How Cancer Crossed the Color Line

3366 The Journal of Clinical Investigation http://www.jci.org Volume 121 Number 9 September 2011 early part of the 20th century, women’s reproductive cancers occupied nearly all of the social awareness about the disease, leading to hypotheses about the relationship between cancer incidence and women’s reproductive roles. An explanatory model that linked cancer incidence to the changing social roles of women was reinforced by the observation that African-American women experienced lower rates of cancer, and it was speculated that this was related to the fact that women remained closer to their “natural” roles in those communities. Toward the middle of the century, differences in cancer incidence between racial and ethnic groups became of increasing interest, as some of the first epidemiologic studies of cancer rates provided surprising and vivid accounts of the population variation. These differences spawned new hypotheses about the causes of cancer, including the role of diet and environmental exposure. These studies also brought more attention to the debate about the role of inadequate access to care and poor reporting infrastructure in masking the true burden of cancer among minorities. By the last half of the century, cancer awareness had grown substantially as had the challenges in finding effective prevention and treatment. Public desperation for effective cancer treatment and skepticism about the intellectual establishment led to the increasing politicization of cancer at the same time that race became even more politicized in the US. Following the report by Howard University researchers in 1972, demonstrating the dramatic increase in the cancer burden among African Americans, the social and political activity around race and cancer coalesced in a growing focus on racial disparities in cancer incidence. The story of race and cancer in the US is important, and there is a sense of achievement in the publication of this book. It offers an overdue perspective both on the history of cancer in our society and on how we come to define and understand differences across racial groups in any disease. However, Wailoo writes as a historian for a social science audience, and the book’s impact in those fields is likely to be far greater than that in the biomedical world. Several topics receive too little attention to be satisfying for most cancer researchers, particularly those interested in disparities. The debate about the role of biology/genetics is glossed over with little insight into the revolutions in molecular genetics that continue to inform and influence the discourse surrounding race and cancer. Similarly, the role of health care quality, encompassing prevention, early detection, and treatment, receives remarkably little attention given its prominence in the lay and medical press about cancer disparities. Wailoo identifies one of the fundamental paradoxes of racial disparities research (i.e., that racial identity must be simplified and categorized if disparities are to be measured and monitored) but has very little to offer as a way forward in this area. Science grows from attempts to explain observations. The history of race and cancer in the US shows how the interpretations of some observations can be been influenced by the sociopolitical environment of any period and can, in turn, influence the sociopolitical environment in the future. In the end, the main reason to read How Cancer Crossed the Color Line has less to do with gaining a comprehensive understanding of race and cancer in the US and more to do with catching yet another glimpse of the fundamental truth that science and society are inextricably linked. How cancer crossed the color line