Breast Cancer Isn’t Always a ‘Battle’
Two new books about breast cancer look at the disease in a different light
Earlier this year, I was having drinks with my friend L. We hadn’t seen each other in quite a while because she had moved out to the West Coast, while I still live in New York. We were already close, but our friendship grew more rooted when she and I were diagnosed with breast cancer within weeks of one another during the summer of 2016.
Having each other as sounding boards to share fears and commiserate about surgery and treatment aftermath and side effects helped immeasurably. But what struck me then, and what I brought up again over cocktails, was how specific and individual our experiences were, and how “breast cancer” isn’t some monolith battle to be conquered and survived, but an illness to be treated and managed, subject to so many other internal and external forces.
Why, I wondered, and L. concurred, is American culture so obsessed with public displays of victory when the truth is so much more complicated and contradictory? Each of us emerged from our time in the Cancerland trenches thinking, yes, this was unpleasant, stressful, debilitating, and demoralizing, but there were also far worse experiences. Was breast cancer as big a deal as people liked to believe, or were we each minimizing what had happened to better survive our respective futures?
Later, upon returning home, I kept thinking about that discussion with L. and how I thought I might find the answers to my questions where I always find the answers to my most pressing questions: in the pages of books. The literature on cancer, I discovered, was plentiful, but its contents were frustratingly sparse, heavy on firsthand experiences delivered with a dollop of self-help empowerment or from doctors opining on best practices from some mythical mountaintop.
“There seemed to be very little I could do to participate in my own care. I merely submitted to a largely effective regimen that is the result of decades of trial and error.”
I could, and did, take comfort and find solace in Susan Sontag’s Illness as Metaphor, Audre Lorde’s The Cancer Journals, and, going back further in time, Mary Roberts Rinehart’s 1947 essay “The Right to Live.” That essay, by the most popular American mystery writer of the first part of the 20th century, chronicled her successful breast cancer surgery and treatment 11 years after her original diagnosis, a delay necessitated by the stigma still prevalent at the time. “In one sense I did not save myself,” Rinehart wrote. “My surgeon did that. But I had recognized my danger in time… None of my activities have been affected, or even curtailed.”
Rinehart’s feelings mirrored many of my own, as did Sontag’s and Lorde’s, but I craved more contemporary accounts that wrestled with the standard language of cancer-speak, cast them aside, and created something new. Two new releases — The Undying by poet and essayist Anne Boyer, and Radical by health journalist and professor Kate Pickert — are both books I wish I could have read while being treated for breast cancer.
Kate Pickert was diagnosed with invasive breast cancer at a fairly young age—35. Her tumor tested positive for the marker HER2 but negative for estrogen and progesterone. It was malignant at a more aggressive pitch than mine, which required Pickert to undergo chemotherapy prior to surgery and radiation afterward, whereas I, two years older than Pickert at diagnosis, had surgery first, followed by chemotherapy and radiation.
Though she has a clear personal connection to the subject matter, Pickert draws upon skills honed as a journalist at Time, where she covered health care — including breast cancer news, like Angelina Jolie’s double mastectomy. But she quickly found that even her reporting expertise hadn’t prepared her for the reality of the disease. “Despite the familiar archetype of a breast cancer patient who battles the disease, I never felt like I was at war,” Pickert writes in Radical’s introduction. “In fact, there seemed to be very little I could do to participate in my own care. I merely submitted to a largely effective regimen that is the result of decades of trial and error.”
Surrender is key to the treatment of cancer, but what, exactly, does one surrender to? That was what Pickert sought to find out, traveling through the highways and byways of Cancerland, discovering in great detail how richly funded and poorly understood breast cancer remains. No wonder Pickert felt “mental whiplash” at the dichotomy between media depictions of breast cancer and her own experience. It’s a whiplash that all of us who have been treated feel to specific degrees.
Pickert is a clear, thoughtful writer with the appropriate combination of openness and skepticism. She travels the country interviewing everyone with a vested stake in diagnosing and treating breast cancer, from doctors to patients, risk analysts to educators. What seemed so simple a quarter-century ago — “you have cancer, you need to take it out,” in the words of Shelley Hwang, chief of breast surgery at Duke Cancer Institute — is now far more complex. Mastectomies may be medically unnecessary in many cases. Annual mammograms are more likely to be a burden and statistically inconclusive. Chemotherapies may soon be replaced by gentler drugs.
Despite the millions upon millions of dollars poured into research, the conclusion Pickert draws in Radical is that, still, no one really knows the best course of action. Breast cancer is no monolith. What works for one patient is a disaster for others. More personalized and targeted treatment is the way forward, but it is also far more difficult to get funded and extrapolate to the broad pool of breast cancer patients. And tens of thousands of women are still dying from breast cancer each year.
The lack of certainty may be a frustrating conclusion for those who read Radical in search of definitive answers. But it was exhilarating for me, who prefers to occupy a space of discomfort. Why should I be arrogant enough to think I can master a disease or treat a malignant tumor as if it were “other,” when in fact, it was always there, within me, hovering between being benign and cancerous? And why should cancer doctors also think they know best across the board?
As Henry Keurer, a breast surgeon at MD Anderson, told Pickert, “Instead of saying, ‘What’s in it for us,’ we need to say, ‘What’s in it for the patient?’” Innovative treatments and procedures may be a boon to doctors and researchers looking for prestige and for the fewer in number whose treatment proves successful. But if breast cancer treatment is to keep evolving and changing, the patient’s needs must be central — even if those needs are at odds with the culture of battles won and lost and diseases conquered.
If Pickert turns outward for answers, Anne Boyer turns inward. An essay-memoir literary hybrid, The Undying is a search for new meaning and new phrases to convey her experience as a 41-year-old single mother, of diagnosis, treatment, and recovery from triple-negative breast cancer (the opposite of my and Pickert’s diagnosis).
Early in the book, Boyer notes the historical change from writers being reluctant to link themselves to breast cancer to the exact opposite today—a near-compulsive obligation to announce the diagnosis loudly: “The silence around breast cancer that Lorde once wrote into is now the din of breast cancer’s extraordinary production of language. In our time, the challenge is not to speak into the silence, but to learn to form a resistance to the often obliterating noise.”
The Undying takes direct aim at that obliterating noise. It is ruminative, funny, mordant, and provocative, the fragmented structure of short paragraphs and laser-sharp sentences heightening the impact upon the reader. Here is Boyer throwing a dart dead-center at how the culture wishes her to behave: “A single mother with breast cancer should be an opportunity for a sentimental projection worth a thousand country songs. She should be beautifully devised, donating her easy-to-see agony to the mythic accruals of art.” What she should be and what she is, of course, are in diametric opposition to one another.
Like Pickert, Boyer jettisons the battle metaphors so often associated with breast cancer and digs underneath for more provocative truths — for instance, about the exorbitant cost of care. “You must have a desire to live, but it is also necessary to believe that you are a person worth keeping alive,” is one of Boyer’s more blunt observations. “My problem is that I wanted to live millions of dollars’ worth but could never then nor now answer why I deserved the extravagance of this existence, why I consented to allow the marketplace to use as its bounty all of my profitable troubles. How many books, to pay back the world for my still existing, would I have to write?”
There is pain, of course. A book about breast cancer cannot ignore that. But there is great beauty in The Undying, a testament to Boyer’s devotion to language’s timeless power. “I was corroded, I was mutilated, I was uncertain. I was not okay.” Boyer’s singular, brilliant grappling with her own breast cancer, this “minor form of reparative magic” makes room for each of us to grapple with our own singular experiences.
I had to wait several years beyond my treatment to get these fine works, but many women currently diagnosed and undergoing treatment — far too many — will have immediate access to the spectrum of honesty and contradiction that both Boyer and Pickert cover in overlapping ways. Diseases, even the most common ones, are isolating. These two books bridge the gap between fright and calm, between terror and treatment, between horror and hope, and are vital additions to the new canon of cancer books.
Update: An earlier version of this story incorrectly stated the nature of Kate Pickert’s diagnosis. Her tumor tested positive for the marker HER2 but negative for estrogen and progesterone.