Rose Kushner, 60, author, journalist and an outspoken advocate for women with breast cancer, died Jan. 7 at Georgetown Univ. Hospital in Washington of the disease that was her crusade for the past 17 years. She lived in Kensington, MD.

Kushner was one of the few female war correspondents in Vietnam as a reporter for the Baltimore Sunpapers. She gained national attention in 1975 when she turned her journalistic talents to chronicling her struggle with breast cancer. Her first book on the subject was “Breast Cancer: A Personal History & An Investigative Report,” published by Harcourt Brace Jovanovich. Her second book, “Why Me? What Every Woman Should Know About Breast Cancer to Save Her Life,” published by W.B. Saunders Co. in 1977 is regarded as a standard reference.

Tenacious and opinionated, Kushner became a leading critic of standard medical procedures. At the same time, she supported increased funding for cancer research and legislation requiring insurance reimbursement for mammography screening.

“She did more for women with breast cancer than any other human being in the world,” said Helene Brown, director for community applications of research at the Jonsson Comprehensive Cancer Center at UCLA and a member of the National Cancer Advisory Board. “Prior to Rose, you were a good patient if you sat still and took the treatment and you were a bad patient if you asked questions. She gave women–and men–the right to question their doctors.”

Kushner frequently was at odds with physicians, and especially surgeons, over what they considered standard therapy for breast cancer. Her first target was the then routine “one step” procedure, in which women with suspicious lumps in the breast would be anesthetized, the lump removed for biopsy, and if it was found to be malignant, the breast would be removed. A woman often did not know whether she would wake up from surgery with one breast or two.

She also strongly opposed routine use of the Halstead radical mastectomy, particularly after the National Surgical Adjuvant Breast & Bowel Project studies demonstrated that modified radicals, and in many cases, lumpectomies, were just as effective and less disfiguring.

When Kushner found a lump in her breast in 1974, she refused to submit to the one step procedure. In “Why Me?” Kushner wrote about her search for information about breast cancer. She found a general surgeon who performed the biopsy and then found a breast cancer specialist to perform a modified radical mastectomy.

The American Cancer Society was one of the establishment groups that Kushner fought vigorously on the issue. “In the early 1970’s, we didn’t see eye to eye,” said Alan Davis, vice president for government affairs at ACS. “She kept at it and finally convinced the doubters.”

In “Why Me?” Kushner called ACS “a conservative organization that moves with the speed of a senile snail.” Later, she became an advisor to the society and served on its Breast Cancer Task Force. In 1987, ACS gave Kushner its highest award, the Medal of Honor. Last year she also received the American Cancer Society D.C. Division’s Courage Award.

Last month the Society of Surgical Oncology announced Kushner would receive its annual James Ewing Layman’s award at the society’s annual meeting in May. In 1975, Kushner was heckled off the stage when she spoke at the society’s meeting. Other organizations have recognized her work. Last year, the “Ladies Home Journal” named her one of America’s 100 most important women.

“She accomplished a great deal in raising the idea of treatment alternatives in the medical establishment and among patients,” said David Korn, chairman of the NCAB.

Kushner was a frequent participant and observer at NCI meetings and developed a reputation for asking astute questions. She became a role model for other patient advocates. In 1980, President Carter appointed Kushner to the NCAB. She served on the board until 1986.

“It was hard for some of those physicians who were not used to the idea of consumer advocacy to deal with Rose, who could look them in the eye and say what she thought,” said Grace Monaco, president of the Candlelighters Childhood Cancer Foundation. “She taught me not to be afraid to speak my mind in the company of physicians.”

“She was very committed to what she was doing and she never quit–that’s what made her maddening to some people and endearing to others,” said Nancy Brinker, founder of the Susan Komen Foundation and a member of the NCAB.

“She was tough to work with,” Brown said. “There was an abrasive side to her nature. But if you knew her at all and listened to what she had to say, you’d realize she was a worthy critic. She upset a lot of people, and in doing so she probably saved a lot of lives.”

Paul Engstrom, vice president for population sciences at Fox Chase Cancer Center and chairman of the Div. of Cancer Prevention & Control Board of Scientific Counselors from 1986 to 1989, got to know Kushner when she served on an evaluation committee for the Women’s Health Trial, a dietary cancer prevention trial that NCI later ended at the committee’s recommendation.

“The striking thing Rose was able to do was to bring the esoteric scientific discussion around to remind us that we were dealing with women’s lives,” Engstrom said. “She understood what medical scientists were trying to do, and was able to talk to them on the same plane, with logic and persuasion that pricked our bubbles.”

Kushner also was a persistent lobbyist, both on the state and national levels. She pushed for laws that require doctors to fully inform women with breast cancer of their treatment choices and for insurance reimbursement for mammography screening. Many states have enacted such legislation and Congress two years ago approved Medicare mammography reimbursement as part of the Catastrophic Coverage Act. When the bill was repealed last November, the mammography portion went down with it.

Bill Honoring Kushner To Be Introduced

In 1975, Kushner founded the Breast Cancer Advisory Center to provide information to women on breast cancer. In 1988, she began a political action committee, BreastPac, to raise money to help elect candidates who fight for breast cancer research funds. She also was instrumental in establishing the National Alliance of Breast Cancer Organizations.

Rep. Mary Rose Oakar (D-OH) plans to reintroduce legislation next week that will require Medicare reimbursement for mammography screening. The title of the bill will be “The Rose Kushner Memorial Breast Cancer Act of 1990,” The Cancer Letter has learned.

Oakar has said that Kushner’s advice and emotional support helped her during her mother’s and sister’s battles with breast cancer. Kushner worked on a number of cancer initiatives that the congresswoman has sponsored.

“She was a pioneer in changing the course of the way women with breast cancer were treated, not only by the medical profession but by others,” Oakar told The Cancer Letter through a spokesman last week. “The legacy of Rose Kushner’s work will be realized when we have found a cure for cancer.”

‘She Left Us With A Challenge’

In a letter sent last week to Kushner’s family, NCI Director Samuel Broder wrote, “I wish to extend to you my deepest sympathy for your loss. Rose was an extraordinary woman. Think how much better the world would be if we all absorbed the lessons of our own lives, shared what we had learned, assisted those less able and tried to change conditions that needed to be changed. She changed a personal tragedy into a crusade and helped women all over the world. She faced her own fears, did her own grieving and then empowered others to learn how to seek the best care, get the best advice and retain the right to make personal decisions.

“As a journalist, her best subjects were her own experience, those of other women with breast cancer and their families. She turned her journalism into activism and every time she was at a meeting, her presence was felt. Her efforts as a lobbyist changed laws and insurance policies. She was fearless as she represented the rights of patients.

“There will always be public records of her activism, not only in her books, but also because so often the suggestions that she made, ‘the outrages that she experienced, became institutionally sanctioned recommendations for change….

“We valued her judgment and her hard won wisdom. She left us with a permanent challenge: Listen to the patient.”

Kushner is survived by her husband , Harvey, her sons Gantt of Silver Spring, MD, and Todd of Rockville, MD; her daughter Lesley Kushner of San Francisco, and her brothers, Isaac and Meyer Rehert of Baltimore and Paul Rehert of West Palm Beach, FL.

Contributions may be sent to the Lombardi Cancer Research Center, Georgetown Univ. Medical Center, 3800 Reservoir Rd. N.W., Washington, D.C. 20007.