Bathsheba's Breast: Women, Cancer and History (review)

This remarkable book, originally published in 2002 and recently reissued in paperback, probes the history of breast cancer, unquestionably one of the most dreaded diseases affecting women. The author, James S. Olson, is both the chair of the History Department at Sam Houston State University and a cancer survivor. In his introduction, we learn that he contemplated this book during his own personal odyssey with cancer and its treatment.

The book examines breast cancer as both medical condition and social phenomenon. Although heart disease is a far more prevalent cause of death in women and lung cancer has a greater case mortality, women uniformly and disproportionately fear breast cancer, largely due to the fact that, in addition to being a prevalent and life threatening disease, breast cancer involves potential disfigurement and a broad assault on one's self esteem and sexuality.

The book traces the chronology of diagnosis and treatment of breast cancer. Both Hippocrates and Galen knew this disorder. Though no longer thought to be due to an excess of "black bile," the cause of breast cancer remains mysterious to this day. Olson traces the progress in our understanding of this disorder through the traditional landmarks of medical history: developments in surgical anesthesia and antiseptic technique, the discovery of x-rays and radiology, radioactivity and radiation therapy, and advances in pathology and staging. His grasp of the relevant medical issues is comprehensive, and his chronology provides the framework through which he interweaves the current controversies, including the rise and fall of hormonal therapy, breast implants, environmental carcinogens, pesticides, and, most recently, ecogenetics.

What makes this book so compelling is Olson's ability to communicate the experience of having this affliction through the cases of famous (and infamous) women throughout time. The book is a veritable who's who of women with breast cancer. It includes unforgettable women such as Dr. Jerri Nielsen, the emergency physician in Antarctica who excised her own tumor and then went on to treat herself with adjuvant chemotherapy, as well as such notable women as Anne of Austria (mother of Louis XIV), George Washington's mother, Adolf Hitler's mother, and Abigail Adams (daughter of John and Abigail Adams and the sister of president John Quincy Adams.) Olson makes their situations memorable and accessible to a modern audience. His descriptions of surgical treatment in the pre-analgesic and pre-antibiotic era (when the operation required a male physician with brute strength and a lightning fast pace) are unforgettable and harrowing.

Olson leads us through the unexplored territory of infamous diseases in modernity. Of late, a handful of diseases—breast cancer among them—have become lightning rods for larger a social movements. What started as a few demanding and entitled patients with breast cancer has evolved into a readily identifiable cause involving power, presence, money, and politics. It is clearly as effective as is its more controversial counterpart Act Up, the highly political organization of the early HIV movement. The effectiveness of the breast cancer lobby, however, reflects the particular attributes of women-run organizations, such as grassroots lobbying, along with local and community networks of family, coworkers, and friends. Olson draws our attention to the evolution of cancer patient labels from "victims" or "sufferers" to the current terminology of "cancer survivors." The ubiquitous (and now mundane) pink ribbons are a testament of this sisterhood of survivors and supporters who relinquish dependency for empowerment. Olson also emphasizes the new and critical roles played by advocacy groups, self-help movements, alternative medicine, and evidence-based practice.

At the heart of the book are the controversies around the evolution of surgery. Time has barely diminished the legacy of the character and phenomenon that was William Stewart Halsted. After 100 years, it is still Halsted's eponymous procedure—the radical mastectomy—that remains the standard against which all treatments are measured. Halsted's classic operation removed the breast tissue and the underlying lymph nodes and the pectoralis muscle en...