Joseph H. Farrow, M.D.: A Physician Devoted to Understanding Breast Cancer
“Joseph Farrow belongs to that special group of truly great physicians, those few giants on whose shoulders we stand today. The gift of his knowledge, his kindness, and his friendship will always remain with us.” 1
Joseph Farrow was born in Rocky Mount, Virginia. He received his B.S. degree in 1926 and his M.D. degree in 1930 from the University of Virginia. After interning at St. Elizabeth’s Hospital in Richmond, Virginia, he took a surgical residency at Watts Hospital in Durham, North Carolina. At Presbyterian Hospital in New York, he did a Fellowship in Surgical Pathology, followed by further training in Surgery and Radiation Oncology. He joined the staff at Memorial Sloan-Kettering Cancer Center where he rose from Clinical Assistant on the Breast Service to Attending Surgeon and Surgeon-in-Chief of the Breast Service in 1960. He held this position until he retired in 1969. He served in the U.S. Navy as a Commander from 1942 to 1946.
Dr. Farrow received many honors during his career, including Presidency of the American Radium Society and the James Ewing Society. In addition to being an excellent teacher and clinical surgeon, he and his colleagues at Memorial Sloan-Kettering wrote extensively on all aspects of breast cancer as recognized in the 1960′s and 70′s.
In 1969 he gave the James Ewing Lecture before the James Ewing Society. The topic was current concepts in the detection and treatment of the earliest of early breast cancer. This topic, now called in situ carcinoma of the breast, has received almost more attention in the decade around the turn of the twenty-first century than any other aspect of breast conditions. Examining this article and comparing it with an in-depth review on this subject written in 2004 illustrate Farrow’s depth of knowledge and understanding of this little known entity as well as his anticipation of its importance in the future.
Farrow gave recognition to a paper written by Fred W. Stewart and Frank W. Foote in 1941 which emphasized the potential for these lesions to become multi-centric and infiltrative. It was not until 1950, however, when Foote reported a follow-up of these cases “confirming their earlier observations” that the surgical service at Memorial Sloan-Kettering began to treat in situ carcinoma more aggressively. A study from that institution looking at cases of in situ lobular and in situ ductal carcinoma from 1949 to 1967 revealed for the first time the increasing incidence and potential seriousness of these entities. The incidence rose from 13 percent of all breast cancers at their institution to over 30 percent. More lobular carcinomas than ductal were diagnosed, and the difference between them became more evident. Very few mammograms were done at this time. Most of the lesions were investigated because of a lump or nipple discharge. Multi-centricity and bilateral involvement in lobular carcinoma, and to a lesser degree, ductal in situ lesions were of concern to them and influenced their treatment. Ductal carcinomas treated by local excision alone resulted in a 20 percent recurrence rate with infiltration.
This led to the use of radical mastectomy or modified radical mastectomy in all in situ carcinomas. With a cure rate of over 90 percent, they concluded that the increased use of mammography as well as a greater understanding of the pathology and behavior of the disease would hopefully lead to improved methods of treatment and less radical surgery.
A 2004 review article, The Management of Ductal Carcinoma in Situ in North American and Europe, by Elizabeth Ceilley et al., was published in the journal of Cancer. They reported ductal carcinomas in situ as representing 15 percent of all breast cancers diagnosed in the U.S. In contrast with Farrow’s report, the majority of their cases were diagnosed by mammography. They also emphasized that in spite of a normal mammogram, biopsy was indicated in the face of clinical indications.
The danger of inadequate treatment endorsed the recommendation that local excision alone was not sufficient. Comparison of concepts of treatment at these different times emphasizes Farrow’s basic understanding of an important but little known breast condition as well as the advances which have allowed less radical, effective treatment.
Dr. Farrow also wrote articles on hormone therapy and rehabilitation after the treatment of breast cancer. A review of these articles and a look at today’s writings in these areas makes us appreciate his depth of knowledge of all aspects of breast cancer and the role he played in helping us develop our current understanding of the disease and the methods of management.
At a national conference on breast cancer in 1971, Dr. Farrow talked of the antiquity of breast cancer. He concluded his remarks with the following statement: “Despite over 30 years of personal experience in the diagnosis and management of breast cancer, I humbly recognize I do not have any final answers.” If we refer back to the original tribute regarding Dr. Farrow, we realize that he was a giant who belonged to that special group of physicians on whose shoulders we stand today.
Dr. Farrow’s wife Florence maintained a close relationship with the University of Virginia School of Medicine. She served on the Alumni Board, and she established the Joseph Farrow Professorship in Surgical Oncology. The first recipient was Dr. Morton C. Wilhelm, and the current holder is Dr. Craig Slingluff. Mrs. Farrow also made major contributions to the Claude Moore Health Sciences Library during her lifetime and in her will.
Footnote
1. “A Personal Tribute to Joseph H. Farrow, M.D. 1904-1977,” CA: A Cancer Journal for Clinicians, 27, No. 3, May-June 1977, p 183.