Unnatural History: Breast Cancer and American Society

Though many chapters in Unnatural History: Breast Cancer and American Society revisit expected material — Susan Emlen’s personal account of her surgery for a breast cancer in 1814, Halsted’s development of the radical mastectomy — author Robert Aronowitz succeeds at combining these stories with newer ideas about the development of breast cancer “risk rhetoric” into an overall compelling and well-researched narrative about how the medical establishment dealt with breast cancer as a diagnosis throughout the last two centuries and how the public responded. One of the main premises is that “American women fear breast cancer now more than the last 100 years.” Undoubtedly — given the current ubiquity of the “1 in 8” statistic and the visibility of causes such as the Race for the Cure — this is true; Aronowitz takes up the pertinent question why. While acknowledging the tentative observation of increased breast cancer incidence (and therefore visibility), he mainly focuses on how sociological and cultural aspects of illness and medicine in the last century have shaped our ideas about cancer, and breast cancer in particular. Much of the story lies in the history of how cancer was understood: Was it considered a local or a constitutional disease? How did it “travel?” Over what aspects could medicine have an effect? In the chapters detailing the personal experiences of Susan Emlen (in 1814) and Rachel Carson (in the 1960s), Aronowitz points out striking continuities in medical care surrounding breast cancer: For example, in the face of so many unknowns, medical professionals often hedged answers to patients in an effort to communicate a delicate combination of realism and hope, most of the time by withholding an actual cancer diagnosis. Toward the end of the book, Aronowitz delves into his most original material by dissecting the “rhetoric of risk” that has come to dominate our thinking about breast cancer. Women, he argues, have been increasingly encouraged to think of themselves as at risk for breast cancer. In theory, this serves the purpose of convincing women to get screened early and regularly, but he argues it also has promoted a fear of breast cancer that is if not inappropriate, at least disproportionate to the cause. The question of fear seems to lie at the root of his discussion. Aronowitz strikes a chord in his assessment that our culture disproportionately fears breast cancer and that this cultural fear ultimately plays out in individual women’s lives to the detriment of their overall well-being and decision-making capabilities, yet it remains important to explore the dynamics of that fear in order to set us on the path toward appropriately mitigating it. Aronowitz’s work does not intend to capture the entire story; its complexity is likely beyond the scope of one work anyway. It is to his credit that he sheds new light on how we understand breast cancer, and his focus on “non-biological” aspects of the disease opens future doors. Overall, the book provides valuable insight and several revealing historical gems illuminating how our understanding of breast cancer has changed with the times. Fans of history of medicine (as well as the history of surgery, oncology, and women’s health) will find many chapters rewarding, and, along with the other works that begin to deconstruct how we think about our medical practices in a historical and sociological light, it is an important addition to all medical libraries.