MITTERRAND’S DEADLY SECRET

FRENCH PRESIDENT FRANCOIS MITTERrand had been in office just six months when his doctor gave him the grim news: the leg and back pains he had been experiencing were due to a previously undiagnosed cancer of the prostate that had spread to his bones. The prognosis was not good. Half the men in Mitterrand’s condition die within three years. Only 1 in 10 survives a decade or more.

But that’s just what Mitterrand did. And his death two weeks ago–following a string of highly publicized prostate-cancer deaths that includes those of Telly Savalas, Don Ameche and Frank Zappa–served to underscore how unpredictable the disease can be and why regular checkups are so important for the middle-aged men who are most susceptible. Prostate-cancer rates have been rising steadily for the past two decades; it is now for men the second most deadly form of cancer, after lung disease, striking 300,000 Americans each year and killing 40,000. Although doctors can easily treat a growing cancer before it spreads, many men discover their condition the way Mitterrand did–after the cancer has already metastasized.

The question of how sick Mitterrand was, and when he learned about it, is now the center of a fierce political debate in France. Last week his former personal physician, Dr. Claude Gubler, published a book disclosing that Mitterrand had, despite promises to be candid about his health in office, kept the seriousness of his cancer secret from the public for more than a decade. Shortly after publication, a French court banned the book from sale.

The controversy also sheds new light on the advances in cancer treatments that make it possible for men like Mitterrand not only to live but also to function at a high level years after their disease is diagnosed. From the moment his cancer was detected in 1981, Mitterrand’s doctors kept close tabs on his condition by monitoring the level of certain proteins, called tumor markers, that are produced by cancer cells. Within a month of his first treatments–with radiation and hormones–those levels had plummeted. Radiation killed much of the cancer, and the hormones slowed the growth of whatever tumor was left.

It could be argued that Mitterrand was justified in keeping his condition secret. As long as his markers stayed low, the chances that he could work effectively remained high. Even advanced prostate cancer grows more slowly than other tumors and can often be held in check. By contrast, patients who have lung cancer that has spread to their bones usually die within six months.

By 1992, however, Mitterrand’s blood tests showed the cancer had started to grow again. Surgery was now unavoidable, and Mitterrand had to tell the public about his condition. According to Dr. Gubler, the French President was so sick during his last months in office that “he was no longer capable of carrying out his duties,” a claim that Mitterrand’s family and the politicians who worked with–and against–him deny. In any event, he turned over the keys of office to his successor, Jacques Chirac, last May. Finally, three Saturdays ago, according to the French newspaper Le Monde, he asked a doctor what would happen if he stopped taking all his medications except for pain-killers. The doctor replied that he would be dead in three days. Within three days, Mitterrand died.

–By Christine Gorman. Reported by Thomas Sancton/Paris