An orphan in East Baltimore
Rose Rehert was born on June 22, 1929, in East Baltimore, Maryland, the fourth and youngest child of Israel and Fannie Rehert, Jewish immigrants from Eastern Europe. Both of her parents died by the time she was ten, and she went to live with her aunt Golde. She grew up speaking Yiddish at home and attended Hebrew school as well as classes at the Workmen’s Circle, the Jewish labour and cultural organisation.
She was a bright and eager student who dreamed of becoming a physician. But her older brothers would not pay for college, and after high school she went to work. From 1947 to 1951 she was assistant to the animal behaviourist Dr. Horsley Gantt at the Pavlovian Laboratory of the Johns Hopkins School of Medicine, while taking evening pre-medical courses at Baltimore Junior College. Gantt encouraged her to write, and she discovered she had a gift for it. She also took a year away from her job to work with Second World War refugees in Europe.
Journalist and mother
In 1951 she married Harvey Kushner, an engineer and management consultant, and they had three children: Gantt, born in 1952, Todd, born in 1956, and Lesley, born in 1958. While raising them she kept studying, at Montgomery Junior College and the University of Maryland, where she graduated with honours in journalism in 1972.
She worked as a writer and editor, often on science and medicine, and reported from abroad. In 1967 she was a Vietnam War correspondent for the Baltimore Sun, one of the few women reporting from Vietnam. The columnist Peter Lisagor wrote that her tentative conclusion about what the United States was doing wrong there was “everything.” She later covered the Yom Kippur War of 1973. She also wrote an unpublished memoir with the wry title “I Wasn’t Raised to be a Jewish Mother.”
The lump
In June 1974 Kushner found a lump in her breast. At the time, American women with a suspicious lump usually signed a consent form and went under general anaesthesia for a biopsy. A pathologist examined the tissue while she was still asleep, and if it was cancer the surgeon immediately performed a Halsted radical mastectomy, removing the breast, the chest muscles beneath it and the lymph nodes of the armpit. A woman often did not know whether she would wake up with one breast or two, and she had no say in what was done.
Kushner, who lived near the National Library of Medicine, the National Institutes of Health and the National Cancer Institute in suburban Maryland, used her reporter’s skills and read the medical literature. She concluded that the one-step procedure was not necessary and that the radical operation was not the only option. She insisted on a biopsy alone, followed by a decision made in consultation with specialists. Many surgeons turned her down; she even asked them to sign a contract forbidding them to remove her breast. When the biopsy showed cancer she chose a modified radical mastectomy, which spares the chest muscles, and travelled to the Roswell Park Memorial Institute in Buffalo, New York, where Dr. Thomas Dao agreed to perform it.
Turning a diagnosis into a cause
While she recovered, Kushner realised that most women did not have her access to research libraries or her confidence in arguing with doctors. Her first major article on breast cancer appeared in the Washington Post on October 6, 1974. She travelled to England, Scotland, Scandinavia and Russia to see how other countries treated the disease, and found that European doctors were far more critical of the radical mastectomy than their American colleagues. She wrote her book in a matter of weeks. Breast Cancer: A Personal History and Investigative Report appeared in 1975; revised editions followed as Why Me? in 1977 and Alternatives in the mid-1980s. The Cancer Letter later called Why Me? a standard reference.
The response was overwhelming. Letters arrived from women desperate for information, some addressed simply to “Mrs. Breast Cancer, Kensington, MD.” In 1975 Kushner and Dorothy Johnston founded the Breast Cancer Advisory Center, a hotline and information service that answered calls and letters from thousands of women and sent out fact sheets until 1982.
Changing the standard of care
Kushner was relentless. She went to medical meetings, questioned speakers and challenged established practice. In 1975 members of the Society of Surgical Oncology booed her when she challenged their standard treatments. In May 1976 she was the first person to testify before the Senate health subcommittee on breast cancer, calling for the two-step procedure, for the modified radical to replace the Halsted operation as standard treatment, and for more clinical trials and more breast specialists.
In June 1977 she was the only non-physician appointed to a National Institutes of Health panel reviewing the treatment of primary breast cancer. In 1979 the panel concluded that the Halsted radical mastectomy should no longer be the standard treatment, and Kushner persuaded her fellow members to include a statement calling for an end to the one-step procedure. When she died, Dr. Bruce Chabner of the National Cancer Institute called her probably the single most important person in ending one-step breast cancer surgery. The two-step approach she fought for, in which a woman is told the results of her biopsy before any decision about surgery is made, was by the time of her death, as the Washington Post reported, routine virtually throughout the world, and much of the credit was given to her.
She also pressed for state and federal laws giving women a choice of procedure and requiring doctors to tell patients about all their treatment options, for insurance and Medicare coverage of mammograms, for limits on radiation doses in mammography, and for warnings about breast cancer risk on oral contraceptives.
Inside the establishment
Her influence grew with her credibility. President Jimmy Carter appointed her to the National Cancer Advisory Board, where she served from 1980 to 1986 as one of its first lay members. She joked that she had become a full-fledged member of the Establishment. The American Cancer Society, which she had once called a conservative organisation that moved with the speed of a senile snail, later made her an adviser and in 1989 appointed her to its Breast Cancer Task Force. In 1986 she helped found the National Alliance of Breast Cancer Organizations, an umbrella group for the growing patient movement, and served on its board until 1989.
She did not always win the argument, and not all her positions have aged equally well. When her cancer recurred in the early 1980s she declined chemotherapy and was treated with tamoxifen, and she campaigned against what she saw as indiscriminate use of aggressive adjuvant chemotherapy, calling it the Halsted radical of the 1980s. The historian Barron Lerner has suggested that the vehemence of that campaign may have reflected her personal stake in her own treatment choice and a close working relationship with the makers of tamoxifen.
Jewish roots
Kushner was a child of Yiddish-speaking Jewish immigrants and was raised within Baltimore’s Jewish community, at Hebrew school and the Workmen’s Circle, after losing both parents. Her first great act of service, working with refugees in postwar Europe, came out of that world. She reported on Israel’s Yom Kippur War, and her unpublished memoir title, “I Wasn’t Raised to be a Jewish Mother,” suggests the humour with which she viewed the expectations of her upbringing. “I consider everything I do social work,” she once said.
Honours and a lasting voice
Kushner received awards from the American Medical Writers Association in 1980 and 1985 for her writing on breast cancer. The American Cancer Society gave her its Medal of Honor in 1987 and its Courage Award in 1988. In 1990 the Society of Surgical Oncology, whose members had booed her fifteen years earlier, gave her the James Ewing Award for outstanding contributions by a layperson in the fight against cancer.
Rose Kushner died of breast cancer on January 7, 1990, at Georgetown University Hospital in Washington, aged 60. Until a few days before her death she was lobbying for health insurance to cover mammograms, and she had recently organised BreastPac, a political action committee to raise money for candidates who supported breast cancer programmes, asking every woman who had ever found a lump in her breast to give a dollar. The Washington Post noted that, though basically a private person, she did not hesitate to use her own medical history to advance the cause, at the cost of her own privacy. Helene Brown of UCLA’s Jonsson Comprehensive Cancer Center said that she did more for women with breast cancer than any other human being in the world: before Rose, a good patient sat still and took the treatment; Rose gave women, and men, the right to question their doctors.
Today the principle she fought for is simply how medicine works. A woman with a breast lump has a diagnosis first, then time to understand her options, get a second opinion and take part in the decision. Informed consent and shared decision-making, and the patient advocacy movement that now sits at the table in cancer research, all owe something to a stubborn Baltimore journalist who refused to sign a blank cheque for her own body.
Sources & further reading
Rose Kushner, Jewish Women’s Archive Encyclopedia · Rose Kushner, Wikipedia · Rose Kushner: War correspondent and breast cancer advocate, The Cancer Letter / Cancer History Project · Sandy Rovner, Rose Kushner, Advocate for Cancer Patients, Dies, Washington Post, January 9, 1990 (reprinted by Veteran Feminists of America) · Researched from the sources above and checked against them. Spotted an error? Tell us.
A life of tikkun olam. This is part of tikkun olam, the Jewish idea of repairing the world, and every one of us can add to it.