History of breast cancer

Bathsheba's Breast: Women, Cancer & History. By James S. Olson (Baltimore: Johns Hopkins University Press, 2002. x plus 302 pp.).

In 1967, while touring the Rijksmuseum in Amsterdam, Italian surgeon and art aficionado T.C. Greco noticed discoloration and swelling in the breast of the naked figure of Bathsheba in Rembrant's painting, Bathsheba at Her Bath. Intrigued, Greco researched the existing sources on the genesis of the painting and discovered that Rembrandt's model for the figure, who was his mistress, had died after a long illness. As a result of his research, Greco wrote a renowned article in which he contended that Rembrandt's model had suffered from breast cancer. Thus begins James Olson's absorbing and comprehensive history of breast cancer and its treatment over the millennia. Olson begins his history in the 6th century with the advice of the court physician of the Byzantine empress Theodora, the wife of Justinian, that she have her cancerous breast excised; he concludes his study by examining the most recent debates over mastectomy, chemical treatment (radiation and chemotherapy), drugs like tamoxifen, and the possibility that a toxic environment has caused the recent alarming increases in the incidence of breast cancer in the U.S. population.

Olson demonstrates a laudable sensitivity to the tortures endured by women suffering from this illness. He details its horrible "crab-like" character, with the possibility that untreated breast cancer can result in ulcerating tumors appearing in the neck, torso, and armpit before death occurs. Moreover, radical mastectomies, in which not only the breast but also the lymph nodes and breast muscles are removed, can produce a damaging psychological sense of mutilation as well as the reality of ongoing pain and the loss of arm movement. Olson is not afraid to take on the surgical establishment. He details their arrogance towards their female patients, accuses them of a "cavalier masculine certainty" about the efficacy of radical surgery even when it was under significant attack, and notes that in Europe, with many more female oncologists than in the United States, radical mastectomies are much less often performed.

Olson combines genetic arguments with the history of medicine and the history of appearance more generally to show the ways in which the cultural meaning of the breast--and of its treatment--have been constructed over time. He shows how the history of breast cancer treatment was for many centuries embedded in Galenic humoral theories--under which it was viewed as the result of an overproduction of "black bile"--theories which resulted in the rejection of surgical intervention and the use of a variety of ineffective herbal concoctions. The rejection of "humoralism" in the nineteenth century, with its belief that breast cancer was largely a localized condition, and the rise of therapeutic empiricism, brought surgery to the fore. The discovery of anesthesia and antisepsis in the later part of the century allowed William Steward Halsted to develop radical mastectomy in the 1890s, a procedure based on the notion that breast cancer at base wasn't systemic. The discovery of antibiotics and blood transfusions by the 1930s brought ever more aggressive surgeries. At the same time technicians using x-rays in that decade and radioactive materials during the Second World War noted the ability of both of these products to destroy skin cells, thus laying the foundation for radiation and chemotherapy. The discovery of hormones by the 1930s brought preliminary observations on their relationship to the disease and such experimental procedures as removal of the ovaries, the adrenal glands (in the kidneys), and the pituitary gland (in the brain) to cut off hormonal production.

Sensitive to the ironies and inconsistencies of historical development, Olson advances the thesis that the high recent rates of breast cancer may be related to demographic and cultural trends, acting in tandem with the genetic and hormonal frameworks for women established over centuries of evolution. At present women are menstruating earlier than ever before in history, having their babies later, and failing to breastfeed. Yet these situations correlate with an increased tendency toward breast cancer, caused by the negative effects of a heightened production of estrogen through the life cycle. It is no accident that throughout history, as Olson points out, nuns had high rates of breast cancer, for they neither had children nor breastfed. Moreover, the recent cultural fixation with large breasts as a signal sign of sexual beauty and the concomitant development of surgical breast enlargement have furthered breast reconstruction surgery after mastectomy, helped to overcome the age-old stigma against breast cancer, and aided the development of a women-generated breast cancer movement that has challenged the hegemony of male surgeons and stimulated research in new areas of treatment for the disease.

Although physicians were not much better at curing breast cancer in the 1970s than they were in the 1900s, rates of recovery have improved since then. The breast cancer establishment now recognizes that the cancer process is shared by over 200 diseases--the cancers--which may have little else in common and that it is intricately and subtly connected to genetic and environmental variables. They now understand that a cure may be remote but that they may be able to turn it from an acute killer into a chronic malaise.

Olson's book is enhanced by the inclusion of numerous compelling vignettes of women undergoing breast cancer and its treatment--from Nabby Adams, Abigail Adams's daughter, to Klara Hitler, the mother of Adolf Hitler. Both scholars and general readers can enjoy this book, although one wishes that the author had drawn more completely on the many feminist analyses of the breast and breast cancer that have appeared, such as Marilyn Yalom, A History of the Breast (Knopf, 1997).

Lois Banner

University of Southern California, Los Angeles