How Cancer Crossed the Color Line (review)

On July 25, 1972, the Washington Star broke news of the Tuskegee study, describing a decades-long U.S. Public Health Service (PHS) examination of the effects of untreated syphilis on black men. In what the media rightfully called racist science akin to Nazi medical experiments, the PHS had continued the study even after the development of antibiotics, withholding the cure from the study's subjects in order to complete the project. In How Cancer Crossed the Color Line, Keith Wailoo reveals how physicians, scientists, and public health officials engaged in a less cynical but similarly deficient crusade that consciously and unconsciously ignored people of color.

In 1913, at the peak of the progressive movement, a group of physicians, businessmen, and professional women organized the American Society for the Control of Cancer, forerunner of the American Cancer Society (ACS), which advocated education and early detection. At the same time, however, racist theories permeated American culture, public policy, and science, with Jim Crow tightening its grip on the South. In a society where de jure and de facto discrimination prevailed, people of color fell below the radar screen of the cancer awareness movement, which focused on middle- and upper-class white women, particularly those with breast cancer. Not surprisingly, the personal cancer narratives in the popular press during the first half of the twentieth century invariably involved white women, leaving people of color with less access to information and to appropriate medical care.

At the outset of the awareness movement, the medical community considered cancer a malady of "civilized," not "primitive," people and, by extension, of whites as opposed to people of color. Only "civilized" women seemed worthy targets of the anticancer crusade, so the racist logic went, because only they had the internal "self-awareness" necessary to follow ACS advice. Not until 1977, with the well-publicized death from breast cancer of African American singer Minnie Riperton, did black women gain access to such narratives and did such notions begin to wane.

Wailoo also insists that American oncology, ostensibly characterized by carefully tested hypotheses, empirical methods, and statistically measured results, rests on a racist foundation, and without careful examination of that problem, morbidity and mortality rates among people of color will continue their disproportionate course. Not until the 1970s did American oncology become aware of black people. The civil rights movement had elevated racial consciousness, but Howard University's seminal study in a 1977 issue of Medical Annals of the District of Columbia really opened American oncology to the reality of racial disparities in cancer outcomes.

The National Cancer Institute (NCI) responded with its SEER (Surveillance, Epidemiology, and End-Results) program to collect new, relevant data. Critics immediately exposed weaknesses in SEER, not the least of which, according to Wailoo, was the "new truth . . . that the gathering of population health statistics and the categorization by group was inseparable from the politics of recognition and representation, and that categorization produced disparities" (p. 141). For Wailoo, shifting definitions of race over time constitute the Achilles' heel of such data collection. In the 1920 U.S. census, for example, Mexican Americans were classified as whites, but in the 1930 census they ceased to be white and became the "Mexican" race instead. The forces of acculturation and assimilation also change over time, making folly of fixed racial categories. Wailoo endorses the need for social categories of identity but asks epidemiologists "to distinguish more carefully among the many meanings of race. . . . While racial analysis can tell us that differences exist across so-called racial groups, they don't explain why those differences exist; nor can those social differences be attributed to biological notions of race. Those who have claimed that racial categories are proxies for biological or genetic differences are proven to have erred many times in history" (p. 183).

Today, whole departments in medical schools, comprehensive cancer centers, and the NCI engage in "health disparities" research, identifying the influence of race, gender, class, economics, and politics...