Given her status as an icon in the breast cancer movement, it might surprise people to learn that Betty Ford made a decision that caused Rose Kushner, one of America’s first breast cancer activists, to become nearly apoplectic.  Yet Mrs. Ford, who died last week, was less of a crusader than a transition figure in the nascent breast cancer movement.  Seeing her in this light makes her contributions no less remarkable.

Although other famous women, most notably Shirley Temple Black, had gone public with their stories of breast cancer, the diagnosis of the disease in a First Lady was a momentous event in September 1974.  At that time, cancer was still very much in the shadows.  People with other forms of cancer routinely kept their diagnoses private, even from relatives and close friends.  When the cancer affected the breast, and required removal of an organ with such intense connections to motherhood and sexuality, the silence was often deafening.

Rose Kushner had received her own diagnosis of breast cancer three months before Mrs. Ford, in June 1974.  Kushner was a Washington D.C. journalist who, by her own account, had “a streak of stubbornness and a loud voice.”

Rather than merely consulting physicians when she discovered an “elevation” in her left breast, Mrs. Kushner went to the local public library, where she found a book by a Cleveland surgeon, George Crile, Jr., that argued that surgeons routinely performed unnecessarily “mutilating” operations on women with breast cancer, removing not only their breast and nearby lymph nodes, but both chest wall muscles on the affected side.

Moreover, Mrs. Kushner learned, the decision to proceed with this disfiguring operation occurred when the woman was under anesthesia.  If the biopsy of a lump showed cancer, the surgeon would ask the husband’s permission to proceed with the traditional radical mastectomy.  Women thus awakened from anesthesia not knowing whether or not they had lost their breast.  For Mrs. Kushner, very much a part of 1970s feminism, silencing a woman at one of the most crucial moments of her life, was thoroughly unacceptable.

Thus, when the media reported that Mrs. Ford had found a lump and was to undergo surgery, Mrs. Kushner kicked into gear.  Using her journalistic connections, she called the White House to inform the First Lady that she should undergo only a diagnostic biopsy and then discuss treatment options with her surgeon.  Moreover, if she had cancer, she should decline radical surgery in favor of a less aggressive—but equally effective—operation.

Mrs. Kushner got through to the economist Milton Friedman, one of President Gerald Ford’s speechwriters, and made her case.  Yet when Mr. Friedman returned to the phone, he told Mrs. Kushner he was sorry, but that “The president had made his decision.”  Mrs. Kushner later characterized Mr. Friedman’s statement as “the all-time sexist declaration of no-woman rights.”

Sure enough, Mrs. Ford underwent the one-step operation, had a positive intraoperative biopsy and then a traditional radical mastectomy.  Mrs. Kushner later wrote that Mrs. Ford had been “butchered unnecessarily.”

As we know, Mrs. Ford went on to survive her breast cancer and become a courageous spokesperson, urging women not to be ashamed of the disease and to get mammograms and do breast self-examinations.  So many women followed her advice and received an early diagnosis of breast cancer in the mid-1970s that the rate of the disease appeared to increase.

It should not detract at all from Mrs. Ford’s contributions that she followed the advice of her male doctors and husband.  The breast cancer movement, thanks to women like Rose Kushner, who died of her disease in 1990, helped to empower women (and men) to challenge their physicians and study the medical literature by themselves.  Women with breast cancer are among the best informed patients I see.

Yet medical decisions are rarely political statements.  Rather, they are a shared process in which women, along with their families and doctors, reach informed choices that fit their personal preferences and life situations.  They then can use these experiences to educate others with the disease.  This is what Betty Ford did so eloquently.