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 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. 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 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. 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 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, 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. 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 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 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. 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. 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 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 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 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 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 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 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 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 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 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 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. 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. 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 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 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 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 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. 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 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. 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. 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 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, 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 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 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, 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 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 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 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 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 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 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 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 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 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 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 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. 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 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 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 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 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 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 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, 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 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 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 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. 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 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, 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 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, 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 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 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, 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. 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 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 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. 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 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. 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 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, 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. 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 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 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. 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. 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 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 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 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 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 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 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 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 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 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 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. 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. 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 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 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 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 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. 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 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. 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. 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 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, 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 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 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, 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 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 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 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 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 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 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 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 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 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 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 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. 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 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 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 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 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 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 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, 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 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 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 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. 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 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, 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 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, 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 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 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, 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. 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 your favorite shows.