- How Cancer Crossed the Color Line by Keith Wailoo
Arguably, the disease most feared by early-21st century Americans is cancer. Cancer carries a social and cultural weight far beyond the actual incidence of the disease. Consider, for example, breast cancer, a central topic in the book under review: Today most people consistently and mistakenly believe breast cancer to be a far greater risk to a woman’s health than heart disease. “Race,” too, has been a central theme throughout United States history, a cross-cutting, amorphous, ubiquitous concept that has played an important role is almost every type of social relationship. Not surprisingly, given the enormous cultural weight of “cancer” and “race,” over the past century the two have had much to do with each other. The sensitive, nuanced history under review thus fills a crucial gap in our understanding of the interrelationships between medical history and U.S. social history. Wailoo has superbly integrated a broad mass of historical sources into a coherent and compelling narrative. He uses a diverse range of material, ranging from (but hardly limited to) fiction, movies, congressional testimony, patient case records, and medical literature. Because attempts to measure who suffers from cancer are central to the story Wailoo wishes to tell, the history of cancer epidemiology is an important part of the book. Here Wailoo displays greater than usual ease and familiarity with quantitative reasoning and does an excellent job of conveying statistical concepts to the non-quantitatively-inclined reader.
Early in the 20th century cancer was believed to be a disease of civilization and thus a rare affliction for African Americans. On the other hand, white Americans, especially white women, were thought to be at increased risk of breast cancer. These women were seen having an inner life upon which cancer [End Page 804] awareness and cancer prevention could be built. Most public health efforts thus focused their cancer-prevention efforts on well-off, well-educated white women. Spokespersons for cancer prevention had to fight off the gruesome imagery of cancer deaths in order to bring discussion about cancer into the public realm. The cause of cancer was usually deviations from proper behavioral norms—eschewing breast feeding, having too few children (or too many), or failing to adopt proper hygienic methods. All of these moral transgressions would put a woman at increased risk for cancer.
But, as Wailoo points out, not all observers were quite so certain that African Americans had an innate resistance to cancer. Some wondered just how one could make those comparative assumptions when the underlying data about cancer incidence in African Americans were scanty at best. During the Depression, new research projects, supported by the 1937 creation of the National Cancer Institute (NCI), brought previously unstudied populations into view. With these studies came a realization that the connections between race and cancer were nowhere so clear as they had at first appeared.
The Second World War and the Cold War brought new tensions to the ongoing debate about how to combat cancer. Cancer discourse used military motifs to emphasize early detection. Breast self-examination was widely promoted for early cancer detection, more on the basis of assumed models of disease progression than on solid empirical evidence of effectiveness. Social norms that determined whether or not to inform women about their cancer diagnosis started to change. While some clung to the older idea that women would do best if kept in the dark about their disease, standard medical practice shifted to embrace the belief that all patients, including women with breast cancer, ought to be told the truth about their diagnosis. The social movements of the 1960s increased appreciation of the nuances of racial classification as well as leading to a growing awareness of the importance of cancer epidemiology, and by the 1970s researchers became aware that they had missed a striking increase in cancer among African Americans. Soon afterwards the NCI initiated a new tracking program known as “SEER” (Surveillance, Epidemiology, and End-Results) that continuous to track cancer in the entire populations of...