In Edwardian England (at least on PBS) there is a place called Downton Abbey, where titled gentlefolk are facing change of all kinds. Missing heirs, potential weddings, sordid affairs, and crumbling traditions vie for viewer's attentions with period costumes, French cuisine, and shifting politics. But downstairs, supporting the lives of the wealthy, are the servants, ruled over by the butler, Mr Carson - and Mrs Hughes, the housekeeper. Mrs Hughes has discovered a lump in her breast, in a time that barely mentioned that motherly organ, and she fears that her life may soon be ended. What are her options? How can she afford medical care? Will she still be a part of the Crawley ancestral home - or will she lose her position?
In the 1920's when a woman found a breast lump, she was most likely discovering breast cancer that had gone undetected until it was actually too late to treat. She had no mammogram to consult, no annual clinical breast exam to assist her in making decisions, and few options for treatment. Diagnosis would have been made by biopsy, but results could take months to develop. Imagine the agony we now endure when waiting a week or a few days for a biopsy report, compared to two months of waiting! Mrs Hughes would have no health insurance to help cover her surgical costs, and no sick leave program or job insurance to preserve her post at the Abbey. As you might imagine, she isn't earning a fortune and hasn't got a financial safety net, either!
It seems that the Crawley family might advance funds for her medical needs, but still, her options are fearful. She would have faced the prospect of a radical mastectomy and no discussion of breast reconstruction. The loss of her breast, chest muscle, and lymph nodes would have disabled her for housekeeping duties and almost certainly would have produced a bad case of arm lymphedema. After surviving surgery, there were no drugs to help halt the spread of cancer, and no follow-up therapies to extend her life beyond an initial period of survival. A diagnosis of breast cancer is devastating today, but 100 years ago, it spelled the loss of home, livelihood, community, and life. How far we have come!
Breast cancer is still a terrible disease, but survival rates are now around 85% over five years for early-stage tumors. Early detection, surgery, and modern treatments have paved the way for better outlook and longer lives after cancer than ever before. Researchers continue to work on targeted therapies and surgical techniques that preserve the breast or rebuild it, making life after treatment more comfortable for many. Laws have been enacted that provide help with finances, job security, and health insurance. While we still don't have The Cure, we are making progress and hope to eventually crack the code that defeats breast cancer. Until that day, Mrs Hughes reminds of of just how far we have come.