Beauty without the Breast by FM Knaul (review)

In this book, Knaul presents a raw account of her personal journey with breast cancer, interspersing her own experiences with knowledge she gained about the ways in which women across the globe are denied access to essential, life-saving diagnosis and treatment. By becoming an advocate for her own health through asserting her right to participate in decisions about her treatment, Knaul came to recognize that poor women in medically underserved communities are often not afforded such rights. This recognition motivated her to design and garner support for various initiatives promoting research, awareness, and early detection of breast cancer for women in developing countries, especially in Latin America.

Knaul herself serves as the chief economist of the Mexican Health Foundation, and she is also the wife of the former Minister of Health of Mexico. As a highly educated woman with years of experience in health care policy, she is a valuable resource for understanding how global health policies affect access to treatment for women with breast cancer. Similarly, her experience as a patient with the disease in question significantly boosts her credibility as an expert.

Knaul details her journey with cancer for over five years. Throughout the narrative, she takes time to address various widely held myths and cognitive distortions about breast cancer treatment and survival, and she even admits how she herself believed many at the outset of her journey. Knaul is achingly honest in equally highlighting both her weaknesses and her strengths. Such honesty encourages readers to accept their own vulnerability during health crises. Knaul clearly emphasizes that strength and courage do not entail absence of all fear of loss. Knaul writes that her own transition from a passive observer to an assertive participant in her health decisions fueled her desire to design Tómatelo a Pecho, a program empowering women to participate actively in the decisions that must be made about their bodies. Her determination to make this program successful helped her to find meaning and purpose in her suffering.

While the book is readable, its emotional content is heavy. The book is written in a first person narrative, and the reader will likely experience a sense of reading something private and highly valued, akin to reading someone’s richly descriptive diary. Knaul unabashedly shares the acute fear and anger she experienced throughout the process as she searched for a clear diagnosis, underwent multiple surgical operations, and agreed to receive chemotherapy. She writes openly about the progression of her self-identity throughout her time in the “world of the sick” (p. 46), moving from seeing herself as a frail and weak spectator to an active participant in her treatment process. While lengthy, her book is bravely written in a way that empowers women to address taboo topics such as hair loss, sexual non-health, and beauty without having a breast.

Knaul herself acknowledges the most important difference between herself and most other cancer patients. Due to her social status and professional connections, she was endowed with much greater privilege in receiving access to the best possible health care in both Mexico and the United States. In fact, she serves as a colleague to many of the physicians who became essential in her treatment. Knaul expresses gratitude throughout the book for the excellent treatment she received and the freedom she was given in making choices affecting her health care. However, each thread of thankfulness is juxtaposed with a lamentation for women across the globe who experience something entirely different: lack of early detection, lack of choices in selection of treatment options, lack of support from their partners, and lack of empathy from hostile health care systems. As Knaul recognizes, “This disease does not discriminate. It neither recognizes nor respects cultural, socioeconomic, or geographic boundaries. The barriers of inequity and injustice only appear when the cancer must be found and treated” (p. xxvi). Knaul proposes that this absence of responsiveness from the health care system exposes the underlying gender discrimination faced by women across the global, especially...