Dina Rabinovitch is the only journalist in the UK famous for her cholent recipe (which includes Persian mint, blood oranges and one secret ingredient from an old friend's Hungarian aunt). She has four children, all of whom will be coming with her to Limmud in Nottingham this December, to hear her speak. She is currently writing a book - Take Off Your Party Dress - on living with breast cancer. Her columns about the illness are available on the Guardian website. Here Dina discusses James S. Olson's Bathsheba's Breast.
Dina Rabinovitch on Bathsheba's Breast: Women, Cancer and History by James S. Olson
The books start coming almost as soon as the food. It is the second way people respond - those who are able to respond - when they hear you have cancer. I think they bring food because they want to nourish you.
The books are different; the books are about empowerment. People have the oddest ideas about cancer, the main one being that cancer is not just a physical illness, not just about cells dividing too rapidly - though this is a proven, known fact, as incontestable as the earth's roundness - but that it is somehow a psychologically-rooted disease, that the mind has some role to play in cancer.
Above all else, people seem to believe that you will have a better chance of surviving cancer - that disease of the body to which as yet no complete cure has been found - if you can 'take control' of your illness. Information-gathering is supposed to be one of the prime ways of doing this; like squirrels bustling about collecting nuts to ward off winter's harshness, so hoarding and wielding knowledge about your options is supposed to strengthen you against cancer's ravages, and supposed to lessen the chances of the cancer returning.
I don't myself believe this. But I proved as vulnerable to people's gifts as I am to breast cancer, and so I read the books family and friends left on the doorstep. The ones about how your personality predestines you for cancer: as if from overdosing on too many women's magazine personality quizzes at once, I now know I am too angry, too controlling, too repressed, and my upbringing wasn't up to much either, but also that I find it difficult to say no, and am incurably unassertive. So naturally I also read the numerous texts about which foods poison you and which ones heal, and (my own personal favourite) Breast Cancer for Dummies, one of a series of books more usually aimed at computer users.
It was the books that first made me feel fear - a pointless emotion in these circumstances. Immune to doctors' grave looks, I turned out to be porous to print.
One book changed all that, gave me back my balance. Bathsheba's Breast is written by James Olson, professor and Chair of the History Department at Sam Houston State University. He wrote the book as a response to losing his left hand and forearm to cancer - having first chosen a simple excision and radiotherapy over full amputation, before the return of the tumour (twice) forced him towards the final loss. 'The choices,' he writes, 'seemed so bewildering, so vague and imprecise. Scientists, I naively thought, ought to be different from historians, less likely to debate an issue and traffic in contrasting personal opinions.'
When it came to writing about the subject, Olson made a historian's choice, opting to explore breast cancer rather than the soft-tissue sarcoma which attacked him, because (he writes) 'throughout much of human history breast cancer was cancer, and prominent women who endured the disease left behind a rich paper trail'. This appealed to me, and I shredded my own paper trail.
It's Olson's next sentence which clinched it for me, made Bathsheba's Breast my manual: 'The gender dynamics of the disease - female patients and male physicians - have also been a constant over time, shaping perceptions of the disease and its treatment.' The barrier between me and this book had been the male author. In the columns I've written about my breast cancer, gender courses through the story: my breast-feeding son, my husband, my male doctors, my mother's silence about our family medical history. With Olson's pinpointing of the issue, like all the others he analyzes - the quacks, the history of the labelling of a cancer personality, the doctors' (continued) stumbling in the dark - it felt like here I was engaged with somebody who spoke my language. When you are a patient, that sensation is rare.
Reading Olson's book is genuinely informative background, but just that alone: it's not about making decisions, it's simply context, like hearing a particularly intelligent parliamentary debate without any vote riding on it. It's an intellectual pleasure - nice, you know, a distraction from the shrill and conflicting cancerama babble.
The history is gripping. Breast cancer is the visible manifestation of the more than 200 differing versions of this disease, the lump that can be seen. 3,500 years ago Egyptian medics described bulging tumours in the breast. The mastectomy is equally ancient; in 548 AD Aetios of Amida, physician to the Byzantine court wrote:
I make the patient lie down and then I incise the healthy part of the breast beyond the cancerous areas and I cauterize the incised parts. Then I again incise and excise the breadth from its depths and I again cauterize the incised area. And I repeat the procedure often.It is almost too painful to be reminded that anaesthesia did not come until the 1850s.
Olson traces a time-line from the oldest cases of breast cancer to the current day, taking in all the celebrity names along the way, from the lovers of emperors to Nancy Reagan. He records the roots of the idea that it came from 'black bile' and the mad nutritional theories, as well as the chauvinism of the personality prognoses. This is informative stuff, and it sheds light on other areas of female medicine: for example, the surgeons who insisted it was morally beneficial for women to feel pain during surgery. The backbone of the text charts the history of the arguments over mastectomy and then radical mastectomy, and the muddle of scientific opinion. 'In fact,' Olson says, 'eighteenth-century physicians knew only a little more about the causes of breast cancer than Hippocrates and Galen and only a little less than contemporary oncologists.'
But while the causes of cancer may elude, there has been progress on the cure. Olson writes about the newest generation of drug, herceptin - 'one more weapon,' as he puts it, 'in an increasingly sophisticated arsenal'.
Because he is first of all a historian, he describes; so he doesn't say what may well be the case: that there's more profit in finding a cure than in working out the cause. It doesn't feel like a cause that should be too hard to elucidate: take Japanese women with their low rates of cancer, and move them to Ohio - within two years their cancer incidence has risen. My own cancer doctors talk often about the Japanese, and how little they suffer from even lung cancer; yet Japanese men are notoriously heavy smokers. Breast cancer has doubled since the 1970s; every three minutes in the United States a woman is being diagnosed. You would think finding out why would be money well spent.
What Olson's book reveals is how the treatments - surgery, chemotherapy and radiotherapy - have been the subject of debate and swerving opinions for as long as they have existed; how each famous woman of recent times who has made the personal decision about which course to pursue has had to endure media scrutiny followed by criticism over how her choice influences others in the same situation. My generation may be the last, or perhaps the one before the last, to die of this disease. It is a story we are only beginning to look back upon clearly. This book is the first I have read that actually does that simple job of unbiased analysis. It is intensely interesting.
The OED definition of cancer has been the same since 1889. It reads:
A malignant growth or tumour in different parts of the body that tends to spread indefinitely and to reproduce itself and also to return after removal; it eats away or corrodes the part in which it is situated and generally ends in death.As the century changed, the editors of the OED were contacted by Macmillan Cancer Research, who urged an alteration to the hundred-year-old entry. The campaigners wanted something along the lines: 'What happens when a group of cells grow in a disorderly way and invade neighbouring tissues. They may or may not later spread into distant parts of the body'.
The entry in the online and multiple-volume edition of the OED has yet to be changed - dictionary processes occurring more slowly than medical ones. As John Simpson, editor-in-chief of the OED, told me, 'It's all to do with cycles of revision; there are many definitions that long ago needed updating. At the moment we're working on P.' However, the shorter versions of the OED, the single-volume texts, do not employ scary terminology like 'eats away' and 'corrodes'; and from these volumes, too, the inevitability of death has been removed.
[A list of the pieces that have appeared to date in this series, with the links to them, is here.]