When First Lady Nancy Reagan underwent a modified radical mastectomy early Saturday morning, she joined a small but growing group of women who, because of their prominence, have had to grapple publicly with what is usually a private struggle.
From Shirley Temple Black to Happy Rockefeller to Betty Ford, they have transformed their own battles against cancer into public awareness campaigns by candidly and openly discussing the pain of and emotional adjustment to the disfiguring surgery.
"Cancer is the great leveler," said actress Jill Ireland, who lost her right breast to the disease three years ago and earlier this year wrote "Life Wish," a best-selling autobiography about her ongoing battle with the disease.
"(Mrs. Reagan) may be in a more glamorous suite, surrounded by security," Ireland said in an interview, "but that couldn't make her any less frightened."
Black, the one-time child film star whom many credit with making it acceptable for the famous to talk about their breast cancer, said that being a public figure can be a help when facing a crisis of such magnitude. In her experience, she said, "the people who were having the most difficult time were the ones who didn't have anything to do and were feeling kind of sorry for themselves."
But whatever the patient's public profile, Black and other prominent breast cancer patients agreed in interviews Friday and Saturday, it is the personal battle that remains the most challenging.
"Nobody can really help you," said Black. "It's between God and you and your doctor and your spouse. It's something you have to manage yourself and it's not difficult, if you consider the alternative."
To Jill Ireland, the terror of breast cancer begins "when you sit on that cold steel table with a little paper gown around you" waiting for word on the initial biopsy.
Although the First Lady's biopsy was performed under general anesthesia and she did not learn the outcome until the mastectomy had been performed, Ireland said there is still terror in learning that the lump was malignant, and emotional trauma in the loss of a breast.
"I know right now," she said, "that Mrs. Reagan is going to feel terrified."
Nevertheless, Ireland believes "that 50% of the process of getting well is in the hands of the patient, and Mrs. Reagan, with her courage and spiritual strength, will not only survive but be personally empowered by this catastrophe."
The 51-year-old actress, who is serving as honorary chairman for the American Cancer Society's 1987-88 campaign, has never met the First Lady but would like to tell her, "Hang in there. Take a look at us. Take a look at the sisterhood around you who are living wonderful lives with one breast or no breasts."
Unlike Mrs. Reagan, whose cancer apparently was confined to the seven-millimeter lesion that doctors removed along with her left breast and adjacent lymph nodes, Ireland's cancer had spread to eight lymph nodes and, she said, is still not in remission.
"I was told I was a bad statistic," said Ireland, who has been married for 19 years to actor Charles Bronson. "I was terrified, but I began to fight and, in the fight, I discovered so many things about myself. . . ."
Ireland, who portrays a First Lady of the United States in the recently released film "Assassination," has no regrets, "none at all," about telling everyone the details of her struggle with cancer, including the six months of chemotherapy that caused her hair to fall out.
When Ireland speaks publicly, she often says, "Hello. My name is Jill. I'm the girl who had everything, including cancer."
It "never occurred" to her, she said, that her loss of a breast would affect her relationship with her husband. "And I don't think it will occur to Mrs. Reagan, either. They have a very longstanding, close relationship. Losing a breast is a very small thing to give up for more time with someone you love."
Rose Elizabeth Bird, 50, who last year lost her job as chief justice of the California Supreme Court when the voters failed to reconfirm her, said her mastectomy 10 years earlier helped her put defeat in perspective.
"You learn to live your life each day as if that is your life," she said. "If you think about dying, you think very clearly about what you're doing with your life each day. And the loss of the job is not the most important thing in your life."
Bird, who was secretary of agriculture and services in the cabinet of Gov. Edmund G. (Jerry) Brown Jr. at the time she was diagnosed with cancer, recalled:
"When I had my mastectomy--I had a modified radical--I woke up at Stanford Hospital and someone gave me a copy of the (San Francisco) Chronicle and there was my picture and underneath it said, 'Right Breast Removed.' That to me was a little bit of a shock, although it was certainly accurate.
"At that time--I think it's less true now--most people thought of it as a death sentence. When you did meet them, they would become quite solemn and very concerned."