Even casual fans of “Mad Men” knew that the cigarette-smoking chickens would come home to roost one day. That day came in the show’s penultimate episode, when Betty Draper Francis learned she had advanced lung cancer.
To recap: During Sunday’s episode, an injury sent Betty to the doctor, where he discovered tumors in her lungs. However, he declined to share the diagnosis with her until Betty's husband, Henry Francis, came down to the clinic. The cancer is advanced. It leaves Betty with a year at the most, which leads her to stoically decide -- over Henry's desperate objections -- against treatment.
According to Dr. Otis Brawley, chief medical officer of the American Cancer Society, the portrayal of Betty's care was almost entirely spot-on: A woman diagnosed with lung cancer in 1970 would have been given the patronizing care that Betty received. Though not a fan of the show, Brawley watched the episode and explained it was par for the course back when “cancer” was a generally whispered or unspoken word, and the medical community was generally patronizing to women as well as cancer patients.
“I can tell you that there was misogyny in medicine, and I can tell you there was actually a time in the United States when it was common not to tell people they had cancer, but they told the family,” Brawley told The Huffington Post. "I can tell you that there was a time when many people did not even say the word ‘cancer’ or simply used the words ‘Big C.’"
The notion that patients needed to be protected from the truth lingered into the 1990s, according to Brawley.
“I graduated from medical school in 1985, and I can remember taking care of patients in the ‘80s and ‘90s, from families who were generally not very sophisticated, where people were outraged that the patient had been told that they had cancer,” Brawley said.
One reason doctors and families may have wanted to keep diagnoses a secret from patients is that back then, there was often very little that could be done to try to treat the tumors. In 1970, a woman with advanced lung cancer -- even a very wealthy and well-connected woman like Betty -- didn’t have very many options. It makes sense that Betty would decline to try experimental or invasive treatments, said Brawley, but it is unlikely a doctor would have made the recommendation to treat at all.
“[Betty] was very appropriate for the time,” said Brawley. "In the early 1970s, we had a couple of chemotherapies, but there were huge arguments as to whether or not they actually made people live any longer."
And in fact, because Betty didn't have any cancer symptoms -- meaning, her tumors didn't grow in a way that caused nerve pain or blocked blood flow -- it’s doubtful that doctors would have offered to treat her cancer at all.
“Our standard of care up until the 1980s was that if someone had quiescent, metastatic cancer of the lung [cancer that has spread but has no symptoms], we actually did nothing,” Brawley explained. “It wasn’t until the mid-90s that someone like [Betty] would be offered chemotherapy when she was asymptomatic."
Of course, Betty wasn’t truly asymptomatic when it came to her cancer: After becoming short of breath walking up a flight of stairs, Betty trips and falls, cracking a rib or two. While at the hospital, an X-ray reveals advanced lung cancer that seems to have spread to both lungs. The cancer could also explain, said Brawley, why Betty was so worn down from climbing the stairs in the first place.
"Someone who has cancer that has spread to both lungs as [Betty] does can have fluid that can accumulate outside the lung but inside the chest cavity, and that can decrease the ability of the lungs to expand, causing shortness of breath,” said Brawley. “It is incredibly common among people who present like her."
Finally, despite putting on a brave face for her daughter, Betty may have also been feeling alone after receiving her diagnosis.
Brawley points out that while the code of secrecy and shame around cancer diagnoses began to crumble in the 1970s, it wasn’t until 1972 and 1974 that celebrities like Shirley Temple and Betty Ford, respectively, came forward about their own struggles with breast cancer. Because the final season of “Mad Men” takes place in 1970, it’s unlikely that Betty would have known any public female figures who spoke openly about cancer.
Thankfully, a lot has changed since the time Betty would have received her cancer diagnosis, especially when it comes to cigarette smoking rates. In the U.S., cigarette smoking rates for women peaked at about 44 percent in the 1960s. In 2013, the latest year available for this data, that rate was 15 percent.
Unfortunately, it’s going to take a little while longer for the rates of lung cancer to follow suit. It’s still the leading cause of cancer death in both men and women in the U.S., according to the Lung Cancer Foundation, and while death rates are declining nationwide, they are steady or rising among women who are of daughter Sally Draper's generation, so to speak. They were born in the 1950s and would be approaching 65 years old by now, which is the age at which most lung cancers are first diagnosed.