An Early Voice for Breast Conservation Therapy Reflects on a Changing Field

Cheryl Alkon
Published: Saturday, Mar 17, 2018
Samuel Hellman, MD
Samuel Hellman, MD
As a trailblazer who helped breast cancer treatment evolve from radical mastectomy to the judicious use of radiation therapy with limited tumor removal, Samuel Hellman, MD, is considered one of the world’s premier radiation oncologists.

Now in his mid-80s, Hellman began his medical training in an era in which the reigning breast cancer protocol was to cut it all out, including the entire breast and underlying muscle, and possibly radiate the remaining area afterward. But Hellman always pushed for less extensive surgery and a stronger emphasis on radiation, and his reputation was well known.

In 1983, Hellman was recruited to, and eventually joined, New York’s Memorial Sloan Kettering (MSK) Cancer Center as physician in chief. MSK was known for its team of surgeons, and many, if not all of them, typically performed full mastectomies for treatment. Once he took on the role, someone asked Hellman how he and the surgeons would get along.

“I said, ‘The way porcupines make love: very carefully!’” Hellman recalled, laughing.

His dedication to radiation oncology and speaking out against the status quo has been a hallmark of his career. “I became the leading American proponent, in speeches and debates, for the conservative management of women who had breast cancer,” said Hellman. “At the time, I was the chairman at Harvard and I had the bully pulpit. I think most people would say I was the one who really fought the surgeons and brought it to people’s attention.”

He was also living by one of his favorite philosophies: all patients need not be painted with the same broad brush of how to treat their cancer. “Medical science is general, but patient care is given individually. The essence of the ‘art of medicine’ is in applying that medical knowledge to each unique patient,” he said.

The challenges of radical mastectomy were many: Patients were more likely to cite concerns or unhappiness about their changing body image with the full loss of 1 or both breasts, the likelihood for postsurgical complications was greater with a more extensive surgery, and patients faced the risk of restricted arm and shoulder use post mastectomy. Throughout the 1970s and 1980s, Hellman, along with other oncologists working in the United States, Europe, and Canada, pushed for breast cancer treatment with biopsy or limited tumor removal with radiation. Ultimately, randomized trials conducted by others comparing the results of radiation therapy versus surgery successfully supported Hellman’s stance, and the use of radical mastectomy as the leading breast cancer treatment has since been almost completely eliminated.

“I think I made a real contribution to breast cancer treatment, but it was more political by engaging in the academic debate than it was in making a discovery or inventing the treatment,” Hellman said in a 2002 interview that the American Society for Therapeutic Radiology and Oncology (ASTRO) conducted as part of its efforts to document the history of radiation oncology. He also began writing up case studies of patients who had been treated more conservatively, which attracted wide interest after being published in peer-reviewed journals.

Leading the Way

Hellman has spent decades as a pioneer in radiation oncology. After his postgraduate medical training at Yale and in Great Britain, he established the first Department of Radiation Oncology at Harvard Medical School in 1970, a feat he considers one of his greatest contributions to the field. He was the founding professor and director of Harvard’s Joint Center for Radiation Therapy and was appointed the Alvan T. and Viola D. Fuller-American Cancer Society Professor and chairman of the Department of Radiation Therapy.

When he was recruited from Harvard to become the physician in chief at MSK in 1983, he was thrilled. “The implication of the title and job itself was really what I loved,” he said. “I was now in charge of all clinical cancer care.” He stayed there until 1988, when he was recruited to become the dean of Biological Sciences at the University of Chicago and vice president of the university and its Pritzker School of Medicine. In 1993, he was named the A.N. Pritzker Distinguished Service Professor in the Department of Radiation and Cellular Oncology at the university. He is currently an emeritus faculty member in the Radiation and Cellular Oncology Department at the University of Chicago.

Hellman has also served as president of ASTRO and was the first president of the American Society of Clinical Oncology who was a radiation oncologist.

In addition to his contributions to breast cancer treatment, Hellman has been instrumental in technological developments, such as the introduction of the linear accelerator for stereotactic radiosurgery. He also was recognized for advancing the understanding and management of Hodgkin disease.

View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: How Do We Leverage PARP Inhibition Strategies in the Contemporary Treatment of Breast Cancer?May 31, 20191.5
Community Practice Connections™: A Better Way to Stop Pain: Paths Toward Responsible Postsurgical Pain Management for Patients With Breast CancerMay 31, 20191.5
Publication Bottom Border
Border Publication