The Ways We Talk About Cancer
Elaine Schattner
University of Columbia Press
March 2023
BOOK REVIEW
THE evolution of cancer diagnoses and treatments parallels medical history and the author, an oncologist and a breast cancer patient and advocate, joins prodigious research with her journalism skills to produce a must-read book. From Whispers to Shouts charts public perceptions and the fascinating social history of cancer, and the slow but steady advances in cancer care. The author has scoured all media from print to film, radio and television, to the more recent information explosion of the digital era. Schattner’s comfort with social media, where patients share information, medical professionals debate treatments, and where Dr Google has become a patient’s go-to health adviser, will particularly appeal to all those daily scrollers making sense of the information overload dealing with their own cancers.
Spanning from the mid-19th Century to the present day, Schattner does really well to pluck the common threads of cancer reporting to show how, “balancing hype, skepticism, and legitimate optimism would challenge physicians, journalists, and patients for years to come.” The author’s childhood illness, medical training, including an early career in an HIV lab when AIDS became a devastating disease, and work as a medical practitioner come together in this unique book. While a breast cancer diagnosis “irreparably ruptured” her career, it surely allowed her to come to the writing of this book with skin in the game.
Early purported causes of cancer included parasites and diseased fish, and there was a theory that cancers were contagious. Popular magazines began to run articles about cancer. A 1913 Ladies’ Home Journal storyused “plain language and blunt terms” to report on various cancers to educate readers. Whilst most cancer prognoses were bleak, articles very often noted most cases were treatable if found early and pushed readers to remain aware, detect early signs, and take responsibility for their own health. The awareness campaigns that arose from these early journalistic efforts formed the basis for cancer education for decades to come, when surgery remained the prime treatment option. The 1920s saw new technology, telephone, radio and film, join print media and lectures as informational and educational tools. The author’s thorough analysis of popular culture and its links to cancer in the various media is a highlight of this book.
Another long-practised activity, indeed a paradox, that appears to have remained a constant to this day is the degree of joy and fun infused into breast cancer fundraising events. Of course, this dreadful malignancy is obviously anything but fun for patients, especially late-stage ones. And, as a man with breast cancer, I wondered if the long-term ubiquitous use of the color pink to denote awareness did much to mask the fact that the disease was genderless. How many men have been inhibited from presenting to their doctors with breast lumps? How many men have died with late-stage diagnoses because their treatment was so delayed?
Running alongside advances in science and the philanthropists who so very often provided the funds for new hospitals and research facilities, were the charities formed to propagate information and raise further funds. At the same time the rise of hucksters who peddled bogus cures to the desperate, presage the quacksters of today who try to sell ineffective “natural” treatments or give advice on the latest herbal remedies.
As science and research progressed, particularly through the 20th Century, knowledge gained from scientific discoveries, including safe anaesthesia, allowed for better surgery based on proven techniques. When my mom was treated in 1959, her only options were a radical mastectomy, which included loss of chest muscles and all right-arm lymph nodes, followed by strong radiation. According to the author, at this time, “five-year survival hovered around 65 percent; one in three breast cancer patients still died within five years.” My young mother was one of these people.
While surgery and later radiation treatment became standards, effective chemotherapies were years away, as was endocrine therapy. Early cancer drugs were severe on patients, and hair loss and other side effects made them look (and obviously feel) quite poorly. However, the invention of cancer drugs in the form of chemotherapy, which improved patient survival prospects, changed treatments forever. When tamoxifen was approved by the FDA, it became a new, effective adjuvant treatment for hormone receptor-positive patients.Tamoxifen’s approval for use in breast cancer treatment heralded availability of powerful drugs that block hormone receptors, of which many are now available.
Medical history throws up incredible similarities through the decades, and in the late 19th Century curable patients were separated from the incurable. Schattner couldn’t help noting the parallels to today, when many cancer charities keep metastatic patients out of the fundraising limelight, preferring to show young early-stage moms (less than age 40) in the promo material, when these patients are around five percent of new patients. In fact, even in the early 20th Century, when surgery was the only treatment offered.
Schattner doesn’t shy away from such issues as the financial toxicity of cancer treatments, which means that, as with today, the best care was reserved for those who could afford it. This remains a big barrier to cutting-edge treatment today, ensuring poorer outcomes for people with low incomes and/or without good medical insurance. Many of these are minority groups and people of color. Charted here, also, is the rise and rise of cancer charities and associations, many for individual patient cohorts, including Stage 4 patient groups such as Metup and Metavivor.
The more recent advent of patient advocates has strengthened breast cancer social media communities and diminished the “fear, feelings of hopelessness, shame and ignorance” that Schattner points out have been a constant since the day breast cancer was first discussed. As has access to improved medications along with patient’s personal searches for information and advice during the era that saw the internet and social media on an exponential rise. Through dealing with her own serious medical issues, the author has been able to bridge what is often a cavernous divide between patients and their medical teams.
From early public reticence to even mention the word cancer (whispers) to the modern information era (shouts) this book is most of all about hope. Hope expressed by patients and medical professionals through the decades based on medical advances in treatments and early detection. The author, who has put her heart and soul into this fine book, advocates for transparency and clear communications to be a major part of the modern doctor’s tool kit, along with the oft-praised, good bedside manner. While there is so much to learn from this book, medical professionals, patients and all those interested in the history of cancer will understand just why there are, with the exception of immunotherapy for blood cancers, yet no widespread cures. It is an important addition to the literature on cancer, and up there with classics of the genre including Mukherjee’s, The Emperor of All Maladies.
Rod Ritchie
President, Board of Directors
Male Breast Cancer Global Alliance
From Whispers to Shouts: The Ways We Talk About Cancer by Elaine Schattner
Available here: https://amzn.asia/cYlcfdY