Behind lengthy battle, a litany of lost souls

Look at Rembrandt’s 1654 painting, “Bathsheba at Her Bath,” and you quickly understand why the Dutch painter was a master of light and shadow. King David’s concubine, in all her ample, naked glory, sits in a warm, coppery light. All else, including the servant who carefully wipes between her toes, is lost in murk and shadow. Of course that must have been the painter’s intent: It is impossible, as it was for David, to keep one’s eyes off the voluptuous body of this woman.

But T.C. Greco, an Italian doctor on a visit to the Rijksmuseum in Amsterdam in 1967, could not help but use his physician’s eye, not an art lover’s, to notice something peculiar. Bathsheba’s left armpit seems swollen, and the left breast seems grainy, presenting, in the parlance of breast cancer, peau d’orange -- the skin of an orange. Greco researched and found that the model for the painting, Hendrickje Stoffels, the painter’s mistress, died not long after its completion, and in an Italian journal, Greco argued that what killed Stoffels was breast cancer.

James S. Olson uses this interesting anecdote to highlight an important message of his book “Bathsheba’s Breast” -- that breast cancer, perhaps more than any other cancer, has been an intrusive, visible scourge to women for a long time. “Breast cancer may very well be history’s oldest malaise, known as well to the ancients as it is to us,” writes Olson, chair of the history department at Sam Houston State University in Huntsville, Texas.

“Bathsheba’s Breast” is an invaluable aid to those breast cancer survivors with an interest in taking the long view of their illness. It’s a little too easy to lose perspective if one only reads the newspapers and magazines. There one finds headlines and claims about great strides being made ever since maps of the genome were first produced in 2000, ever since Herceptin was touted in 1999 as a cutting-edge therapy that attacked some forms of breast cancer at the genetic level. Though these breakthroughs are considerable and praiseworthy, Olson’s book shows that, in reality, humanity has made a long, slow crawl toward understanding and treating breast cancer.

Breast cancer may not be the oldest malaise, as Olson suggests -- who can say what is? -- but for obvious reasons of anatomy it has been one of the most conspicuous, most noticed throughout history, mentioned in chronicles about the Persian Queen Atossa in 490 BC, Byzantine Empress Theodora in AD 548, French King Louis XIV’s mother, Anne, and the list goes on.

These lives and others are documented by Olson, a skillful writer (“John Wayne: American”) who blends stories of personal battles with the disease -- like 19th century novelist Fanny Burney’s harrowing description of her mastectomy in an age that didn’t have anesthesia -- with the scientific and medical developments that are moving us beyond the traditional mastect- omy, radiation and chemotherapy approach (“slash, burn and poison,” as Dr. Susan Love maligns them) to the brink of a new age of treatment on the micro-cellular level.

The Dark Ages of breast cancer treatment, Olson says, lasted a very long time. Ancient Greek physicians understood that breast cancer (and cancer in general) was a systemic problem not neatly solved by cutting away the diseased tissue. Yet they didn’t have the technology to recognize metastasis, the systemwide spread of malignant cells to nutrient-rich parts of the body. Instead, from antiquity until the 1700s, systemic treatment was dominated by Galen and his theory of the four humors. Cancer was caused by an imbalance of the humors -- blood, phlegm, yellow bile and black bile -- and by bleeding and other measures, the balance, and health, could be restored.

It was only in the latter part of the 18th century that mastectomy and removal of lymph nodes, thanks to the scientific advances of the Enlightenment, replaced the notion that draining fluids could produce a cure. With this medical sea change, the mastectomy, in ever more radical versions, became the dominant treatment well into the late 20th century. Olson describes the early gruesome surgeries that left women mutilated, with concave chests. A 19th century surgeon severed the breast with a small saw and “scooped out lymph nodes with his fingers,” heedless of hygiene, while the patient screamed, forcibly restrained in a chair. With the advent of anesthesia, not to mention sterile operating rooms, antibiotics and cosmetic surgery, mastectomy evolved into a more accepted practice.

But “accepted” isn’t exactly right. As Olson shows, women have long fought against a male-dominated medical establishment (more in America than in Europe) that insisted on mastectomy alone as the method of treatment. After the discovery of chemotherapy following World War II, and the use of radiation, lumpectomies and drugs like tamoxifen, more options have become available for women. The efforts of female activists and such high-profile figures as Nancy Reagan and Candice Bergen also have inspired more women to play a larger role in their treatments.

Reading “Bathsheba’s Breast” has perhaps the unintended effect of stripping the gilding off what we know about cancer today. The fact that oncologists have many impressive chemotherapy drugs at their disposal is tempered by the realization that 40 or 50 years of chemotherapy isn’t much time to perfect a treatment, especially when Olson portrays surgeons struggling for 200 years to develop less debilitating mastectomies. The bitter fact is that every statistic that a doctor throws at a patient about her chances on one chemotherapy regimen versus another has been paid for, through trial and error, with the lives of many women. In one chapter, Olson poignantly calls these souls who have volunteered for new treatments a brave “nameless sorority, forgotten by all but their families.”

Scientists, though, are gaining insights into therapies -- newer drugs (like Xeloda) only destroy cancer cells, leaving hairline and appetite intact. And though “Bathsheba’s Breast” may make readers feel a bit frustrated, it does seem we’re at the beginning of a new stage, a push for something better. Herceptin is a sign of this bold, better way, and other treatments are being tested (like Phortress, which is set for clinical trials in England) that may turn breast cancer from “an acute killer to a chronic malaise,” Olson writes.

Today’s cancer research offers plenty of hope to all those courageous people on the journey initiated by their diagnosis, and “Bathsheba’s Breast” is an important traveling companion whose most promising chapters have yet to be written.