Great strides in research and clinical practice have decreased breast cancer mortality rates by more than 35% since 1990, yet about 40,000 American women die of the disease each year. In Radical: The Science, Culture, and History of Breast Cancer in America, health-care journalist Kate Pickert writes eloquently about the contradictions, triumphs, and defeats she experienced after being diagnosed with invasive breast cancer at age 35.
Organized in 12 chapters, Radical is both a vivid personal history of one woman’s diagnosis as well as her medical and emotional battles with breast cancer and also an examination of the past, present, and future of breast cancer. Ms. Pickert, a journalism professor at Loyola Marymount University in Los Angeles and a former health-care reporter for TIME Magazine, handles the literary balancing act with poise, writing with verve and confidence.
Title: Radical: The Science, Culture, and History of Breast Cancer in America
Authors: Kate Pickert
Publisher: Little, Brown Spark
Publication Date: October 2019
Price: $27.95, hardcover, 336 pages
Ms. Pickert was diagnosed in 2014 and had, as she describes, the “old and new. In addition to a double mastectomy, surgical removal of 22 lymph nodes under my arm, rounds of harsh chemotherapy, 5 weeks of daily radiation treatment, and a full year of infusion targeted therapy.” She was in trim shape, otherwise healthy, and had no family history, so her diagnosis came as a shock. However, she notes, during her 372 days of treatment, even though she’d been unlucky to develop aggressive breast cancer, and her treatments were at times “soul-draining,” had she been diagnosed a decade earlier (before the breakthrough drugs she was given), she would not have survived to write her story.
Diagnosis: A Life-Changing Moment
The life-changing moment of diagnosis for a patient with cancer is seared into the memory, like an emotional branding iron. Ms. Pickert describes her own diagnosis, with details that firmly personalize the difficult process. “For me, the goo oozing from my nipple was annoying but nothing to panic about.” She went for a mammogram, which found signs of calcification, and a biopsy was ordered.
Ms. Pickert continues: “I was alone, working in my home office the day after the biopsy, when a nurse called, and I scribbled on paper as she talked. DCIS. Stage 0. I went to the surgeon the following day. She told me that the DCIS was too widespread for a lumpectomy and I’d need a mastectomy. I burst into tears as she explained that after reconstructive surgery, I could have the tattoo of a nipple to replace my original one.”
The author is well connected in the oncology community, and readers of The ASCO Post will enjoy meeting some oncology luminaries during the gripping narrative. Ms. Pickert writes: “When I told Larry Norton, Memorial Sloan Kettering’s top breast cancer doctor, that I was writing a cultural and scientific history of breast cancer in America, he said, ‘That’s not a book. That’s an eight-volume set.’”
To the author’s credit, this is a well-honed book that captures much without composite characters, and no timelines have been altered for narrative convenience. Quotes from doctor visits are as close to verbatim as possible, and all of the interviews and anecdotal data are meticulously documented and referenced.
Ms. Pickert chronicles the cultural history of breast cancer and the activist/advocacy movements, rife with pink ribbons, marches, and branding. She also highlights the rise of the Susan G. Komen Foundation, doing a deep dive into the lobbying, business connections, and governmental machinations necessary to generate public pressure to increase funding for breast cancer research and transforming screening mammograms into annual routine care for women older than age 40. She points out the Susan G. Komen Foundation “pushed the idea that mammograms were necessary for cure.”
“If I have learned anything from writing this book, it’s that for progress [in breast cancer] to continue, we must be open to change.”— Kate Pickert
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At that juncture, the author introduces another oncologist who is a household name in the oncology community. “The thing to know about Laura -Esserman is that she doesn’t see problems. The other thing to know about Dr. Esserman is that often she believes she is the ideal person to enact the kind of systemic change that’s needed…. Her assertiveness to upend existing systems of breast cancer diagnosis and treatment elicit extreme reactions.”
The author goes deep and personal with her relationship with Dr. Esserman, shedding light on the inner life of a hard-charging oncologist, whose dedication to the field is mesmerizing. The value of mammography is dissected but never resolved. Dr. Esserman’s frank opinions about overscreening will be put to the test as principal investigator of WISDOM (Women Informed to Screen Depending on Measures of Risk), one of the largest and most important screening trials in modern history.
A Thankful Survivor
Ms. Pickert does an admirable job toggling from background history and her own medical challenges, giving the narrative a propulsive pace. Her telling of a 6-month bout of lymphedema is stark and poignant, as is her crushing emotional letdown after breast reconstruction. And on every page, it becomes clear that oncologists are a special breed of doctors, caring for our most vulnerable patients.
“Progress in the fight against breast cancer in America has been, by any measure, remarkable…. If I have learned anything from writing this book, it’s that for progress to continue, we must be open to change,” Ms. Pickert comments, ending her powerful and informative memoir. This book is highly recommended for readers of The ASCO Post.