Bathsheba's Breast: Women, Cancer, and History [Paperback]

James S. Olson (Author)

Book Description

Publication Date: January 5, 2005 | ISBN-10: 0801880645 | ISBN-13: 978-0801880643 | Edition: 1

"Breast cancer may very well be history's oldest malaise, known as well to the ancients as it is to us. The women who have endured it share a unique sisterhood. Queen Atossa and Dr. Jerri Nielsen—separated by era and geography, by culture, religion, politics, economics, and world view—could hardly have been more different. Born 2,500 years apart, they stand as opposite bookends on the shelf of human history. One was the most powerful woman in the ancient world, the daughter of an emperor, the mother of a god; the other is a twenty-first-century physician with a streak of adventure coursing through her veins. From the imperial throne in ancient Babylon, Atossa could not have imagined the modern world, and only in the driest pages of classical literature could Antarctica-based Jerri Nielsen even have begun to fathom the Near East five centuries before the birth of Christ. For all their differences, however, they shared a common fear that transcends time and space."—from Bathsheba's Breast

In 1967, an Italian surgeon touring Amsterdam's Rijks museum stopped in front of Rembrandt's Bathsheba at Her Bath, on loan from the Louvre, and noticed an asymmetry to Bathsheba's left breast; it seemed distended, swollen near the armpit, discolored, and marked with a distinctive pitting. With a little research, the physician learned that Rembrandt's model, his mistress Hendrickje Stoffels, later died after a long illness, and he conjectured in a celebrated article for an Italian medical journal that the cause of her death was almost certainly breast cancer.

A horror known to every culture in every age, breast cancer has been responsible for the deaths of 25 million women throughout history. An Egyptian physician writing 3,500 years ago concluded that there was no treatment for the disease. Later surgeons recommended excising the tumor or, in extreme cases, the entire breast. This was the treatment advocated by the court physician to sixth-century Byzantine empress Theodora, the wife of Justinian, though she chose to die in pain rather than lose her breast. Only in the past few decades has treatment advanced beyond disfiguring surgery.

In Bathsheba's Breast, historian James S. Olson—who lost his left hand and forearm to cancer while writing this book—provides an absorbing and often frightening narrative history of breast cancer told through the heroic stories of women who have confronted the disease, from Theodora to Anne of Austria, Louis XIV's mother, who confronted "nun's disease" by perfecting the art of dying well, to Dr. Jerri Nielson, who was dramatically evacuated from the South Pole in 1999 after performing a biopsy on her own breast and self-administering chemotherapy. Olson explores every facet of the disease: medicine's evolving understanding of its pathology and treatment options; its cultural significance; the political and economic logic that has dictated the terms of a war on a "woman's disease"; and the rise of patient activism. Olson concludes that, although it has not yet been conquered, breast cancer is no longer the story of individual women struggling alone against a mysterious and deadly foe.

Editorial Reviews

From Library Journal

Olson (history, Sam Houston State Univ.) lost his left hand and forearm to cancer, an experience that led him to research the history of breast cancer. His narrative history shows that this disease was known in ancient Egypt and that it took the lives of prominent women, including Empress Theodora, wife of Justinian; Anne of Austria, mother of Louis XIV of France; Mary Washington, mother of George; the environmentalist Rachel Carson; and many others. Olson examines the evolution of cancer research, the politics and economics of the disease, the gender dynamics of female patients and male physicians, and the rise of patient activism. The book chronicles advances in breast-cancer diagnosis and treatment and the uncertainty that women must face while making difficult choices. Unlike Ellen Leopold's A Darker Ribbon, which focuses on the relationships of two specific women with their physicians, Olson takes a broader view, showing that there is still a long way to go but that women no longer struggle alone. This historical take on an important topic, backed by extensive notes, is a good choice for public and academic libraries. Barbara M. Bibel, Oakland P.L., CA
Copyright 2002 Reed Business Information, Inc. --This text refers to the Hardcover edition.

From The New England Journal of Medicine

James S. Olson has taken on the task of recounting the entire history of breast cancer -- from Queen Atossa, who lived in Babylon in 490 b.c., to Dr. Jerri Nielsen, who was trapped in Antarctica in 1999 -- and has done it in a concise, attractive, enjoyable book. He tells the stories of affected women throughout the ages, including Queen Anne, Mary Washington (the pro-British mother of George), Nabby Adams, Hitler's mother, Betty Ford, Happy Rockefeller, Nancy Reagan, Shirley Temple Black, Rachel Carson, Linda McCartney, and many others. For the first 2000 years, the humoral theory of Galen held sway. Cancers were thought to be caused by an imbalance of black bile, which meant that local therapy was futile. Breast cancer was a particularly horrible disease, since it generally took its time to kill its victims, slowly destroying the body over the course of many years in a very visible, tangible manner. Women delayed seeking treatment for as long as possible -- and with good reason. Systemic treatments such as purging and bleeding were ineffective and only added to the intense suffering. It took Anne of Austria, the queen mother of France and the most influential woman of her time, three years to die, which she did in 1666. The best she could hope for was to die well, surrounded by her family. Dying well was an art that was cultivated in the 17th century as a response to an unavoidable but predictable fate. By the next century, scientific thinking started to replace older theories. Anatomists observed the orderly spread of breast cancer to local groups of lymph nodes. A brave empiricist actually tasted a breast cancer to show that it was not composed of bile. The idea of curing breast cancer through local therapy took hold. The lack of anesthesia did not prevent efforts to perform mastectomies. First-person accounts by women who underwent this procedure are chilling. Nabby, the only daughter of John and Abigail Adams, underwent surgery at the family home under the hand of John Warren while strapped to a chair and held by two physicians, but she ultimately succumbed to the disease. A German physician warned surgeons about the procedure: "Many females can stand the operation with the greatest courage and without hardly moaning at all. Others, however, make such a clamor that they may dishearten even the most undaunted surgeon and hinder the operation. To perform the operation, the surgeon should be steadfast and not allow himself to become discomforted by the cries of the patient." By the time Dr. William Halsted began his career in the late 1800s, anesthesia allowed more humane and complete surgery. Initial results with more extensive local surgery were promising -- so promising that, for the first time, women began to seek treatment when tumors were still small and potentially curable. Although ultimately the Halstedian approach to systematic removal of breast cancer through radical mastectomy proved unnecessary, effective local treatment markedly reduced the suffering of women with breast cancer for the first time. As the hope for a surgical cure for breast cancer waned in the mid-19th century, three new avenues for therapy were under development. Those who worked with radiation in its early stages noticed the damaging effects on skin and thought the same effect might be used to treat cancer. A second-year medical student treated a woman named Rose Lee with radiation in 1896 (only months after Wilhelm Conrad Roentgen's discovery), and the discipline of radiation oncology was born. During both World Wars, pathologists noted the remarkable disappearance of blood cells and lymphoid tissues in victims of chemical warfare. The same alkylating agents were applied to patients with lymphoma, with remarkable results. For the first time, an effective systemic therapy that could be used with curative intent was available, and medical oncology was launched. For many years, a connection had been made between hormones and breast cancer. In the 14th century, breast cancer was known as the nuns' disease because its high frequency among nuns was well recognized. Nulliparity put nuns at a higher-than-average risk, whereas most women at that time bore children at a young age and therefore had relatively low risk. Seven hundred years later, we are better at quantifying the risk, but we still struggle to understand the biologic mechanisms involved. The first oophorectomy was performed as empirical treatment, and its results were dramatic, albeit short-lived. Soon after the first removal of the ovaries, physicians tried adrenalectomy and then excision of the pituitary gland. Unfortunately, the treatment became almost as bad as the disease. However, with the development of pharmacologic agents to block the effects of hormones, the final tool of modern breast-cancer treatment became available. With the failure of radical surgery to cure breast cancer and with the hope for a systemic cure, breast cancer once again came to be viewed as a systemic disease -- in a modern version of Galen's humoral theory. By the time breast cancers became palpable, most that were destined to metastasize had already done so. Well-planned studies showed that conservation of the breast and radiation resulted in survival rates equal or superior to those associated with radical mastectomy. The use of chemotherapy resulted in small but significant improvements in survival. It is more difficult to chronicle the more recent history, since current debates remain unresolved, the protagonists are still active, and we do not have the advantage of hindsight. In addition, the history of breast cancer in the latter half of the 20th century became more complex, thanks to the rise of the women's movement, environmentalism, and the politicization of the disease. Some readers will undoubtedly object to the relative weight Olson gives to one side or another in these debates. The importance of the rising incidence or "epidemic" of breast cancer in the 1980s and 1990s is a good example. Was it due to an environmental cause (e.g., pollution or pesticides), or as seems increasingly likely, was it due to a combination of an aging population, earlier detection by mammography, and lifestyle-related choices (having fewer children later in life, for instance, or breast-feeding for briefer periods or not at all)? Rachel Carson, the mother of the environmental movement, who won many battles in her campaign against environmental pollution, lost her battle with breast cancer. But was she more susceptible because of pollution by chemical companies or because of her own choice to remain childless? The effect of the introduction of screening mammography in the 1980s on the future of breast-cancer treatment and prognosis is another area of active debate. The remarkable shift toward patients' presenting with smaller invasive cancers or with noninvasive cancers cannot be disputed. However, Olson's statement that "mammograms probably caused tens of thousands of needless operations per year" as a result of the detection of ductal carcinoma in situ can be disputed. The recent downward trend in mortality from breast cancer -- the first such decline ever -- could be attributed to the detection and effective treatment of cancer at its earliest stages. In fact, the postmammography era may see yet another paradigm shift. Although most palpable cancers have spread by the time of detection, many cancers that are detected on screening are curable by local surgery. Thus, both Galen and Halsted may yet be proved correct in the upcoming decades. Susan Lester, M.D., Ph.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.

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Product Details

• Reading level: Ages 18 and up
  
• Paperback: 320 pages
• Publisher: The Johns Hopkins University Press; 1 edition (January 5, 2005)
• Language: English
• ISBN-10: 0801880645
• ISBN-13: 978-0801880643
• Product Dimensions: 8.9 x 5.9 x 1 inches
• Shipping Weight: 14.4 ounces (View shipping rates and policies)
• Average Customer Review: 4.4 out of 5 stars  See all reviews (7 customer reviews)
• Amazon Best Sellers Rank: #454,514 in Books (See Top 100 in Books)

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9 of 9 people found the following review helpful:

5.0 out of 5 stars Fighting with Hope Against Breast Cancer, February 12, 2004

By 

Philip Caudill (The Woodlands, Texas USA) - See all my reviews
(REAL NAME)   

This review is from: Bathsheba's Breast: Women, Cancer, and History (Hardcover)

Bathsheba's Breast: Women, Cancer & History by James Olson is a far-reaching examination of the dreaded disease of breast cancer. Impressive for its scope of historical, medical, political and personal references, the book transcends its obvious historical imperative by including much about living with hope in the face of adversity as well as dying without surrendering to the evil disease.

A cancer diagnosis today is not necessarily a death sentence. Olson explains how breast cancer has threatened all women, regardless of demography, since at least the time of the pharaohs and probably since creation of the species. The fifth of Olson's 11 carefully referenced chapters inaugurates the book's evolution of Hope for breast cancer sufferers, signaling with its title, "New Beginnings: Assault on the Radical Mastectomy." Make no mistake, neither the chapter nor the book reveal the silver bullet that will conquer breast cancer. However, from this point forward, Bathsheba's Breast explains how medical science has made progress against the disease - sometimes despite itself - and how that progress appeared to be accelerating at the end of the 20th century, albeit in tortuously slow steps for those fighting the disease. Increasingly credible optimism emerges as Olson explains the evolution of medicine's knowledge and attitudes about breast cancer, the birth of breast cancer patient advocacy and the growing arsenal of weapons that medical researchers, physicians and patients are bringing to the fight.

Olson is comprehensive, well organized and even entertaining in an appropriate tone for such a serious topic as he gives us the history, evolution and status of the war against breast cancer. Bathsheba's Breast is suitable for all readers, regardless of gender, ethnicity, age or health. Its appeal to such a broad audience lies mainly in the mature tone and integrated style with which Olson approaches all aspects of the subject. It's also because he's deciphered cancer's jargon of "omas" and "ectomies" so they're understandable, both in definition and in context. Readers will be pleased how smoothly he combines history, complicated medical research, political science and public opinion with the personal stories of patients to produce a compelling read.

Faithful to the historigraphical method, the book ventures 3,500 years back to an Egyptian surgeon who wrote about "bulging tumors" in the breast for which "There is no treatment." Olson tells how Hippocrates, the father of Western medicine, studied the nature and cause of cancer, attributing its cause to "black bile," one of his four theoretical fluids of the body: blood, phlegm, yellow and black bile. The book develops a special character as it links these ancients to women of subsequent history who suffered from breast cancer. We learn about victims like Theodora, wife of Justinian, the emperor of Byzantium in the sixth century, Anne of Austria, the mother of Louis XIV in the 17th century, George Washington's mother in the 18th century, Abigail Adams, daughter of President John Adams in the 19th century and many sufferers in the 20th century. These personal experiences of breast cancer victims provide substantive information and welcomed inspiration for all readers, no doubt especially for those with the disease. Some stories are optimistic, others sad, some even humorous. Teddy Roosevelt's far-from-bashful, strong-willed daughter, Alice Roosevelt Longworth, battled the disease throughout much of her life. She lost one breast to cancer in 1956 and in 1970, at age 86, underwent a second mastectomy on the other breast. Emerging from the second operation, she announced unashamedly she was "America's only topless octogenarian."

The 20th century's sexual revolution, catalyzed by nude photos of Marilyn Monroe and increasingly large monthly circulations of Hugh Hefner's "Playboy" magazine beginning in the 1950's, established the cult of the breast in America. Olson explains how big breasts became big business as society placed new value on them because of their erotic appeal. As America's fascination with the breast was exported around the world, women, men and physicians became more amenable to alternative treatments for breast cancer. Ironically, preoccupation with eroticism encouraged the pursuit of a cure.

Bathsheba's Breast adds credibility and emotion to the history of breast cancer by sharing experiences of many 20th century women who've fought the disease with bravery and hope. The legacy of Rose Kushner's 16-year battle against breast cancer and the indifference it often suffered from arrogant physicians and disinterested politicians is unforgettable. Her emotions flared - as do those of readers today - as we read about a surgeon shouting at her, "No patient is going to tell me how to do my surgery."

No doubt Kushner told that surgeon what she wrote in her best-selling, 1975 book, Breast Cancer, "We women should be free, knowledgeable, and completely conscious when the time comes for decision, so that we can make it for ourselves. Our lives are at stake, not a surgeon's." Kushner is the founder of the American breast cancer advocacy movement who battled valiantly but ultimately lost her war with the disease in January, 1990.

The evolution of breast cancer advocacy in America inspired by Rose Kushner is a compelling part of the book. Olson visits labs and legislatures to explain breast cancer's clinical and political issues, ranging from the campaign for lumpectomies and radiation instead of radical mastectomies as initial treatment alternatives to the need for greater government support for cancer research. He tells how Shirley Temple Black, Betty Ford, Happy Rockefeller, Betty Rollin, Jill Ireland, Linda McCartney, Dr. Jerri Nielsen and many others had the courage to go public with their battles against breast cancer, generating publicity that kept the disease in clinical and political focus.

Although Olson mentions it only quietly in a brief preface at the beginning of the book, his personal battle against cancer has permitted him to fuse Bathsheba's Breast with an empathy that's probably the ultimate reason why the book is as good as it is. It wastes no time with irrelevance as it moves seamlessly from history, medical science and politics to the media, pop culture and patients. The story of the battle against breast cancer is multi-faceted and James Olson shines a bright light on all of them.

5 of 5 people found the following review helpful:

5.0 out of 5 stars An Excellent Blend of History and Medicine, May 27, 2003

By 

Paula D. Matuskey (Ellicott City, MD) - See all my reviews
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This review is from: Bathsheba's Breast: Women, Cancer, and History (Hardcover)

My husband purchased this book for me after he heard the author on NPR. I could not put it down. The author's approach to looking at breast cancer over time, the changes in treatment options, and how accidental findings changed the course of medical treatment over time was illuminating. The book also raises the spectre as to how much of breast cancer treatment advances, or lack of, were the result of this being primarily but not exclusively a female disease. I do not have a formal medical background, so I was a little leary that it would be too technical. But instead, I found it to be highly readable and engaging. It also sends a strong message that from the beginning of time breast cancer held no one harmless. And in many ways, the key to the advances have come from patients taking their health destiny into their own hands and not simply accepting a physician's treatment recommendation. Certainly sheds light on the more recent discussions about the value of mammography as a diagnostic tool. Well worth reading!!

3 of 3 people found the following review helpful:

5.0 out of 5 stars A sensitive,multi-faceted and comprehensive look at breast cancer, August 11, 2005

By 

Jessica G. Schreiber "Mover and shaker" (Chicago, IL) - See all my reviews
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This review is from: Bathsheba's Breast: Women, Cancer, and History (Hardcover)

James Olson is to be commended for writing this much needed history of breast cancer for the layman. My husband is a radiologist beginning a fellowship in breast imaging. He discovered this fascinating book and when he was finished I asked him to give it to me. Like the previous reviewer, I couldn't put it down. I don't have breast cancer, but I am of the age when many of my peers have developed this frightening disease. Olson is realistic, empathetic, and well informed. My favorite line came from former child star Shirley Temple Black who, rather than have a biopsy turn into a radical mastecomy, responded to the press by saying, "The surgeon will make the incision. I will make the decision." You can't read this book without having enormous respect for the women who did their own research, asked the right questions, and took on the conventional wisdom and arrogance of male physicians. At the same time, Olson is brutal on the hucksters and frauds who attempt to explain away cancer with psychobabble and unproveable theories. Bathseba's Breast is not an optimistic book, but it can be reassuring that slow, steady progress is being made in the battle against breast cancer.