changed the standard of care for two different types
of cancer. And she was one of rejected Princesses modern worthies,
and those are usually about a woman who died within
the last fifty years. The Rejected Princesses Modern Worthies posts
tend to be pretty brief, so this one hits the highlights.
Dr Peters helped revolutionize the treatment of both breast cancer
and Hodgkins lymphoma, but at the time that she did,
(01:47):
her work was largely ignored and dismissed. So naturally immediately
I wanted to know a lot more about this person
and what she did. Therefore, we're gonna have a whole
episode on her today. Hooray, will do the usual set
up on early life. Mildred Vera Peters was born in Rexdale, Ontario,
on April nineteen eleven. She was one of seven children,
(02:10):
and her parents were dairy farmers. Her mother was also
a teacher. Vera and her siblings worked on the farm,
starting at a very early age, particularly after the sudden
death of their father. Her first education was in a
one room schoolhouse. She finished high school at sixteen, and
she wanted to knew already that she wanted to become
a doctor. She was too young to start medical school, though,
(02:33):
so she enrolled in the University of Toronto to study
math and physics, and then she transferred to the medical
program the following year. She worked summer jobs to save
up her money, and her brother and her sisters helped
pay her way as well. While she was working as
a waitress on a tourist ship, she met Ken Lobb,
who was the man she would later marry and they
would eventually have two daughters together. While she was still
(02:57):
in medical school, her mother was treated for breast cancer,
and after a recurrence, she was treated by Dr Gordon Richards,
who at that point was one of the most respected
doctors in the field of radiation oncology, which at that
point was pretty early in in its development. Dr Richards
was also one of the doctors that there is studied under,
(03:18):
and Vera's mother unfortunately did die for cancer, which was
one of the things that led Bevera to want to
study the disease later in her life. Dr Peters graduated
from medical school in nineteen thirty four and went on
to a residency in radiology at Toronto General Hospital. At
this point in medicine, there was no official training protocol
(03:38):
or certification for radiotherapy, so Dr Peters apprenticed with Dr
Richards and she started working at the Ontario Institute of
Radiotherapy in ninety five, and she continued to work with
Dr Richards right up until his death in January of
ninety nine. Before we get into more of the specifics
of her medical work, here's a caveat dot Or. Peters
(04:00):
did really groundbreaking work and the treatment of two different cancers,
and we're going to talk about them enough to give
a sense of why her work was so important. But
this is absolutely not meant to be a thorough exploration
of either cancer, uh even or even of the human
body systems that they involved. This is also definitely not
a thorough examination of how these cancers are treated today,
(04:22):
because the whole field of oncology has evolved tremendously since
Dr Peters retired in nineteen seventy six. So this is
much more about how the developments that Dr Peters helped
launched changed the way medicine was working at time than
about the diseases specifically or how they're treated today. So
Dr peters first groundbreaking work was in the treatment of
(04:44):
Hodgkin's disease, which was before that point considered to be incurable.
Now more commonly known as Hodgkins lymphoma, this is a
cancer that affects the lymphatic system. It's name for Dr
Thomas Hodgkin, who described it in eighteen thirty two, whom
The major difference between Hodgkins lymphoma and the more common
non Hodgkins lymphoma is that Hodgkins lymphoma involves large, abnormal
(05:08):
cells called read Sternberg cells, while these cells are not
present in non Hodgkins lymphoma. Between its first description in
eighteen thirty two and nineteen o two, no doctors reported
any successful treatment of Hodgkins lymphoma at all. The first
somewhat successful treatment was, which was described in nineteen o two,
(05:30):
was the use of X rays on the involved lymph nodes,
and while this did shrink the affected nodes somewhat, it
didn't cure the disease, it maybe bought people a little time.
There were a few advances between nineteen o two and
nineteen thirty nine, when Dr rhinegel Bare of Geneva, Switzerland
described treating the affected lymph nodes with radiation. He treated
(05:52):
both the affected lymph nodes and other parts of the
body that were not apparently affected, and while some of
his patients did improve, many relapsed, and he didn't think
of any of them as having been cured. Dr Peter's mentor,
Doctor Richards, who we mentioned earlier, installed a four hundred
kilt radiation machine at the Ontario Radiotherapy Institute in ninety seven,
(06:14):
just a couple of years before doctor Jilbert's description of
his method. This was a higher voltage machine than what
doctor Gilbert was using, and Dr Richard used this machine
to treat his patients for a variety of cancers. Dr
Richard's method with Hodgkins lymphoma was to use extended field
radiation on the affected lymph nodes and adjacent nodes. Although
(06:37):
some accounts described this a radiation of nearby nodes as prophylactic,
it wasn't really to prevent disease. It was to kill
cancerous cells that had already spread to adjacent nodes but
weren't yet detectable. At first, Dr Peters primarily worked under
Dr Richard's supervision. She was kind of apprenticing to him,
but as she became more experienced as a doctor, she
(06:59):
began to treat patients on her own as well. In
after ten years of treating lymphoma patients with the four
Kabot machine, Dr Richards made an observation to Dr Peters.
It seemed to him that some of their patients were
surviving a long time with no relapse, even though Hodgkins
lymphoma was supposedly incurable, and he asked her how she
(07:21):
wanted to evaluate their work on the matter. So there
are some people who interpret this as meaning that Dr
Richards should get credit for what happened next. After all,
especially at the beginning, he was the one who was
successfully treating the patients for their cancer. But what he
really did was give Dr Peters a question to answer,
and the work she did to answer that question eventually
(07:43):
changed the perception of Hodgkins lymphoma for being an incurable
disease to a curable one. Dr Peter spent two years
studying one hundred and thirteen patients who had been conclusively
diagnosed with Hodgkins lymphoma and treated with radiation at the
hospital to where she worked. She largely did this by
hand at her dining room table. She was ready to
(08:05):
present her findings to her colleagues in ninety nine, which was,
unfortunately after Dr Richards had already died. Her findings revealed, though,
that his theory was right. Their patients were living longer
than limphoma patients at other hospitals. Their five year survival
rate had doubled and their ten year survival rate had tripled.
Patients in Stage one, which was the least advanced stage,
(08:29):
lived a median of eleven point six years, and she
didn't describe any of the patients as cured, but their
prognosis was really a lot better, and her tone was
a lot more optimistic than any of the medical wisdom
on Hodgkin's lymphoma at the time. The idea of approaching
Hodgkins lymphoma with the goal of curing it was revolutionary,
(08:51):
and even though Dr Peters had clear, compelling data to
back up what she was saying, it took about ten
years for the medical establishment to start taking this concept seriously.
Dr Peters presented a follow up paper in nineteen fifty
six that included two Hodgkins lymphoma cases with all of
the data just as solidly pointing to the idea that
(09:13):
Hodgkins disease could be cured, especially in the early stages.
But perceptions in the medical field didn't really start to
change until Eric C. Easton and Marian H. Russell, using
Dr Peters data confirmed her work in their paper Cure
of Hodgkins Disease that was in nineteen sixty three. Uh,
it took even longer than that for the idea that
(09:36):
Hodgkins disease could be approached as something that can be
cured in a medical textbook. Treatments have continued to advance today,
especially if it's caught in the early stages. Hodgkins disease
is considered to be one of the most curable adult cancers.
Having made these kinds of strides and Hodgkins disease, Dr
(09:57):
Peters turned her focus to breast cancer, which was personally
important to her because of her mother, And we'll talk
about that work after a brief ad break. So to
get back to Dr peters work with breast cancer in
the Ontario Cancer Institute at Princess Margaret Hospital opened and
patients and staff from Toronto General, including Dr Peters and
her patients, were transferred there. As a side note, we're
(10:20):
about to talk about breast cancer for a while, and
while men can and do get breast cancer, we're really
going to be talking about women here because that's the
work that Dr Peters was doing. All of her focus
was on breast cancer treatment in women, not in men's,
so we're not excluding men for some other reason. That's
just the work that she was focused on. So at
(10:41):
this point, the overwhelming majority of patients who were diagnosed
with breast cancer were treated with a radical mastectomy also
called the Halstead procedure for the doctor who popularized it.
Almost as soon as they were diagnosed, they would go
in for a biopsy, which was done under general anesthesia,
and if the lump was cancers, they'd have them stectomy
before they regained consciousness. This made the possibility of breast
(11:04):
cancer particularly terrifying. Women got onto an operating table not
knowing if they had cancer or not, and not knowing
if they would wake up without a breast or not.
The mostectomy itself, which was the standard treatment regardless of
whether the cancer had spread beyond one tumor, was a
lot more involved than messtectomys typically are today. A radical
(11:26):
mastectomy removes more than just the breast. It also removes
the pectoral muscles under the breast, along with the lymph
nodes under the arm on the same side as the
affected breast. This idea was that the cancer was less
likely to spread if you literally removed all of the
things adjacent to it where it was most likely to spread.
And you know, while these are the places that cancer
(11:48):
is most likely to go after appearing in the breast,
this court was the course of action regardless of whether
cancer had been detected in any of these other places.
Less to say, a radical mass ectomy permanently and significantly
altered the body. Even after the reconstruction, a woman's chest
itself would look a lot different. It would basically be
(12:11):
concave because of the loss of the pectoral muscle wall
Over and over again. Modern medical papers described radical mass
ectomies of the past as and this is quote disfiguring
such a huge change to such a personal part of
the body was psychologically and emotionally damaging. For many patients
for the rest of their lives. Can also be physically disabling,
(12:33):
since it removed some of the muscles used to control
a person's arm, and the loss of lymph nodes can
lead to permanent swelling and an increased likelihood of infections
in the arm. Nerve damage was also a really frequent complication,
and this is why today radical mess ectomy is extremely
rare and it's only performed when there really is cancer
(12:54):
in those adjacent tissues. When people have mass ectomies today,
they're usually what's considered a full mastectomy, which removes the
breast but leaves at least some of the lymph nodes,
or a modified radical mast ectomy, which removes the breast
and lymph nodes but only gets into the pectoral muscles
if the cancer has actually spread there. Even though a
(13:14):
radical mastectomy was a standard of care for breast cancer
patients at this point, there were a few people who
didn't have them because of other medical conditions, or, in
a very limited number of cases, the patients who just
put their foot down and refused to have more aggressive surgery.
These patients had surgeries that conserved more of their breast.
It was either a simple mastectomy or a lump ectomy.
(13:37):
Unless there was some medical reason why a woman could
not have a radical mastectomy, these options were pretty much
always against medical advice. Dr Peter's previous work with lymphoma
meant she was particularly insightful when it came to how
cancer spread through the lymphatic system. Patients were often referred
to her for follow up radiation treatment after their surgery,
(14:00):
and she also had personal experience with how traumatic breast
cancer treatment could be after she had lost her mother
to the disease in nineteen thirty three, so she wanted
to see if less drastic treatments could prove to be
as effective as a mastectomy while still preserving as much
of the breast as possible. She published her first work
on the subject in nineteen sixty seven, and it was
(14:21):
based on comparing the survival rates for women who had
been treated for their cancer with different forms of treatment.
She studied the record of seven thousand patients who had
been treated between nineteen thirty five and nineteen sixty eight.
Hundred and fifty two of these patients had had their
lump removed during their biopsy. A hundred and twenty four
(14:42):
of those had radiation as their only follow up treatment,
while the others had some combination of a masstectomy and radiation.
What she found was that there was absolutely no difference
in the survival time between the women who had just
had a lambectomy when the women who had had a
mastectomy when it came to women with stage one and
stage two breast cancer, in her opinion, the more conservative
(15:05):
surgery which preserved the woman's breast was just as viable
a medical option as a mestectomy. And this was a
completely controversial stance at the time. In her words, quote,
I was refuted and shunned by most of the outstanding
surgeons in the States, except for Dr George Cryle of Cleveland.
(15:25):
She was determined, though, and so she decided to do
a case a case control study of the records from
Princess Margaret Hospital. So while she had previously combed through
all of the records and looked at them as a whole,
this time she controlled for the age of the patients,
there are other health factors, whether they also had other cancers.
She narrowed it down to only patients with stage one
(15:47):
breast cancer, and then she meticulously matched up the ones
who had a lump ectomy and radiation with the ones
who had a mess spectomy and radiation, and to match
them up she looked at their ages, how large the
tumor was, and the year that the treatment took place.
This gave her a hundred and forty five pairs in
which the lampectomy group had no statistically significant difference than
(16:08):
the massed ectomy group. In fact, the lumpectomy group had
slightly better survival than the mast ectomy group. In other words,
for women with stage one cancer, a more conservative treatment
that preserved their breasts did not harm their chances of survival.
Radical mass ectomy was not necessary when the disease had
not started to spread. In nineteen seventy five, she presented
(16:31):
these findings at the Royal College of Physicians and Surgeons
of Canada meeting in Winnipeg, Manitoba. Their response was really
skeptical at best. Two years later, Dr Peters published an
updated version of the paper and an international journal which
gave it more exposure and also came to the exact
same conclusions. In that paper, she was really direct in
(16:51):
her opinion, she said, quote as more and more conservative
studies ripen, as more and more concerned physicians observed the
adverse effect of excessive treatment. As more and more women
become armed with knowledge, mastectomy and early breast cancer may
become as old fashioned as bloodletting. Dr Peters retired from
the hospital the year before that revised paper was published,
(17:14):
although she maintained a part time practice and she continued
to teach. But gradually oncologists did start taking a more
conservative approach to early stage breast cancers. Today, women with
early stage breast cancer generally have a mestectomy if there's
some medical reason to do so. Dr peters impact on
(17:34):
the medical field also went beyond just the specific treatment
of these two cancers, and we'll talk about how after
a brief ad break so to return to Dr Peters.
A lot of people take the idea of patient centered
care to for granted today, even if they've never heard
that term specifically. I know that lots of people have
(17:55):
lots of different access to medical care, depending on all
kinds of factors, including their income, love on their age,
and their race, and lots lots of different issues. But
for the most part, when people go to the doctor,
they kind of expect their doctor to treat them like
a human being and to listen to them and to
explain what's going on. And uh, this was not really
how things worked. When Dr Peters started practicing medicine, she
(18:19):
was really a forerunner in the idea of listening to
a patient's wishes and explaining to them and helping them
make decisions about their own treatment. Uh, this whole idea
was really far from standard at when she was practicing medicine. Yeah,
she actually got to know her patients and she helped
them make decisions about their own health care, rather than
(18:40):
just seeing them as a condition to treat and telling
them what to do. Another common attitude today is that
when you go to the doctor, you should get a
treatment that's going to be the right amount to solve
the problem, not something that's just going to be so
completely aggressive that it's going to blast the problem away
but then also leave you with potentially lots of scars,
are huge side effects, or you know, lots of adverse
(19:04):
effects to taking care of the problem. This was also
core to Dr Peter's philosophy as a doctor. She wanted
to do the most conservative treatment to get the job done,
and it was really different from a lot of what
was going on at the time. Obviously, doctors were putting
women to sleep to do a biopsy, and then taking
their entire breast, even in the case of really small
tumors that hadn't progressed anywhere. Um, she really wanted to
(19:27):
avoid the risks that came of side effects and other
complications by doing a more minimal treatment but still treading
the actual problem. And she was also a role model
for young women who were interested in becoming doctors, not
just because of her success as a doctor, but also
because she proved that a woman could be a doctor
while also being a wife and mother, and that was
(19:47):
something that really needed proving at this point in history.
She did a lot of her research at home, so
she was compilingly her work by hand. She wouldn't have
been able to make the breakthroughs that she did otherwise,
but outside the of the medical world old she was
Mrs lob mother of two. I think a lot of
the other like female forerunners in the world of medicine
we've talked about, have been women who eschewed the more traditional,
(20:12):
stereotypical feminine side. And so it actually was a big
deal that in addition to being a doctor, she got
married and had children. Uh, all of this work was
additionally incredible because at this point there were hardly any
women doctors at all, let alone women doctors who were
on the cutting edge of their field, revolutionizing the treatment
(20:33):
of multiple diseases. And Dr Vera Peters became an Officer
of the Order of Canada in nineteen seventy eight. She
was awarded the Gold Medal from the American Society of
Therapeutic Radiology in nineteen seventy nine and the Woman of
Distinction Award from the Canadian Breast Cancer Foundation in Sadly,
she died of cancer on October one, nine at the
(20:56):
age of eighty two. She died at Princess Margaret Hospital
in Toronto, where she had worked for most of her career,
and she was inducted into the Canadian Medical Hall of Fame.
In It's kind of a side note, there was a
play about her called Radical, which was written by Charles Hayter,
who was also an oncologist, that actually premiered to just
(21:17):
sell out standing room only crowd at the Toronto French
Festival in July. Thank you, Dr Vera Peters. I know
you and I both have family experience with breast cancer.
And the fact that somebody said, okay, we we have
got to just stop treating women as a thing to
(21:39):
put on a table and remove part of their body
without actually talking to them about it. Like that's a
big deal. The idea of um not being asked questions
about treatment is so alien to me that it's shocking. Yeah, yeah,
uh and you I said this to you off Mike,
and now I'm just gonna say it on Like, as
(22:01):
I was researching this, I found a citation of that
cure for Hodgkins disease paper. It was like a citation
of the paper that was in another, uh, another journal
and incited the male doctor is doctor and the female
author of the paper is miss. And I could not
figure out whether she was actually a doctor when that
(22:23):
notation was published or not, because it is possible that
she was credited on the paper but was not yet
a medical doctor. But I sincerely wonder, based on all
of the other things that were going on at the time,
whether she was discredited as miss instead of doctor because
she was a woman. Yeah, So that's a mystery that
remains to be solved. In the meantime, I think you
(22:46):
might have listener mail for us. I do have listener mail.
This is another listener mail from our Brown Versus Board series, uh,
and it is from Gia. Gia says, I recently listened
to Your Brown Versus Board of Education and found the
aftermath episode fascinating. I grew up in downtown Boston, and
even though I was born in the early eighties, people
(23:07):
were still talking about bussing in the nineties and early
two thousands. In Horror, Boston is set up in a
series of small neighborhoods which were once full of families
and children. Was very common for people, especially children and
their mothers, to live their lives wholly in their neighborhood.
My grandmother raised four children, worked, shopped, and socialized in
a one square mile piece of Boston, and back then
(23:30):
that was completely normal. The people of these neighborhoods had
neighborhood pride, and until pretty recently, residents were incredibly territorial.
Black people were chased out of white neighborhoods for not belonging,
but so too were white people chased out of black neighborhoods.
In four I was chased out of an Irish neighborhood
two blocks from my Italian neighborhood because I didn't belong there.
(23:51):
Boston was not immune to racial tensions. But the thing
I was still hearing about in nineteen ninety six was
the horror of having to take a bus with strangers
to a neighborhood far from home, to sit in a
strange school with more strange kids who were from a
completely different culture. My family lived in the Italian section
of Boston, and my mother didn't meet someone who wasn't Italian,
(24:11):
maybe Irish and Catholic until she was fifteen years old.
The prospect of having to go on a bus full
of strangers to a neighborhood where she was not welcome
to be one of the few white kids in a
predominantly back black school. This idea was daunting. Not to mention,
immigrants in my neighborhood didn't want their daughters so far
from home. A cultural thing. Many of my mother's schoolmates
were sent to Catholic school to avoid the need to
(24:33):
move or the need to bus. The Catholic schools were overrun.
She goes on to talk about a more personal story
about integration at her own school, which I'm not going
to go into detail about because I feel like that's
a little bit too much identifying information to go on here.
But um, She ends by saying that now when she
goes back to alma mater, to her alma mater, the
halls seemed more and more colorful, which I thought was
(24:55):
a good note to end on. Uh. I spent a
lot of time in Boston. If you walk around Boston,
you can still still see, uh, really clear hallmarks of
the different cultures that settled different parts of Boston. Like
they're very clear. This this used to be an entirely
Italian neighborhood, and in a lot of cases it's still
predominantly in an Italian neighborhood. But I had not realized
(25:21):
how deeply those community ties ran. And then it was
to the extent that like this little insular, insular neighborhood
was its own little thing that people were very protective
of without seeing it in the greater context of Boston
as a whole, which I think probably most people not
from Boston think of Boston and also probably Cambridge as
(25:47):
a thing, uh, even though there are lots of different
insular communities all around the area. So thank you for
sending us that note. If you would like to write
to us about this or any other podcast where History
pocasts at how Stuff works, dot com. We're also on
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(26:08):
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(26:28):
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(26:53):
more on this and thousands of other topics, it how
stuff works dot com. In in
Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Frying. So we've
mentioned quite a number of times that we have an
extensively long list of two dudes on the podcast. There
(00:24):
are hundreds and hundreds and hundreds of listeners submitted suggestions,
and then we have our own to do lists, and
they're both very long and sometimes sort of like when
you're uh you have access to hundreds of channels on
the television, it just feels like nothing's on. I scrolled
through all those things, and there are so many great
(00:44):
ideas on there, but none of them are quite catching
my attention that day. And you and I both know
from experience that the best episodes come from when we're
really engaged with what we're talking about. Yeah, if you're
just not in the mood for a topic, even if
it's an awesome topic, it just won't turn out as
well as if you wait a little while all and
let it become the thing that catches your mood. Right,
And some of the things I was in the mood
(01:04):
to talk about, we're on hold until uh Stuff could
come in from the library. So I was browsing around
the Internet and found a post on Rejected Princesses about
Dr Vera Peters, who was one of the foremost oncologists
in the world in her time. Not only was she
one of the only female oncologists in the world, she
(01:25):
completely changed the standard of care for two different types
of cancer. And she was one of rejected Princesses modern worthies,
and those are usually about a woman who died within
the last fifty years. The Rejected Princesses Modern Worthies posts
tend to be pretty brief, so this one hits the highlights.
Dr Peters helped revolutionize the treatment of both breast cancer
and Hodgkins lymphoma, but at the time that she did,
(01:47):
her work was largely ignored and dismissed. So naturally immediately
I wanted to know a lot more about this person
and what she did. Therefore, we're gonna have a whole
episode on her today. Hooray, will do the usual set
up on early life. Mildred Vera Peters was born in Rexdale, Ontario,
on April nineteen eleven. She was one of seven children,
(02:10):
and her parents were dairy farmers. Her mother was also
a teacher. Vera and her siblings worked on the farm,
starting at a very early age, particularly after the sudden
death of their father. Her first education was in a
one room schoolhouse. She finished high school at sixteen, and
she wanted to knew already that she wanted to become
a doctor. She was too young to start medical school, though,
(02:33):
so she enrolled in the University of Toronto to study
math and physics, and then she transferred to the medical
program the following year. She worked summer jobs to save
up her money, and her brother and her sisters helped
pay her way as well. While she was working as
a waitress on a tourist ship, she met Ken Lobb,
who was the man she would later marry and they
would eventually have two daughters together. While she was still
(02:57):
in medical school, her mother was treated for breast cancer,
and after a recurrence, she was treated by Dr Gordon Richards,
who at that point was one of the most respected
doctors in the field of radiation oncology, which at that
point was pretty early in in its development. Dr Richards
was also one of the doctors that there is studied under,
(03:18):
and Vera's mother unfortunately did die for cancer, which was
one of the things that led Bevera to want to
study the disease later in her life. Dr Peters graduated
from medical school in nineteen thirty four and went on
to a residency in radiology at Toronto General Hospital. At
this point in medicine, there was no official training protocol
(03:38):
or certification for radiotherapy, so Dr Peters apprenticed with Dr
Richards and she started working at the Ontario Institute of
Radiotherapy in ninety five, and she continued to work with
Dr Richards right up until his death in January of
ninety nine. Before we get into more of the specifics
of her medical work, here's a caveat dot Or. Peters
(04:00):
did really groundbreaking work and the treatment of two different cancers,
and we're going to talk about them enough to give
a sense of why her work was so important. But
this is absolutely not meant to be a thorough exploration
of either cancer, uh even or even of the human
body systems that they involved. This is also definitely not
a thorough examination of how these cancers are treated today,
(04:22):
because the whole field of oncology has evolved tremendously since
Dr Peters retired in nineteen seventy six. So this is
much more about how the developments that Dr Peters helped
launched changed the way medicine was working at time than
about the diseases specifically or how they're treated today. So
Dr peters first groundbreaking work was in the treatment of
(04:44):
Hodgkin's disease, which was before that point considered to be incurable.
Now more commonly known as Hodgkins lymphoma, this is a
cancer that affects the lymphatic system. It's name for Dr
Thomas Hodgkin, who described it in eighteen thirty two, whom
The major difference between Hodgkins lymphoma and the more common
non Hodgkins lymphoma is that Hodgkins lymphoma involves large, abnormal
(05:08):
cells called read Sternberg cells, while these cells are not
present in non Hodgkins lymphoma. Between its first description in
eighteen thirty two and nineteen o two, no doctors reported
any successful treatment of Hodgkins lymphoma at all. The first
somewhat successful treatment was, which was described in nineteen o two,
(05:30):
was the use of X rays on the involved lymph nodes,
and while this did shrink the affected nodes somewhat, it
didn't cure the disease, it maybe bought people a little time.
There were a few advances between nineteen o two and
nineteen thirty nine, when Dr rhinegel Bare of Geneva, Switzerland
described treating the affected lymph nodes with radiation. He treated
(05:52):
both the affected lymph nodes and other parts of the
body that were not apparently affected, and while some of
his patients did improve, many relapsed, and he didn't think
of any of them as having been cured. Dr Peter's mentor,
Doctor Richards, who we mentioned earlier, installed a four hundred
kilt radiation machine at the Ontario Radiotherapy Institute in ninety seven,
(06:14):
just a couple of years before doctor Jilbert's description of
his method. This was a higher voltage machine than what
doctor Gilbert was using, and Dr Richard used this machine
to treat his patients for a variety of cancers. Dr
Richard's method with Hodgkins lymphoma was to use extended field
radiation on the affected lymph nodes and adjacent nodes. Although
(06:37):
some accounts described this a radiation of nearby nodes as prophylactic,
it wasn't really to prevent disease. It was to kill
cancerous cells that had already spread to adjacent nodes but
weren't yet detectable. At first, Dr Peters primarily worked under
Dr Richard's supervision. She was kind of apprenticing to him,
but as she became more experienced as a doctor, she
(06:59):
began to treat patients on her own as well. In
after ten years of treating lymphoma patients with the four
Kabot machine, Dr Richards made an observation to Dr Peters.
It seemed to him that some of their patients were
surviving a long time with no relapse, even though Hodgkins
lymphoma was supposedly incurable, and he asked her how she
(07:21):
wanted to evaluate their work on the matter. So there
are some people who interpret this as meaning that Dr
Richards should get credit for what happened next. After all,
especially at the beginning, he was the one who was
successfully treating the patients for their cancer. But what he
really did was give Dr Peters a question to answer,
and the work she did to answer that question eventually
(07:43):
changed the perception of Hodgkins lymphoma for being an incurable
disease to a curable one. Dr Peter spent two years
studying one hundred and thirteen patients who had been conclusively
diagnosed with Hodgkins lymphoma and treated with radiation at the
hospital to where she worked. She largely did this by
hand at her dining room table. She was ready to
(08:05):
present her findings to her colleagues in ninety nine, which was,
unfortunately after Dr Richards had already died. Her findings revealed, though,
that his theory was right. Their patients were living longer
than limphoma patients at other hospitals. Their five year survival
rate had doubled and their ten year survival rate had tripled.
Patients in Stage one, which was the least advanced stage,
(08:29):
lived a median of eleven point six years, and she
didn't describe any of the patients as cured, but their
prognosis was really a lot better, and her tone was
a lot more optimistic than any of the medical wisdom
on Hodgkin's lymphoma at the time. The idea of approaching
Hodgkins lymphoma with the goal of curing it was revolutionary,
(08:51):
and even though Dr Peters had clear, compelling data to
back up what she was saying, it took about ten
years for the medical establishment to start taking this concept seriously.
Dr Peters presented a follow up paper in nineteen fifty
six that included two Hodgkins lymphoma cases with all of
the data just as solidly pointing to the idea that
(09:13):
Hodgkins disease could be cured, especially in the early stages.
But perceptions in the medical field didn't really start to
change until Eric C. Easton and Marian H. Russell, using
Dr Peters data confirmed her work in their paper Cure
of Hodgkins Disease that was in nineteen sixty three. Uh,
it took even longer than that for the idea that
(09:36):
Hodgkins disease could be approached as something that can be
cured in a medical textbook. Treatments have continued to advance today,
especially if it's caught in the early stages. Hodgkins disease
is considered to be one of the most curable adult cancers.
Having made these kinds of strides and Hodgkins disease, Dr
(09:57):
Peters turned her focus to breast cancer, which was personally
important to her because of her mother, And we'll talk
about that work after a brief ad break. So to
get back to Dr peters work with breast cancer in
the Ontario Cancer Institute at Princess Margaret Hospital opened and
patients and staff from Toronto General, including Dr Peters and
her patients, were transferred there. As a side note, we're
(10:20):
about to talk about breast cancer for a while, and
while men can and do get breast cancer, we're really
going to be talking about women here because that's the
work that Dr Peters was doing. All of her focus
was on breast cancer treatment in women, not in men's,
so we're not excluding men for some other reason. That's
just the work that she was focused on. So at
(10:41):
this point, the overwhelming majority of patients who were diagnosed
with breast cancer were treated with a radical mastectomy also
called the Halstead procedure for the doctor who popularized it.
Almost as soon as they were diagnosed, they would go
in for a biopsy, which was done under general anesthesia,
and if the lump was cancers, they'd have them stectomy
before they regained consciousness. This made the possibility of breast
(11:04):
cancer particularly terrifying. Women got onto an operating table not
knowing if they had cancer or not, and not knowing
if they would wake up without a breast or not.
The mostectomy itself, which was the standard treatment regardless of
whether the cancer had spread beyond one tumor, was a
lot more involved than messtectomys typically are today. A radical
(11:26):
mastectomy removes more than just the breast. It also removes
the pectoral muscles under the breast, along with the lymph
nodes under the arm on the same side as the
affected breast. This idea was that the cancer was less
likely to spread if you literally removed all of the
things adjacent to it where it was most likely to spread.
And you know, while these are the places that cancer
(11:48):
is most likely to go after appearing in the breast,
this court was the course of action regardless of whether
cancer had been detected in any of these other places.
Less to say, a radical mass ectomy permanently and significantly
altered the body. Even after the reconstruction, a woman's chest
itself would look a lot different. It would basically be
(12:11):
concave because of the loss of the pectoral muscle wall
Over and over again. Modern medical papers described radical mass
ectomies of the past as and this is quote disfiguring
such a huge change to such a personal part of
the body was psychologically and emotionally damaging. For many patients
for the rest of their lives. Can also be physically disabling,
(12:33):
since it removed some of the muscles used to control
a person's arm, and the loss of lymph nodes can
lead to permanent swelling and an increased likelihood of infections
in the arm. Nerve damage was also a really frequent complication,
and this is why today radical mess ectomy is extremely
rare and it's only performed when there really is cancer
(12:54):
in those adjacent tissues. When people have mass ectomies today,
they're usually what's considered a full mastectomy, which removes the
breast but leaves at least some of the lymph nodes,
or a modified radical mast ectomy, which removes the breast
and lymph nodes but only gets into the pectoral muscles
if the cancer has actually spread there. Even though a
(13:14):
radical mastectomy was a standard of care for breast cancer
patients at this point, there were a few people who
didn't have them because of other medical conditions, or, in
a very limited number of cases, the patients who just
put their foot down and refused to have more aggressive surgery.
These patients had surgeries that conserved more of their breast.
It was either a simple mastectomy or a lump ectomy.
(13:37):
Unless there was some medical reason why a woman could
not have a radical mastectomy, these options were pretty much
always against medical advice. Dr Peter's previous work with lymphoma
meant she was particularly insightful when it came to how
cancer spread through the lymphatic system. Patients were often referred
to her for follow up radiation treatment after their surgery,
(14:00):
and she also had personal experience with how traumatic breast
cancer treatment could be after she had lost her mother
to the disease in nineteen thirty three, so she wanted
to see if less drastic treatments could prove to be
as effective as a mastectomy while still preserving as much
of the breast as possible. She published her first work
on the subject in nineteen sixty seven, and it was
(14:21):
based on comparing the survival rates for women who had
been treated for their cancer with different forms of treatment.
She studied the record of seven thousand patients who had
been treated between nineteen thirty five and nineteen sixty eight.
Hundred and fifty two of these patients had had their
lump removed during their biopsy. A hundred and twenty four
(14:42):
of those had radiation as their only follow up treatment,
while the others had some combination of a masstectomy and radiation.
What she found was that there was absolutely no difference
in the survival time between the women who had just
had a lambectomy when the women who had had a
mastectomy when it came to women with stage one and
stage two breast cancer, in her opinion, the more conservative
(15:05):
surgery which preserved the woman's breast was just as viable
a medical option as a mestectomy. And this was a
completely controversial stance at the time. In her words, quote,
I was refuted and shunned by most of the outstanding
surgeons in the States, except for Dr George Cryle of Cleveland.
(15:25):
She was determined, though, and so she decided to do
a case a case control study of the records from
Princess Margaret Hospital. So while she had previously combed through
all of the records and looked at them as a whole,
this time she controlled for the age of the patients,
there are other health factors, whether they also had other cancers.
She narrowed it down to only patients with stage one
(15:47):
breast cancer, and then she meticulously matched up the ones
who had a lump ectomy and radiation with the ones
who had a mess spectomy and radiation, and to match
them up she looked at their ages, how large the
tumor was, and the year that the treatment took place.
This gave her a hundred and forty five pairs in
which the lampectomy group had no statistically significant difference than
(16:08):
the massed ectomy group. In fact, the lumpectomy group had
slightly better survival than the mast ectomy group. In other words,
for women with stage one cancer, a more conservative treatment
that preserved their breasts did not harm their chances of survival.
Radical mass ectomy was not necessary when the disease had
not started to spread. In nineteen seventy five, she presented
(16:31):
these findings at the Royal College of Physicians and Surgeons
of Canada meeting in Winnipeg, Manitoba. Their response was really
skeptical at best. Two years later, Dr Peters published an
updated version of the paper and an international journal which
gave it more exposure and also came to the exact
same conclusions. In that paper, she was really direct in
(16:51):
her opinion, she said, quote as more and more conservative
studies ripen, as more and more concerned physicians observed the
adverse effect of excessive treatment. As more and more women
become armed with knowledge, mastectomy and early breast cancer may
become as old fashioned as bloodletting. Dr Peters retired from
the hospital the year before that revised paper was published,
(17:14):
although she maintained a part time practice and she continued
to teach. But gradually oncologists did start taking a more
conservative approach to early stage breast cancers. Today, women with
early stage breast cancer generally have a mestectomy if there's
some medical reason to do so. Dr peters impact on
(17:34):
the medical field also went beyond just the specific treatment
of these two cancers, and we'll talk about how after
a brief ad break so to return to Dr Peters.
A lot of people take the idea of patient centered
care to for granted today, even if they've never heard
that term specifically. I know that lots of people have
(17:55):
lots of different access to medical care, depending on all
kinds of factors, including their income, love on their age,
and their race, and lots lots of different issues. But
for the most part, when people go to the doctor,
they kind of expect their doctor to treat them like
a human being and to listen to them and to
explain what's going on. And uh, this was not really
how things worked. When Dr Peters started practicing medicine, she
(18:19):
was really a forerunner in the idea of listening to
a patient's wishes and explaining to them and helping them
make decisions about their own treatment. Uh, this whole idea
was really far from standard at when she was practicing medicine. Yeah,
she actually got to know her patients and she helped
them make decisions about their own health care, rather than
(18:40):
just seeing them as a condition to treat and telling
them what to do. Another common attitude today is that
when you go to the doctor, you should get a
treatment that's going to be the right amount to solve
the problem, not something that's just going to be so
completely aggressive that it's going to blast the problem away
but then also leave you with potentially lots of scars,
are huge side effects, or you know, lots of adverse
(19:04):
effects to taking care of the problem. This was also
core to Dr Peter's philosophy as a doctor. She wanted
to do the most conservative treatment to get the job done,
and it was really different from a lot of what
was going on at the time. Obviously, doctors were putting
women to sleep to do a biopsy, and then taking
their entire breast, even in the case of really small
tumors that hadn't progressed anywhere. Um, she really wanted to
(19:27):
avoid the risks that came of side effects and other
complications by doing a more minimal treatment but still treading
the actual problem. And she was also a role model
for young women who were interested in becoming doctors, not
just because of her success as a doctor, but also
because she proved that a woman could be a doctor
while also being a wife and mother, and that was
(19:47):
something that really needed proving at this point in history.
She did a lot of her research at home, so
she was compilingly her work by hand. She wouldn't have
been able to make the breakthroughs that she did otherwise,
but outside the of the medical world old she was
Mrs lob mother of two. I think a lot of
the other like female forerunners in the world of medicine
we've talked about, have been women who eschewed the more traditional,
(20:12):
stereotypical feminine side. And so it actually was a big
deal that in addition to being a doctor, she got
married and had children. Uh, all of this work was
additionally incredible because at this point there were hardly any
women doctors at all, let alone women doctors who were
on the cutting edge of their field, revolutionizing the treatment
(20:33):
of multiple diseases. And Dr Vera Peters became an Officer
of the Order of Canada in nineteen seventy eight. She
was awarded the Gold Medal from the American Society of
Therapeutic Radiology in nineteen seventy nine and the Woman of
Distinction Award from the Canadian Breast Cancer Foundation in Sadly,
she died of cancer on October one, nine at the
(20:56):
age of eighty two. She died at Princess Margaret Hospital
in Toronto, where she had worked for most of her career,
and she was inducted into the Canadian Medical Hall of Fame.
In It's kind of a side note, there was a
play about her called Radical, which was written by Charles Hayter,
who was also an oncologist, that actually premiered to just
(21:17):
sell out standing room only crowd at the Toronto French
Festival in July. Thank you, Dr Vera Peters. I know
you and I both have family experience with breast cancer.
And the fact that somebody said, okay, we we have
got to just stop treating women as a thing to
(21:39):
put on a table and remove part of their body
without actually talking to them about it. Like that's a
big deal. The idea of um not being asked questions
about treatment is so alien to me that it's shocking. Yeah, yeah,
uh and you I said this to you off Mike,
and now I'm just gonna say it on Like, as
(22:01):
I was researching this, I found a citation of that
cure for Hodgkins disease paper. It was like a citation
of the paper that was in another, uh, another journal
and incited the male doctor is doctor and the female
author of the paper is miss. And I could not
figure out whether she was actually a doctor when that
(22:23):
notation was published or not, because it is possible that
she was credited on the paper but was not yet
a medical doctor. But I sincerely wonder, based on all
of the other things that were going on at the time,
whether she was discredited as miss instead of doctor because
she was a woman. Yeah, So that's a mystery that
remains to be solved. In the meantime, I think you
(22:46):
might have listener mail for us. I do have listener mail.
This is another listener mail from our Brown Versus Board series, uh,
and it is from Gia. Gia says, I recently listened
to Your Brown Versus Board of Education and found the
aftermath episode fascinating. I grew up in downtown Boston, and
even though I was born in the early eighties, people
(23:07):
were still talking about bussing in the nineties and early
two thousands. In Horror, Boston is set up in a
series of small neighborhoods which were once full of families
and children. Was very common for people, especially children and
their mothers, to live their lives wholly in their neighborhood.
My grandmother raised four children, worked, shopped, and socialized in
a one square mile piece of Boston, and back then
(23:30):
that was completely normal. The people of these neighborhoods had
neighborhood pride, and until pretty recently, residents were incredibly territorial.
Black people were chased out of white neighborhoods for not belonging,
but so too were white people chased out of black neighborhoods.
In four I was chased out of an Irish neighborhood
two blocks from my Italian neighborhood because I didn't belong there.
(23:51):
Boston was not immune to racial tensions. But the thing
I was still hearing about in nineteen ninety six was
the horror of having to take a bus with strangers
to a neighborhood far from home, to sit in a
strange school with more strange kids who were from a
completely different culture. My family lived in the Italian section
of Boston, and my mother didn't meet someone who wasn't Italian,
(24:11):
maybe Irish and Catholic until she was fifteen years old.
The prospect of having to go on a bus full
of strangers to a neighborhood where she was not welcome
to be one of the few white kids in a
predominantly back black school. This idea was daunting. Not to mention,
immigrants in my neighborhood didn't want their daughters so far
from home. A cultural thing. Many of my mother's schoolmates
were sent to Catholic school to avoid the need to
(24:33):
move or the need to bus. The Catholic schools were overrun.
She goes on to talk about a more personal story
about integration at her own school, which I'm not going
to go into detail about because I feel like that's
a little bit too much identifying information to go on here.
But um, She ends by saying that now when she
goes back to alma mater, to her alma mater, the
halls seemed more and more colorful, which I thought was
(24:55):
a good note to end on. Uh. I spent a
lot of time in Boston. If you walk around Boston,
you can still still see, uh, really clear hallmarks of
the different cultures that settled different parts of Boston. Like
they're very clear. This this used to be an entirely
Italian neighborhood, and in a lot of cases it's still
predominantly in an Italian neighborhood. But I had not realized
(25:21):
how deeply those community ties ran. And then it was
to the extent that like this little insular, insular neighborhood
was its own little thing that people were very protective
of without seeing it in the greater context of Boston
as a whole, which I think probably most people not
from Boston think of Boston and also probably Cambridge as
(25:47):
a thing, uh, even though there are lots of different
insular communities all around the area. So thank you for
sending us that note. If you would like to write
to us about this or any other podcast where History
pocasts at how Stuff works, dot com. We're also on
Facebook at Facebook dot com slash miss in history and
on Twitter at miss in History. Are Tumbler is missed
(26:08):
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about today, we can come to our parent company's website,
that is how stuff Works dot com. You can search
the word radiation and you will find how radiation works
into detail about how radiation is both dangerous and used
(26:28):
to cure people's cancer. You can also come to our website,
which is missed in History dot com to find all
kinds of stuff about the episodes that we have worked
on lately. In our five episodes that we uh includes
every episode we've ever done, show notes for the episodes
that Holly and I have worked on. You can do
all that and a whole lot more at how stuff
works dot com and missed in history dot com. For
(26:53):
more on this and thousands of other topics, it how
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