February 3, 2024 • 25 mins
This 2015 episode examines how Dr. Peters helped revolutionize the treatment of both breast cancer and Hodgkin's lymphoma. But, at the time, her work was largely dismissed.
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Happy Saturday. This week we had an episode on the
history of mimography, which did not have many women in
it considering its subject matter. So today we have our
past episode on doctor Vera Peters, who really revolutionized the
care of two different cancers, one of them being breast cancer.
Although the medical community's response to her research at the
(00:25):
time was pretty skeptical. She started publishing on this work
in nineteen sixty seven, so right in the middle of
some of what we talked about on this mimography episode,
and near the end of this episode we mentioned a
paper that cited her male co author as doctor but
cited her as miss and not being sure whether the
paper was published before or after she finished medical school.
(00:47):
And we just wanted to note that women with medical
degrees or doctorate's being called miss while their male colleagues
are called doctor. It is not a relic of the
past that still happens today. Yeah, when I listened to
the episode, I was like, kind of make it sound
like this is no longer a problem, But I sure
do know many women who are either doctors or have
(01:07):
doctoral degrees who are deeply frustrated by it, especially on
things like panels and paper titles and et cetera. This
episode originally came out March eighteenth, twenty fifteen, So enjoy
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio. Hello, and welcome to the podcast. I'm Tracy V.
(01:36):
Wilson and I'm Holly Fryme. So we've mentioned quite a
number of times that we have an extensively long list
of to dos on the podcast. There are hundreds and
hundreds and hundreds of listeners submitted suggestions, and then we
have our own to do lists, and they are both
very long and sometimes sort of like when you're you
(01:58):
have access to hundreds of channels on the television, it
just feels like nothing's on. I scroll through all those things,
and there are so many great 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,
(02:19):
it just won't turn out as well as if you
wait a little while and let it become the thing
that catches your mood. Right, and some of the things
I was in the mood to talk about were 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 doctor Vera Peters, who was
one of the foremost oncologists in the world in her time.
(02:43):
Not only was she one of the only female oncologists
in the world, she 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. Doctor Peters helped revolutionize
(03:05):
the treatment of both breast cancer and Hodgkins lymphoma, but
at the time that she did, 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 going to have a whole episode on her today. Hooray,
We'll do the usual setup on early life. Mildred Vera
(03:26):
Peters was born in Rexdale, Ontario, on April twenty eighth
of nineteen eleven. She was one of seven children, 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.
(03:47):
She finished high school at sixteen, and she wanted She
knew already that she wanted to become a doctor. She
was too young to start medical school, though, so she
enrolled in the University of Toronto to study math and physics,
and then she trammedurred 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.
(04:08):
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 in medical school, her mother was
treated for breast cancer, and after a recurrence, she was
treated by doctor Gordon Richards, who at that point was
one of the most respected doctors in the field of
(04:30):
radiation oncology, which at that point was pretty early in
its development. Doctor Richards was also one of the doctors
that Vera studied under, and Vera's mother unfortunately did die
of her cancer, which was one of the things that
led Vera to want to study the disease later in
her life. Doctor Peters graduated from medical school in nineteen
(04:52):
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 or certification for radiotherapy, so
doctor Peters apprenticed with doctor Richards and she started working
at the Ontario Institute of Radiotherapy in nineteen thirty five,
and she continued to work with doctor Richards right up
(05:13):
until his death in January of nineteen forty nine. Before
we get into more of the specifics of her medical work,
here's a caveat Doctor Peters 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 even
(05:36):
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 because the whole field of
oncology has evolved tremendously since doctor Peters retired in nineteen
seventy six. So this is much more about how the
developments that doctor Peters launch changed the way medicine was
(05:58):
working at the time than about the diseases specifically or
how they're treated today. So doctor Peter's first groundbreaking work
was in the treatment of 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, its name for doctor Thomas Hodgkin, who described
(06:20):
it in eighteen thirty two. The major difference between Hodgkins
lymphoma and the more common non Hodgkins lymphoma is that
Hodgkins lymphoma involves large abnormal cells called reed Sternberg cells,
while these cells are not present in non Hodgkins lymphoma.
Between its first description in eighteen thirty two and nineteen
(06:42):
o two, no doctors reported any successful treatment of Hodgkins
lymphoma at all. The first somewhat successful treatment was which
was described in nineteen oh two, was the use of
X rays on the involved lymph nodes, and while this
did shrink the affected nodes somewhat, it did cure the disease,
it maybe bought people a little time. There were a
(07:04):
few advances between nineteen oh two and nineteen thirty nine,
when doctor Rene Gilbert of Geneva, Switzerland described treating the
affected lymph nodes with radiation. He treated 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. Doctor Peter's mentor, doctor Richards, who
(07:28):
we mentioned earlier, installed a four hundred killo radiation machine
at the Ontario Radiotherapy Institute in nineteen thirty seven, just
a couple of years before Jilbert's description of his method.
This was a higher voltage machine than what doctor Jilbert
was using, and doctor Richard used this machine to treat
his patients for a variety of cancers. Doctor Richard's method
(07:52):
with Hodgkin's lymphoma was to use extended field radiation on
the affected lymph nodes and adjacent nodes. Although some accounts
described this irradiation 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.
(08:13):
At first, doctor Peters primarily worked under doctor Richard's supervision.
She was kind of apprenticing to him, but as she
became more experienced as a doctor, she began to treat
patients on her own as well. In nineteen forty seven,
after ten years of treating lymphoma patients with the four
hundred kilovolt machine, doctor Richards made an observation to doctor Peters.
(08:34):
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
wanted to evaluate their work on the matter. So there
are some people who interpret this as meaning that doctor
Richards should get credit for what happened next. After all,
especially at the beginning, he was the one who was
(08:55):
successfully treating the patients for their cancer. What he really
did was give doctor Peters a question to answer, and
the work she did to answer that question eventually changed
the perception of Hodgkins lymphoma from being an incurable disease
to a curable one. Doctor Peter spent two years studying
one hundred and thirteen patients who had been conclusively diagnosed
(09:18):
with Hodgkins lymphoma and treated with radiation at the hospital
where she worked. She largely did this by hand at
her dining room table. She was ready to present her
findings to her colleagues in nineteen forty nine, which was,
unfortunately after doctor Richards had already died. Her findings revealed, though,
that his theory was right. Their patients were living longer
(09:40):
than lymphoma 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,
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 lit better and her tone was
(10:01):
a lot more optimistic than any of the medical wisdom
on Hodgkins lymphoma at the time. The idea of approaching
Hodgkins lymphoma with the goal of curing it was revolutionary,
and even though doctor 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.
(10:24):
Doctor Peters presented a follow up paper in nineteen fifty
six that included two hundred and ninety one Hodgkins lymphoma cases,
with all of the data just as solidly pointing to
the idea that 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. Eesen and Mary
(10:45):
and H. Russell, using doctor Peter's data, confirmed her work
in their paper Cure of Hodgkins Disease that was in
nineteen sixty three. It took even longer than that for
the idea that Hodgkin's disease could be approached as something
that can be cured in a medical textbook. Treatments have
continued to advance today, especially if it's in the early stages.
(11:10):
Hodgkin's disease is considered to be one of the most
curable adult cancers. Having made these kinds of strides in
Hodgkin's disease, doctor 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.
(11:35):
So to get back to doctor Peters's work with breast cancer.
In nineteen fifty eight, the Ontario Cancer Institute at Princess
Margaret Hospital opened and patients and staff from Toronto General,
including doctor Peters and her patients, were transferred there. As
a side note, we're 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
(11:57):
here because that's the work that doctor Peters was doing.
All of her focus was on breast cancer treatment in women,
not in men, so we're not excluding men for some
other reason. That's just the work that she was focused on.
So at this point, the overwhelming majority of patients who
were diagnosed with breast cancer were treated with a radical mastectomy,
(12:19):
also called the Halsted 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 cancerous, they'd have the mestectomy
before they were gained consciousness. This made the possibility of
breast cancer particularly terrifying women got onto an operating table
(12:40):
not knowing if they had cancer or not, and not
knowing if they would wake up without a breast or not.
The mestectomy itself, which was the standard treatment regardless of
whether the cancer had spread beyond one tumor, was a
lot more involved than mestectamies typically are today. A radical
mastectomy removes more than just the breast. That also moves
(13:00):
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
is most likely to go after appearing in the breast,
(13:23):
this court was the course of action, regardless of whether
cancer had been detected in any of these other places.
Needless to say, a radical mastectomy permanently and significantly altered
the body. Even after the reconstruction, a woman's chest itself
would look a lot different. It would basically be concave
because of the loss of the pectoral muscle, wall over
(13:46):
and over again. Modern medical papers describe radical mass deectomies
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 or many patients for
the rest of their lives. Could also be physically disabling
since it removed some of the muscles used to control
(14:07):
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 mastectomy is extremely rare
and it's only performed when there really is cancer in
those adjacent tissues. When people have messt deectomies today, they're
(14:29):
usually what's considered a simple mastectomy, which removes the breast
but leaves at least some of the lymph nodes, or
a modified radical mastectomy, which removes the breast and lymph
nodes but only gets into the pectoral muscles if the
cancer has actually spread there. Even though a radical mastectomy
was a standard of care for breast cancer patients at
(14:49):
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 lumpectomy. Unless there
was some medical reason why a woman could not have
(15:11):
a radical mastectomy, these options were pretty much always against
medical advice. Doctor 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, and she
(15:31):
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 based on
(15:53):
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. One hundred and twenty four of those
(16:13):
had radiation as their only follow up treatment, while the
others had some combination of a mastectomy and radiation. What
she found was that there was absolutely no difference in
the survival time between the women who had just had
a lumbectomy and 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 surgery
(16:36):
which preserved the woman's breast was just as viable a
medical option as a mastectomy. 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 doctor George Cryle of Cleveland.
She was determined, though, and so she decided to do
(16:59):
a case a case control study of the records from
Princess Margaret Hospital. So while she had previously calmed through
all of the records and looked at them as a whole,
this time she controlled for the age of the patients,
their other health factors, whether they also had other cancers.
She narrowed it down to only patients with stage one
breast cancer, and then she meticulously matched up the ones
(17:20):
who had a lumpectomy in radiation with the ones who
had a mastectomy 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 one hundred and forty five pairs in which the
lumpectomy group had no statistically significant difference than the mastectomy group.
(17:41):
In fact, the lumpectomy group had slightly better survival than
the mastectomy group. In other words, for women with stage
one cancer, a more conservative treatment that preserved their breast
did not harm their chances of survival. Radical mastectomy was
not necessary when the disease had not started to spread.
In nineteen seventy five, she presented these findings at the
(18:03):
Royal College of Physicians and Surgeons of Canada meeting in Winnipeg, Manitoba.
Their response was really skeptical at best. Two years later,
doctor Peters published an updated version of the paper in
an international journal, which gave it more exposure and also
came to the exact same conclusions in that paper. She
was really direct in her opinion. She said, quote as
(18:25):
more and more conservative studies ripen, as more and more
concerned physicians observe the adverse effects of excessive treatment, as
more and more women become armed with knowledge, mastectomy and
early breast cancer may become as old fashioned as blood letting.
Doctor Peters retired from the hospital the year before that
revised paper was published, although she maintained a part time
(18:46):
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 mested
to me if there's some medical reason to do so.
Doctor Peter's impact on the medical field also went beyond
(19:07):
just the specific treatment of these two cancers. And we'll
talk about how after a brief ad break, so to
return to doctor Peters, a lot of people take the
idea of patient centered care to for granted today, even
(19:28):
if they've never heard that term specifically, I know that
lots of people have lots of different access to medical care,
depending on all kinds of factors, including their income level,
and 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 this was
(19:51):
not really how things worked. When doctor Peters started practicing medicine,
she was really a forerunner in the idea listening to
a patient's wishes and explaining to them and helping them
make decisions about their own treatment. This whole idea was
really far from standard when she was practicing medicine. Yeah,
(20:13):
she actually got to know her patients and she helped
them make decisions about their own health care rather than
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
(20:35):
but then also leave you with potentially lots of scars
or huge side effects or you know, lots of adverse
effects to taking care of the problem. This was also
core to doctor 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
(20:57):
women to sleep to do a biopsy and then taking
their entire breast in the case of really small tumors
that hadn't progressed anywhere. She really wanted to avoid the
risks that came of side effects and other complications by
doing a more minimal treatment but still trade into actual problem.
And she was also a role model for young women
who were interested in becoming doctors, not just because of
(21:18):
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 something that really
needed proving at this point in history. She did a
lot of her research at home, so she was compiling
her work by hand. She wouldn't have been able to
make the breakthroughs that she did otherwise, But outside of
the medical world she was missus Lobb, mother of two.
(21:41):
I think a lot of the other female forerunners in
the world of medicine we've talked about have been women
who eschewed the more traditional, stereotypical feminine side, and so
it actually was a big deal that, in addition to
being a doctor, she got married and had children. All
of this work was additionally incredible because at this point
(22:04):
there were hardly any women doctors at all, let alone
women doctors who were on the cutting edge of their
field revolutionizing the treatment of multiple diseases. And Doctor 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,
(22:24):
and the Woman of Distinction Award from the Canadian Breast
Cancer Foundation in nineteen eighty eight. Sadly, she died of
cancer on October first, nineteen ninety three, at the 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 twenty ten. It's kind of a side note there
(22:47):
was a play about her called Radical, which was written
by Charles Hayter, who was also an oncologist, that actually
premiered to just sell out standing room only crowd at
the Toronto French Festival in July two. Thank you, doctor
Vera Peters. I know you and I both have family
experience with breast cancer and the fact that somebody said, Okay,
(23:11):
we have got to just stop treating women as a
thing to put on a table and remove part of
their body without actually talking to them about it, like
that's a big deal. Yeah. The idea of not being
asked questions about treatment is so alien to me that
it's shocking. Yeah. Yeah, uh and you. I said this
(23:36):
to you off Mike, and now I'm just gonna say
it on Mike. As 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 it cited the male doctor is doctor
and the female author of the paper is missed. And
I could not figure out whether she was actually a
(23:58):
doctor when that notation was published or not, because it
is possible that she was credited on a 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 just credited as
miss instead of doctor because she was a woman. Yeah,
(24:20):
so that's a mystery that remains to be solved. Thanks
so much for joining us on this Saturday. Since this
episode is out of the archive, if you heard an
email address or a Facebook RL or something similar over
the course of the show, that could be obsolete now.
Our current email address is History podcast at iHeartRadio dot com.
(24:45):
You can find us all over social media at missed
in History, and you can subscribe to our show on
Apple podcasts, Google podcasts, the iHeartRadio app, and wherever else
you listen to podcasts. Stuffy Missed in History Class is
a production of iHeartRadio. For more podcasts from iHeartRadio, visit
the iHeartRadio app, Apple podcasts, or wherever you listen to
(25:08):
your favorite shows.
Happy Saturday. This week we had an episode on the
history of mimography, which did not have many women in
it considering its subject matter. So today we have our
past episode on doctor Vera Peters, who really revolutionized the
care of two different cancers, one of them being breast cancer.
Although the medical community's response to her research at the
(00:25):
time was pretty skeptical. She started publishing on this work
in nineteen sixty seven, so right in the middle of
some of what we talked about on this mimography episode,
and near the end of this episode we mentioned a
paper that cited her male co author as doctor but
cited her as miss and not being sure whether the
paper was published before or after she finished medical school.
(00:47):
And we just wanted to note that women with medical
degrees or doctorate's being called miss while their male colleagues
are called doctor. It is not a relic of the
past that still happens today. Yeah, when I listened to
the episode, I was like, kind of make it sound
like this is no longer a problem, But I sure
do know many women who are either doctors or have
(01:07):
doctoral degrees who are deeply frustrated by it, especially on
things like panels and paper titles and et cetera. This
episode originally came out March eighteenth, twenty fifteen, So enjoy
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio. Hello, and welcome to the podcast. I'm Tracy V.
(01:36):
Wilson and I'm Holly Fryme. So we've mentioned quite a
number of times that we have an extensively long list
of to dos on the podcast. There are hundreds and
hundreds and hundreds of listeners submitted suggestions, and then we
have our own to do lists, and they are both
very long and sometimes sort of like when you're you
(01:58):
have access to hundreds of channels on the television, it
just feels like nothing's on. I scroll through all those things,
and there are so many great 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,
(02:19):
it just won't turn out as well as if you
wait a little while and let it become the thing
that catches your mood. Right, and some of the things
I was in the mood to talk about were 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 doctor Vera Peters, who was
one of the foremost oncologists in the world in her time.
(02:43):
Not only was she one of the only female oncologists
in the world, she 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. Doctor Peters helped revolutionize
(03:05):
the treatment of both breast cancer and Hodgkins lymphoma, but
at the time that she did, 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 going to have a whole episode on her today. Hooray,
We'll do the usual setup on early life. Mildred Vera
(03:26):
Peters was born in Rexdale, Ontario, on April twenty eighth
of nineteen eleven. She was one of seven children, 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.
(03:47):
She finished high school at sixteen, and she wanted She
knew already that she wanted to become a doctor. She
was too young to start medical school, though, so she
enrolled in the University of Toronto to study math and physics,
and then she trammedurred 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.
(04:08):
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 in medical school, her mother was
treated for breast cancer, and after a recurrence, she was
treated by doctor Gordon Richards, who at that point was
one of the most respected doctors in the field of
(04:30):
radiation oncology, which at that point was pretty early in
its development. Doctor Richards was also one of the doctors
that Vera studied under, and Vera's mother unfortunately did die
of her cancer, which was one of the things that
led Vera to want to study the disease later in
her life. Doctor Peters graduated from medical school in nineteen
(04:52):
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 or certification for radiotherapy, so
doctor Peters apprenticed with doctor Richards and she started working
at the Ontario Institute of Radiotherapy in nineteen thirty five,
and she continued to work with doctor Richards right up
(05:13):
until his death in January of nineteen forty nine. Before
we get into more of the specifics of her medical work,
here's a caveat Doctor Peters 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 even
(05:36):
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 because the whole field of
oncology has evolved tremendously since doctor Peters retired in nineteen
seventy six. So this is much more about how the
developments that doctor Peters launch changed the way medicine was
(05:58):
working at the time than about the diseases specifically or
how they're treated today. So doctor Peter's first groundbreaking work
was in the treatment of 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, its name for doctor Thomas Hodgkin, who described
(06:20):
it in eighteen thirty two. The major difference between Hodgkins
lymphoma and the more common non Hodgkins lymphoma is that
Hodgkins lymphoma involves large abnormal cells called reed Sternberg cells,
while these cells are not present in non Hodgkins lymphoma.
Between its first description in eighteen thirty two and nineteen
(06:42):
o two, no doctors reported any successful treatment of Hodgkins
lymphoma at all. The first somewhat successful treatment was which
was described in nineteen oh two, was the use of
X rays on the involved lymph nodes, and while this
did shrink the affected nodes somewhat, it did cure the disease,
it maybe bought people a little time. There were a
(07:04):
few advances between nineteen oh two and nineteen thirty nine,
when doctor Rene Gilbert of Geneva, Switzerland described treating the
affected lymph nodes with radiation. He treated 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. Doctor Peter's mentor, doctor Richards, who
(07:28):
we mentioned earlier, installed a four hundred killo radiation machine
at the Ontario Radiotherapy Institute in nineteen thirty seven, just
a couple of years before Jilbert's description of his method.
This was a higher voltage machine than what doctor Jilbert
was using, and doctor Richard used this machine to treat
his patients for a variety of cancers. Doctor Richard's method
(07:52):
with Hodgkin's lymphoma was to use extended field radiation on
the affected lymph nodes and adjacent nodes. Although some accounts
described this irradiation 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.
(08:13):
At first, doctor Peters primarily worked under doctor Richard's supervision.
She was kind of apprenticing to him, but as she
became more experienced as a doctor, she began to treat
patients on her own as well. In nineteen forty seven,
after ten years of treating lymphoma patients with the four
hundred kilovolt machine, doctor Richards made an observation to doctor Peters.
(08:34):
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
wanted to evaluate their work on the matter. So there
are some people who interpret this as meaning that doctor
Richards should get credit for what happened next. After all,
especially at the beginning, he was the one who was
(08:55):
successfully treating the patients for their cancer. What he really
did was give doctor Peters a question to answer, and
the work she did to answer that question eventually changed
the perception of Hodgkins lymphoma from being an incurable disease
to a curable one. Doctor Peter spent two years studying
one hundred and thirteen patients who had been conclusively diagnosed
(09:18):
with Hodgkins lymphoma and treated with radiation at the hospital
where she worked. She largely did this by hand at
her dining room table. She was ready to present her
findings to her colleagues in nineteen forty nine, which was,
unfortunately after doctor Richards had already died. Her findings revealed, though,
that his theory was right. Their patients were living longer
(09:40):
than lymphoma 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,
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 lit better and her tone was
(10:01):
a lot more optimistic than any of the medical wisdom
on Hodgkins lymphoma at the time. The idea of approaching
Hodgkins lymphoma with the goal of curing it was revolutionary,
and even though doctor 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.
(10:24):
Doctor Peters presented a follow up paper in nineteen fifty
six that included two hundred and ninety one Hodgkins lymphoma cases,
with all of the data just as solidly pointing to
the idea that 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. Eesen and Mary
(10:45):
and H. Russell, using doctor Peter's data, confirmed her work
in their paper Cure of Hodgkins Disease that was in
nineteen sixty three. It took even longer than that for
the idea that Hodgkin's disease could be approached as something
that can be cured in a medical textbook. Treatments have
continued to advance today, especially if it's in the early stages.
(11:10):
Hodgkin's disease is considered to be one of the most
curable adult cancers. Having made these kinds of strides in
Hodgkin's disease, doctor 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.
(11:35):
So to get back to doctor Peters's work with breast cancer.
In nineteen fifty eight, the Ontario Cancer Institute at Princess
Margaret Hospital opened and patients and staff from Toronto General,
including doctor Peters and her patients, were transferred there. As
a side note, we're 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
(11:57):
here because that's the work that doctor Peters was doing.
All of her focus was on breast cancer treatment in women,
not in men, so we're not excluding men for some
other reason. That's just the work that she was focused on.
So at this point, the overwhelming majority of patients who
were diagnosed with breast cancer were treated with a radical mastectomy,
(12:19):
also called the Halsted 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 cancerous, they'd have the mestectomy
before they were gained consciousness. This made the possibility of
breast cancer particularly terrifying women got onto an operating table
(12:40):
not knowing if they had cancer or not, and not
knowing if they would wake up without a breast or not.
The mestectomy itself, which was the standard treatment regardless of
whether the cancer had spread beyond one tumor, was a
lot more involved than mestectamies typically are today. A radical
mastectomy removes more than just the breast. That also moves
(13:00):
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
is most likely to go after appearing in the breast,
(13:23):
this court was the course of action, regardless of whether
cancer had been detected in any of these other places.
Needless to say, a radical mastectomy permanently and significantly altered
the body. Even after the reconstruction, a woman's chest itself
would look a lot different. It would basically be concave
because of the loss of the pectoral muscle, wall over
(13:46):
and over again. Modern medical papers describe radical mass deectomies
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 or many patients for
the rest of their lives. Could also be physically disabling
since it removed some of the muscles used to control
(14:07):
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 mastectomy is extremely rare
and it's only performed when there really is cancer in
those adjacent tissues. When people have messt deectomies today, they're
(14:29):
usually what's considered a simple mastectomy, which removes the breast
but leaves at least some of the lymph nodes, or
a modified radical mastectomy, which removes the breast and lymph
nodes but only gets into the pectoral muscles if the
cancer has actually spread there. Even though a radical mastectomy
was a standard of care for breast cancer patients at
(14:49):
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 lumpectomy. Unless there
was some medical reason why a woman could not have
(15:11):
a radical mastectomy, these options were pretty much always against
medical advice. Doctor 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, and she
(15:31):
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 based on
(15:53):
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. One hundred and twenty four of those
(16:13):
had radiation as their only follow up treatment, while the
others had some combination of a mastectomy and radiation. What
she found was that there was absolutely no difference in
the survival time between the women who had just had
a lumbectomy and 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 surgery
(16:36):
which preserved the woman's breast was just as viable a
medical option as a mastectomy. 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 doctor George Cryle of Cleveland.
She was determined, though, and so she decided to do
(16:59):
a case a case control study of the records from
Princess Margaret Hospital. So while she had previously calmed through
all of the records and looked at them as a whole,
this time she controlled for the age of the patients,
their other health factors, whether they also had other cancers.
She narrowed it down to only patients with stage one
breast cancer, and then she meticulously matched up the ones
(17:20):
who had a lumpectomy in radiation with the ones who
had a mastectomy 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 one hundred and forty five pairs in which the
lumpectomy group had no statistically significant difference than the mastectomy group.
(17:41):
In fact, the lumpectomy group had slightly better survival than
the mastectomy group. In other words, for women with stage
one cancer, a more conservative treatment that preserved their breast
did not harm their chances of survival. Radical mastectomy was
not necessary when the disease had not started to spread.
In nineteen seventy five, she presented these findings at the
(18:03):
Royal College of Physicians and Surgeons of Canada meeting in Winnipeg, Manitoba.
Their response was really skeptical at best. Two years later,
doctor Peters published an updated version of the paper in
an international journal, which gave it more exposure and also
came to the exact same conclusions in that paper. She
was really direct in her opinion. She said, quote as
(18:25):
more and more conservative studies ripen, as more and more
concerned physicians observe the adverse effects of excessive treatment, as
more and more women become armed with knowledge, mastectomy and
early breast cancer may become as old fashioned as blood letting.
Doctor Peters retired from the hospital the year before that
revised paper was published, although she maintained a part time
(18:46):
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 mested
to me if there's some medical reason to do so.
Doctor Peter's impact on the medical field also went beyond
(19:07):
just the specific treatment of these two cancers. And we'll
talk about how after a brief ad break, so to
return to doctor Peters, a lot of people take the
idea of patient centered care to for granted today, even
(19:28):
if they've never heard that term specifically, I know that
lots of people have lots of different access to medical care,
depending on all kinds of factors, including their income level,
and 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 this was
(19:51):
not really how things worked. When doctor Peters started practicing medicine,
she was really a forerunner in the idea listening to
a patient's wishes and explaining to them and helping them
make decisions about their own treatment. This whole idea was
really far from standard when she was practicing medicine. Yeah,
(20:13):
she actually got to know her patients and she helped
them make decisions about their own health care rather than
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
(20:35):
but then also leave you with potentially lots of scars
or huge side effects or you know, lots of adverse
effects to taking care of the problem. This was also
core to doctor 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
(20:57):
women to sleep to do a biopsy and then taking
their entire breast in the case of really small tumors
that hadn't progressed anywhere. She really wanted to avoid the
risks that came of side effects and other complications by
doing a more minimal treatment but still trade into actual problem.
And she was also a role model for young women
who were interested in becoming doctors, not just because of
(21:18):
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 something that really
needed proving at this point in history. She did a
lot of her research at home, so she was compiling
her work by hand. She wouldn't have been able to
make the breakthroughs that she did otherwise, But outside of
the medical world she was missus Lobb, mother of two.
(21:41):
I think a lot of the other female forerunners in
the world of medicine we've talked about have been women
who eschewed the more traditional, stereotypical feminine side, and so
it actually was a big deal that, in addition to
being a doctor, she got married and had children. All
of this work was additionally incredible because at this point
(22:04):
there were hardly any women doctors at all, let alone
women doctors who were on the cutting edge of their
field revolutionizing the treatment of multiple diseases. And Doctor 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,
(22:24):
and the Woman of Distinction Award from the Canadian Breast
Cancer Foundation in nineteen eighty eight. Sadly, she died of
cancer on October first, nineteen ninety three, at the 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 twenty ten. It's kind of a side note there
(22:47):
was a play about her called Radical, which was written
by Charles Hayter, who was also an oncologist, that actually
premiered to just sell out standing room only crowd at
the Toronto French Festival in July two. Thank you, doctor
Vera Peters. I know you and I both have family
experience with breast cancer and the fact that somebody said, Okay,
(23:11):
we have got to just stop treating women as a
thing to put on a table and remove part of
their body without actually talking to them about it, like
that's a big deal. Yeah. The idea of not being
asked questions about treatment is so alien to me that
it's shocking. Yeah. Yeah, uh and you. I said this
(23:36):
to you off Mike, and now I'm just gonna say
it on Mike. As 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 it cited the male doctor is doctor
and the female author of the paper is missed. And
I could not figure out whether she was actually a
(23:58):
doctor when that notation was published or not, because it
is possible that she was credited on a 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 just credited as
miss instead of doctor because she was a woman. Yeah,
(24:20):
so that's a mystery that remains to be solved. Thanks
so much for joining us on this Saturday. Since this
episode is out of the archive, if you heard an
email address or a Facebook RL or something similar over
the course of the show, that could be obsolete now.
Our current email address is History podcast at iHeartRadio dot com.
(24:45):
You can find us all over social media at missed
in History, and you can subscribe to our show on
Apple podcasts, Google podcasts, the iHeartRadio app, and wherever else
you listen to podcasts. Stuffy Missed in History Class is
a production of iHeartRadio. For more podcasts from iHeartRadio, visit
the iHeartRadio app, Apple podcasts, or wherever you listen to
(25:08):
your favorite shows.
Stuff You Missed in History Class News
Hosts And Creators
Tracy V. Wilson
Holly Frey
Popular Podcasts
1. The Podium
The Podium: An NBC Olympic and Paralympic podcast. Join us for insider coverage during the intense competition at the 2024 Paris Olympic and Paralympic Games. In the run-up to the Opening Ceremony, we’ll bring you deep into the stories and events that have you know and those you'll be hard-pressed to forget.
2. In The Village
In The Village will take you into the most exclusive areas of the 2024 Paris Olympic Games to explore the daily life of athletes, complete with all the funny, mundane and unexpected things you learn off the field of play. Join Elizabeth Beisel as she sits down with Olympians each day in Paris.
3. iHeartOlympics: The Latest
Listen to the latest news from the 2024 Olympics.