In a perfect world, all patients would have the information they need to make informed choices. In such a world, the virtuoso violinist with colon cancer could avoid a chemotherapy regimen that renders fingers insensate; the newly married man with prostate cancer could forgo surgery that might affect his erectile function; and the triathlete with breast cancer could decline chemotherapy that might result in heart failure.
But our world is far from perfect — especially, as Kate Pickert reveals in “Radical,” for the more than three million Americans who have been diagnosed with breast cancer.Pickert, a journalism professor at Loyola Marymount University in Los Angeles and a former health care reporter for Time magazine, was diagnosed with a particularly grim form of breast cancer at the age of 35. Soon thereafter, she set out to write a cultural and scientific history of the disease, using narratives of her own experience to anchor her research. Such a whopping undertaking could have easily turned maudlin, strident or just plain eye-glazing; instead, Pickert has produced an evenhanded, powerful and unflinching page-turner.“Breast cancer is emotional,” Pickert writes. And then she reveals how physicians, pharmaceutical companies and even patient advocacy groups have tapped into those emotions to prevent patients from making informed decisions about screening and treatment. She describes the role of Susan G. Komen, the biggest breast cancer charity organization in the United States, in transforming mammograms into an annual ritual for women over 40. With a relentless marketing campaign that helped make cheerful pink ribbons synonymous with a deadly disease, the Komen organization pushed the idea that mammograms were necessary for early detection and early detection was necessary for cure. These efforts persisted even after research proved that mammograms were far from foolproof, especially in younger women where identifying cancers in mammograms was akin to “looking for a golf ball in a snowstorm.”Physicians, too, played a critical role in obfuscating the issues for patients. Pickert writes about surgeons who continued to offer the most disfiguring and disabling surgery long after a 1981 randomized clinical trial definitively concluded that less destructive surgery was equally effective. The surgeons feared that doing anything less would not be enough.Similar mind-boggling practices continue today. Breast cancer oncologists in New York, for example, are more likely than those in Los Angeles to give patients an older chemotherapy drug called “the red devil” (the name comes from its color and its rare but irreversible toxic effects on the heart). Asked to explain the discrepancy, a leading New York oncologist tells Pickert: “There was East Coast jazz and there was West Coast jazz. And there is East Coast oncology and West Coast oncology.”At the end of her book, Pickert falters. Reflecting on the future, she writes, “I am optimistic that this progress will continue.” It’s a statement that feels a little too pat, too cheery pink ribbon, coming from an author who has just effectively made the case for complete transparency, informed decision making and healthy skepticism. But it’s a minor misstep in a book that should be required reading for anyone interested in, as Pickert writes, “a disease so common that to know something about it is to know something about humanity itself.”Pauline W. Chen, M.D., is the author of “Final Exam: A Surgeon’s Reflections on Mortality.”RADICALThe Science, Culture, and History of Breast Cancer in AmericaBy Kate Pickert337 pp. Little, Brown & Company. $28.