Tuesday, June 13, 2017

Bathsheba’s Breast: Women, Cancer & History

Olson, James S. Bathsheba’s Breast: Women, Cancer & History.

Bathsheba’s Breast utilizes biographical sketches, primarily of well-known historical figures, to illustrate the millennia old struggle of women against a disease that is uniquely theirs: breast cancer.  Bathsheba’s Breast concentrates on several themes central to the disease: the pervasiveness of the disease through the centuries, the progress in and barbarity of treatments, and the social problems associated with treatment and research. 

The pervasiveness and impartiality of breast cancer pervades almost the entire text of Bathsheba’s Breast.  This theme is introduced with the example of Atossa, Queen of the Persian Empire in 490 B.C.  Atossa found a lump, which she feared was cancerous and kept hidden until forced to seek help.  She ultimately sought treatment from a Greek slave, who lanced the lesion on her breast.  Luckily for Atossa, the sore was merely an abscess, not a tumor. It falls to other unfortunates to supply Bathsheba’s Breast with more concrete examples of the fear and horror experience by women actually afflicted by breast cancer.

The Roman (Byzantine) Empress Theodora provides an excellent backdrop for the discussion of ancient techniques of treating breast cancer, though she refused the recommended treatment of mastectomy, and used painkillers to maintain her dignity while dying.  Anne of Austria, the wife of Louis XIII of France, and late Renaissance nuns show the pervasiveness of the disease and that it crossed all social strata.  After spending many years visiting convents and witnessing the full effects of breast cancer in the nuns there, including a nun whose cancer had destroyed a large portion of her torso, Anne knew exactly what might lie in store for her when she found a lump in her breast.  However, understanding the course of treatment and denial also kept her from seeking medical help for months.  Anne suffered through a long and painful course of treatment that had little chance of success due to the medical technology of the age.

The second major theme of Bathsheba’s Breast is of the progress made in the fight against the disease over the millennia, as well as the horror of the treatments inflicted upon women by their male doctors. Reading the text gives the distinct impression that in many ways the conception of breast cancer has run full circle from systemic disorder to localized disorder and back again. This process is well documented by Olson and runs throughout.  Beginning with the humoral theory advanced by Hippocrates in the 5th century B.C., physicians believed that breast cancer and other ailments were caused by imbalances of forces within the body.  Interestingly enough, although not really germane to the discussion at hand, Hippocrates is responsible for the modern name of cancer, which he called karkinos after its crab-like appearance.  Clarissimus Galen, who further categorized different lesions and cancers, took up the torch of humoral theory in the ancient world.  After an interlude caused by the breakup of the Roman Empire, Galen’s theory was taken up again during the Renaissance and help sway into the 18th century.  Galen’s humoral theories were responsible for the practices of bloodletting and purging performed by European doctors at the time Anne of Austria was stricken with breast cancer.  One prominent physician blamed her condition on her hedonistic lifestyle, in which she studiously avoided bleeding.  Humoral theory ultimately fell into disuse and surgical procedures began to dominate treatment.

Despite the portrayal of humoral theory being in the ascendant during this time, however, Bathsheba’s Breast also seems to indicate that one of the first options suggested for Anne of Austria was surgical.  This option was rejected in her case due to the advanced state of her disease when she sought help.  Perhaps this was the beginning of the sea change in medical practice that would soon occur.  Olson uses the cases of Mary Washington and Nabby Adams to show that the change in practice from bleeding and humoral theory to one of surgery was not long incoming.  By the beginning of the 19th century, surgery was the preferred solution among learned medical practicians.  In Bathsheba’s Breast this also signals the change from a systemic approach to a more localized one.  This change represents another major theme in the work, as it is emphasized repeatedly, that even in the latter half of the 20th century most doctors treated breast cancer as if the disease was strictly restricted to the breast until it started to metastasize to other parts of the body.

When the surgical method reached its height after the introduction of the radical mastectomy in 1890, so too did the fear of breast cancer treatment among women.  Bathsheba’s Breast not only delivers graphic descriptions of both the radical mastectomy and the super radical mastectomy, which removed the breast, lymph nodes, and much of the chest muscle in an attempt to remove all possible cancer cells, but it describes the surgeons who performed the procedure as only concerned with preserving the lives of their patients.  The emphasis on saving or extending lives at any cost prevented the surgeons from understanding the emotional and physical damage they were causing their patients.  The philosophy of maiming women, as Olson describes it, continued to dominate American breast cancer treatment into the late 20th century, when it was at last challenged by simple mastectomy or lumpectomy combined with radiation and chemical therapies.  Interestingly, success rates for the less drastic surgery are not much different from far more invasive procedures.

One of the most important issues discussed regarding treatment of breast cancer, both ancient and modern, is that most of the doctors are male, while most of the patients are female.  An interesting correlation between the ratios of surgical oncologists of each gender and the preferred treatment method is suggested.  According to the text, in the United States, where surgeons continued to favor aggressive surgery as the primary breast cancer treatment, more practitioners are male.  This is in contrast with European nations, where a larger ratio of practitioners is female, and where less invasive and damaging treatments were adopted earlier.  This implies that the greater “cruelty” of American treatments compared to European ones (for little difference in success rates) is due to a lack of empathy by the health care provider for the emotional damage caused by drastic procedures.  Whether this is due to gender or economics is open to debate, which Bathsheba’s Breast readily illustrates.

These issues are hardly the only ones raised in Bathsheba’s Breast; they are just the most important ones.  A more thorough analysis would also discuss social factors that prevent women from seeking early treatment, or political factors that aid or hinder research into cures.  Other topics presented also include the current state of research and the impact on both research and society resulting from the publicity surrounding high profile breast cancer cases such as Betty Ford and Nancy Reagan.

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