Academic journal article Women's Studies Quarterly

A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century / the Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America

Academic journal article Women's Studies Quarterly

A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century / the Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America

Article excerpt

The claim that mammographic screening saves women's lives was accepted as scientific fact and institutionalized within American medicine almost 3 decades ago. Since then, the debate over how often and at what age mammographic screening should begin has continued relatively unabated, periodically erupting into headline-grabbing controversies, but never challenging the fundamental soundness of the logic governing breast cancer screening, nor threatening the holy trinity of screening technologies: mammograms, clinical breast exams, and breast self-exams. Within the past year alone, however, the New York Times has published dozens of articles challenging the claim that mammographic screening and breast self-exam save lives and even questioning the basic assumptions embedded within the paradigm of early detection. What makes the recent deepening of the debate so interesting, at least from a science studies perspective, is that the main catalyst was not the publication of new data, but rather, the reevaluation of old. This reevaluation, a meta-analysis of seven of the largest and most influential studies of mammographic screening, was published in the British medical journal Lancet late last year (October 20, 2001) and picked up by the New York Times in December. Amazingly enough, after more than 25 years of research and mammographic screening, the Lancet article concluded that we still don't have an answer to the most basic question of all: Does mammographic screening save lives or doesn't it? And there is another question: Why does more research seem only to produce less consensus?

It's questions like these that make the publication of A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century and The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth Century America so timely and so welcome-indeed, so long overdue. Ellen Leopold, the author of A Darker Ribbon, is a well-known feminist scholar, journalist, and health activist who has been involved for years with the pioneering Women's Community Cancer Project (in Cambridge, Massachusetts) and whose provocative and political writings on breast cancer and women's health issues have appeared in a variety of popular forums, including The Nation and Sojourner: The Women's Forum. Barron H. Lerner, the author of The Breast Cancer Wars, is a medical historian and practicing physician whose work has appeared in publications such as Annals of Internal Medicine and American Journal of Public Health and whose book reviews, op-ed pieces, and commentaries regularly appear in Mamm (a women's cancer magazine with a feminist edge), the New York Times, and various other newspapers and magazines. Both separately and together, A Darker Ribbon and The Breast Cancer Wars provide a much needed historical perspective for contemporary debates, demonstrating, among other things, that the roots of the contemporary debate extend into the 19th century.

The first of the two books to be published, A Darker Ribbon, is organized thematically into three parts with overlapping chronologies. Part 1 traces "the evolution of the medical response to the disease" (p. 12). Leopold describes the dynamic but unregulated medical marketplace at the end of the 19th century, the rise of scientific medicine, the monopolistic triumph of allopathic physicians, the divvying up of body parts among medical specialties, the growth of surgery, and the institutionalization of the Halsted radical mastectomy. Leopold argues that the "abandonment of the breast" by gynecologists and family physicians and its uncontested capture by surgeons had repercussions that were felt "in every corner of breast cancer's modern history-in patient attitudes, in the pace and direction of research, patterns of treatment and pastoral care, in the transformation of medical hierarchies, education campaigns, even the definition of disease itself (p. 66). This is one of the main themes of A Darker Ribbon. …

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