Radical: The Science, Culture, and History of Breast Cancer in America

by Kate Pickert

The science, culture and history of breast cancer as told by a reporter who survived it

As a health-care journalist, Kate Pickert knew the emotional highs and lows of medical treatment well -- but always from a distance, through the stories of her subjects. That is, until she was unexpectedly diagnosed with an aggressive type of breast cancer at the age of 35. As she underwent more than a year of treatment, Pickert realized that the popular understanding of breast care in America bears little resemblance to the experiences of today's patients and the rapidly changing science designed to save their lives. After using her journalistic skills to navigate her own care, Pickert embarked on a quest to understand the cultural, scientific and historical forces shaping the lives of breast-cancer patients in the modern age.

Breast cancer is one of history's most prolific killers. Despite billions spent on research and treatments, it remains one of the deadliest diseases facing women today. From the forests of the Pacific Northwest to an operating suite in Los Angeles to the epicenter of pink-ribbon advocacy in Dallas, Pickert reports on the turning points and people responsible for the progress that has been made against breast cancer and documents the challenges of defeating a disease that strikes one in eight American women and has helped shape the country's medical culture.

Drawing on interviews with doctors, economists, researchers, advocates and patients, as well as on journal entries and recordings collected over the author's treatment, Radical puts the story of breast cancer into context, and shows how modern treatments represent a long overdue shift in the way doctors approach cancer -- and disease -- itself.

Genres: Nonfiction, Science, History, Health, Medical, Medicine, Audiobook

336 pages, Hardcover

Published October 1, 2019

Reviews

[Jaime · Rating 5 out of 5]

Well-written and well-researched. I especially appreciated her attention on metastatic breast cancer and metastatic disease - which is so often ignored. I was shocked to find out that the “Cancer Moonshot” so highly touted does not explicitly earmark funding for research on how metastatic disease affects one’s life. Baffling. And that’s just one tidbit. Pickert has done her homework, and interviewed some of the leading researchers and activists in the field.

This is a much-needed book in the world of pinkwashing and false feel-good narratives of breast cancer. It’s a great examination of cultural attitudes, the history of the disease, the dangers of advocacy that prevent actual learning of the facts about a disease, how fear and fear-mongering do us a disservice, the evolution of treatments that continues to this day, and how we need more than pink.

I have lots to say about this book, but for now, I’m just going to say read it.

[Sara · Rating 5 out of 5]

This is my 116 book of the year. It’s been by far the best one! I would give it 10 stars if I could. My oncologist recommended it to me yesterday and it arrived at my house this evening and I read it without putting it down. Finally an up-to-date breast cancer book with history and personal stories in which I can completely relate to. If you are just starting your journey, living after breast cancer, supporting a cancer fighter, or just interested in breast cancer this book is the absolute best! Someday I hope to meet my Kristine sister!

[Kathy · Rating 4 out of 5]

Informative and useful, presented well; it reads like a novel. Nice blend of historical stories and author's own experience.

[Emily · Rating 4 out of 5]

A nice, fairly comprehensive view of the science and history of breast cancer in the United States. I felt like the “cultural” part was a little lacking—even though she does a good job of discussing Komen and the problems with a PR message geared towards prevention, “awareness,” and survivor narratives, she leaves quite a few stones unturned without even mentioning she’s not touching them. There’s clearly a huge geographic disparity in standard of care she hints at between New York and LA, but what about the rest of the country? How much variation is there among providers from what the best evidence available recommends regarding treatment? How much variation is there based on race and SES? Not everyone in LA has the money or resources to know a guy to get in with the “best of the best” doctors she’s fortunate enough to see, so what does care look like for the rest of us? It would have been nice to see an acknowledgement that either such variability exists, or that frankly, we probably don’t have enough data to know how different care is among different groups of patients.

[Irene · Rating 3 out of 5]

This book intertwines the author's personal experiences with breast cancer with explorations of topics related to breast cancer.

There was a lot I liked about this book. Published just this year, it was up-to-date on modern advances and clinical trials. It picked up where Her-2: The Making of Herceptin, a Revolutionary Treatment for Breast Cancer by Robert Bazell (published in 1998) and The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee (published in 2010) left off. For example, the book goes beyond the success of Herceptin, and introduces Perjeta and Kadcyla, two more recently developed targeted therapies for HER2-positive breast cancer.

I appreciated that the author shed light on some of the more controversial and little known aspects of breast cancer. The very first chapter presented eye-opening information on the fact that mammograms underdetect some cancers and overdiagnose others, particularly in younger women. The second-to-last chapter focused on metastatic breast cancer and, in the absence of a cure, the need for more treatment options that could better extend the lives of metastatic patients.

I found the chapter on the Susan G. Komen foundation particularly interesting, from the beginnings of the pink ribbon to the criticisms they've received and their efforts to re-brand themselves in recent years. The book as a whole provided a keen juxtaposition of the celebratory images of pink-washed breast cancer "survivors" against the harsh reality of painful surgery, debilitating cancer treatment, and marginalized metastatic patients who know they will not survive the disease.

I also really enjoyed the chapter on Taxol, a federal funding for scientific research success story. The author humanized the history of Taxol by telling its story through the people who discovered and helped develop the drug. As a breast cancer patient currently receiving chemotherapy with Taxol, I feel personally grateful for every individual who helped bring the drug to market.

All that said, I ultimately rated this book 3 1/2 stars. (1/2 stars not being allowed on Goodreads, I ended up rounding down.) Topics varied widely, and though the book was loosely organized along a chronology of the author's experience from diagnosis through treatment, the narrative seemed to jump disjointedly from one subject to the next.

Several times, the text mentioned "a subtype of breast cancer", but then failed to identify the particular subtype in context. I found this lack of detail frustrating, especially when the book, in other places, did describe subtypes (e.g., estrogen-receptor-positive, HER2-positive, etc.). Not providing such clarifications in all contexts just made those sections seem arbitrarily vague.

The biggest issue I had with the book was its lack of discussion on the choice to not reconstruct after mastectomy surgery. Considering the book's bold presentation of other controversial topics, I think it was a disservice to not fully explore the path of non-reconstruction, i.e., "going flat", with the same validity as reconstruction, especially since the author states that "[n]early 40 percent of women who have mastectomies opt to have plastic surgery" (p. 233), which means that a 60% majority of women do not reconstruct. The author discusses at length her decision-making process for various parts of her treatment, but she did not at all address how or why she chose to reconstruct; it was considered a given.

I was particularly bothered by the chapter on reconstruction being titled "Whole Again", implying that a woman who has a double mastectomy is not "whole" unless they undergo reconstruction. As someone who had a double mastectomy and chose to go flat, I can say with confidence that I feel whole. I wish the author had interviewed breast surgeons who are skilled in flat closure, and I wish she had included the accounts of women who chose to go flat and how they made their decisions, including women who first had reconstructive surgery and then later decided to explant. For a book that seemed tapped into current trends, it was a glaring omission to not at all mention the existence of the "flat movement", including organizations like Flat Closure NOW, which helps to spread awareness and shed light on issues experienced by women who choose to go flat.

To a lesser extent, I also wish the author hadn't shied away from controversy related to cold-capping. Given the book's emphasis on empowering women with knowledge to make their own decisions, I think the book should have mentioned the possible risks, small as they may be.

Overall, a lot of valuable information makes this book a worthwhile read. I understand the topics in the book were driven by the author's personal experiences, but I still wish additional perspectives could have been included, too.

[MaryAnne · Rating 3 out of 5]

The author is a journalist who was diagnosed with invasive breast cancer in her 30s. This book is her attempt to process her diagnosis and come to terms with her treatment (over a year) and prognosis (good for now). She goes into history of breast cancer treatment (going back to the 1800s), the history of the breast cancer awareness movement, and current treatment options. Lots of interesting information but kind of all over the place. I'm definitely more informed about the wide variety of breast cancers, the evolution of treatment options, and the possibility of the disease coming back (even though the chance is small it does come back even to women who caught it and treated it early). A worthwhile read.

[Carissa Miyano · Rating 4 out of 5]

I really enjoyed the blend of historical and more modern stories of how breast cancer treatment and research has evolved to where it’s at today - at times the stories were a bit disjointed but overall it was great information. I feel for the women who had radical mastectomies before anesthesia was invented.

Like another commenter, I wish the author mentioned the option and valid choice to go flat after mastectomy but I also think it’s valid to acknowledge the author didn’t feel “whole again” (which is also the name of a chapter) until she had reconstruction.

[AmberBug com* · Rating 5 out of 5]

After I was diagnosed with Invasive Ductal Carcinoma with lymph node involvement, I was so numb that the last thing I needed was to read more about it. It took me halfway through Chemo to finally make my way through the volumes of books written on cancer to pick ones that I wanted to read.

I am SO glad I picked this one up. It's not a "Chicken Soup" book on cancer. This is chock full of information about the history of breast cancer, how the drugs being used were found (Taxol, one of the drugs I was one was found from the bark of a tree) and so much more.

This was exactly the type of book I needed to work my brain around breast cancer, scientifically (but very accessable).

I'm coming up to my surgery in a few weeks and this book has given me a little more courage. Now on to my next book, more scientific and a workbook on Mastectomies.

Oh, I do need to say that this book is for ANYONE interested in learning about Breast Cancer, it's not speaking just to those who have it... It's something that everyone can learn something from. Highly recommend for anyone!!!

[Basic B's Guide · Rating 5 out of 5]

A necessary read for a necessary change.

As a breast cancer survivor I was impressed and it gave me plenty to think about. As a woman I found it a necessary and insightful look into a culture many of us are aware of but lack the knowledge. Highly recommend this to all women as a must read.

[Kristy · Rating 5 out of 5]

I have read a lot about breast cancer since my diagnosis in March (research is my go-to for managing anxiety!) and while I've read a lot of great stuff, there aren't a ton of things that I would recommend for a general non-breast-cancer-experiencing audience. This is one of those things. Pickert is a science journalist who faced an unexpected and dire breast cancer diagnosis at age 35. After her surgery and treatment, she was compelled to dig into the world of breast cancer and interpret it as a professional journalist. The result is an extremely readable book that combines historical research, contemporary interviews, and Pickert's personal experience into a look at where we are in our understanding and experience of breast cancer as a culture, as well as how we got there.

In one of the most educational (and uncomfortable) chapters Pickert digs into the history of the mammogram and the controversies over how often they should be done and when you should start. This is an uncomfortable topic because it pits breast cancer survivors and the fear of a breast cancer diagnosis against a scientific community with statistics showing that, for many women, a mammogram either doesn't catch their cancer (*raises hand*) or ends up subjecting women to surgeries, harsh chemotherapy and radiation treatments, stress, and financial burdens that, in bulk, don't extend their lives. The idea of not checking for cancer as much as possible freaks me out, but the argument that our reliance on mammograms (and the medical establishment's extreme investment in the technology) is keeping us from better, more individualized systems of cancer detection, is pretty thought provoking.

Ever wonder how chemotherapy was invented? Where that fucking pink ribbon came from? How new drugs are invented, tested, and approved? What breast cancer surgery was like in the 1800s? (spoiler alert: freaking terrifying.) This is the book for you! Get a copy now!

[Christie · Rating 4 out of 5]

Of all the things to look at while poison is being pumped into your body, the Pacific Ocean is a pretty good option.

After dealing with breast cancer at the young age of 35, Pickert, a healthcare journalist, decided that her next project would be on investigating breast cancer. Though this is one of the most studied cancers, we still know so little about what causes it and how best to treat it. Pickert interviews doctors, surgeons, drug researchers, nonprofit directors, and breast cancer patients and survivors to try to understand the current science of breast cancer and how we got here.

Until breast cancer affected my family a few years ago, I hadn't given it much thought. I always kept up with my exams, but it wasn't something I really thought of often or read about. Since then, I have become more interested in the topic and put this book on my TBR when it came into my library. I found this book to be very fascinating and sometimes infuriating. It was interesting to know that while science has progressed, many women are still being treated with the same methods from decades ago. The author also talks about how the advocacy focus on survivors has pushed those who have a low chance of survival to the wayside. I appreciated the author talking about her own journey with breast cancer and interspersing the stories of other patients and survivors along with the scientists and doctors. Though this led to the book not always being the most coherent narrative, it was nice to have that personal touch running through it all.

I definitely recommend this to those who are interested in learning more about the science and history of breast cancer treatment, though I would proceed with caution if you are a current breast cancer patient or family member.

CW: cancer (including death), infertility, medical procedures

[Dr. Ashori · Rating 5 out of 5]

This was an incredible book to read on the topic of breast cancer from someone who went through it first-hand. As a physician, I have only taken care of patients with the disease and diagnosed or managed the disease but have never been this intimate with it. We tend to have an emotional distance from diseases to maintain objectivity, but without these kinds of stories we eventually also disconnect completely. This book helped me understand the nuances of oncology in breast cancer management.
She is a great author and an amazing journalist - the details and the accuracy of the context is top-notch. And to share something so personal with the world, to me that's the ultimate gift from one human being to another.
You have to be a breast cancer patient and someone who can take in data voluminously to write with this level of objectivity - both in depth and in breadth. Because she dives in deep to share what it's like from the patient's perspective and her encounters with friends, family, nurses, and physicians. But she also talks about the science and how drug makers and lobbyists are trying to come up with better methods of treating this condition. She highlights the plight of those living with metastatic disease who are ignored in the entire pink ribbon movement. And something incredibly important that she highlights and describes much better than I can summarize here is the fear and bewilderment patients experience with this disease. The fact that they have to sort through statistics to figure out their survival. I mention this because this is the kind of thing I would want my patients to read if they have the fear of this cancer or are diagnosed with it.

[Sara Hollar · Rating 4 out of 5]

This was an easy read compared to The Emperor of All Maladies: A Biography of Cancer. I read it pretty quickly as I recovered from a mastectomy. It was informative and interesting, although confusing, at times. It felt good to identify with the author through a similar journey.

One thing that bothers me a lot about both these books is that they are both almost entirely drug-focused. She even admits, "there has been no successful large-scale effort to learn what causes breast cancer beyond the small percentage of cases tied to hereditary genetic mutations & the identification of risk factors so ubiquitous among American women that they are virtually useless as warnings." Every book on cancer I've seen centers entirely either on pharmaceutical drugs or natural healing. You better choose, because nowhere I've found will you see integrated information. It's disappointing, to say the least.

[Rachel Chapman · Rating 5 out of 5]

I picked up a lot of books from the library when I was diagnosed with breast cancer. This is the only one I have finished and recommend whole-heartedly. Written by a woman who went through breast cancer herself, she weaves in anecdotes of her own story with the history and evolution of breast cancer research from the 1800s to today. I had heard much of what was in this book from my own diagnosis, my mother's diagnosis (~30 years ago), and my own research, but this book helped me make sense of it all. I found it to be well-researched and non-biased as I myself was trying to decide my own best treatment decisions.

Content warning: I will say there is an in-depth description of watching a mastectomy procedure that I am glad I didn't read before my surgery. It's towards the end.

[Marci · Rating 5 out of 5]

An impressive piece of journalism that pieces together advances in breast cancer treatment in a clear timeline with visual details that stay with the reader. Pickert also amazingly tucks in researchers' and patients' personal stories and personalities which paints their humanity as well as her own as she goes through her own reatment for breast cancer. This isn't a memoir, but an impressive account of how breast cancer treatment has changed and continues to evolve, told through the words of a trained journalist who provides a comprehensive view.

[Mary Ahn · Rating 5 out of 5]

Very thorough and nicely written. Great read for general public as those in medical field. Though her own cancer may have triggered this book, it was well researched and presented without bias. Good journalism. I think all medical workers taking care of breast cancer patients should read this book. I highly recommend.

[Connie Johnson · Rating 4 out of 5]

A well-researched novel with interesting takeaways - many personal stories mixed with statistics. As someone who has recently dealt with breast cancer, I liked learning the history of the drugs that I received, how women persevered through some crazy treatment, and I feel very grateful for those went through it many years ago. Wow, I can’t imagine how they endured it!

[Erin Zwier · Rating 4 out of 5]

I learned a ton reading this book about the history of breast cancer at a time where it felt really important to know more about Kara’s diagnosis. I learned that K is really lucky to live now and that there is still so much more work/research to be done.

[Mad Hapa · Rating 4 out of 5]

Explains the mammogram edict that came out a few years back and the evolution of breast cancer treatment. Doesn't make breast cancer seem any less terrifying but I'm glad this information is out there.

[Diana Duell · Rating 5 out of 5]

This book has a lot of good information. Some of it was hard to read while I was going through my own treatments, but I am glad I finished it. I learned several things; treatment for breast cancer has come a long way, and there are so many different kinds of breast cancer.

[Emma Hinkle · Rating 4 out of 5]

Fantastic book that delved into the science, history, and emotion surrounding breast cancer. The author battled breast cancer so you get to hear her story and how she processes it.

[(a)lyss(a) · Rating 4 out of 5]

I received a copy of this book through the Amazon Vine program in exchange for an honest review.

This is a fascinating but hard to read book. Pickert ties together the history of breast cancer treatment in women and her own experience fighting breast cancer. From radical treatments like full removal of tissue or a woman's uterus to pills and studies, this book explores how science has looked at women and why this cancer in particular can vary widely in different people.

It also gives history like why the breast cancer ribbon is pink. It's definitely an informative read!

[Annabelle Duflock · Rating 4 out of 5]

Incredibly detailed and well researched. Glad I read this because really need to keep studying up for my incoming job but truly really enjoyed reading this

[Edward Irons · Rating 4 out of 5]

Kate Pickert combines her personal experience with a deep dive into the breast cancer medical-industrial complex. An experienced journalist capable of bringing a personal touch to an issue, Pickert allows us to see every issue through the eyes of a patient. She frames her account around her own diagnosis with DCIS (ductal carcinoma in situ) in 2014. And in cases where she couldn’t relate her own feelings, such as during the operation, she returned as an observer. She then related how two senior specialists and a vast support team spent five hours performing a mastectomy. They also began the reconstructive process that would allow the patient to have two firm breasts, in her own skin and with no visible scars. Forty percent of mastectomies now include reconstructive surgery, and over 100,000 such operations being performed each year.

Many mastectomies today are elective (contralateral prophylactic mastectomy, CPM), for women afraid of getting cancer later. Demand for such procedures skyrocketed after Angela Jolie’s announcement of her own case in 2013. In one study, the rate of women with Stage I-III cancer who chose CPM went from 3.9% in 2002 to 12.7% in 2012. Pickert notes that such surgeries constitute 15% of surgeries at the Center for Restorative Breast Surgery in New Orleans. Following a 1998 federal law, reconstructive breast surgery is now widely covered by most insurance, which has led to an upsurge in demand from lower-income women.

The Breast Cancer Landscape

One in eight American women will get breast cancer. Two-thirds of all cases cannot be traced to any specific cause—they are considered (by medical science) to be due to random mutation, in other words “bad luck.” Fifteen percent can be linked to specific risk factors, mainly smoking, early puberty (before 12), having a child after 30, starting menopause before 52, obesity, and drinking. Studies have not confirmed any link between breast cancer and the consumption of processed meats, sugar, or milk, nor is its incidence reduced through consumption of olive oil, green tea, or soy.

There is a genetic link in some cases. UC Berkeley researcher Mary-Claire King determined in 1990 that if one parent had the BRCA1 gene, there is a 50% higher possibility of breast cancer. The BRCA 1 gene has been located, along with the related BRCA2. Both together account of 10% of breast cancer cases.

The Players

Pickert focuses on interviews with established players in the breast cancer field. Their comments and explanations shape what you get from the book, and listing them here gives an idea of the book’s scope:

• Diana Petite: epidemiologist; CDC, UCSF, Kaiser Permanente researcher since 1993; 2004 UL Preventive Services Task Force; 2009 report challenged assumption that annual mammograms are necessary
• Laur4a Esserman: oncologist, breast cancer surgeon; MBA; Stanford; Director, Carol Franc Buck Breast Care Center, UCSF; critic of past treatments
• Etta Pisano: Harvard, chief research officer American College of Radiology; developed mammography guidelines; proponent of screening
• Lorraine Pace: political push for research on clustering in Long Island (Long Island Breast Cancer Study Project)
• Marilee D. Gammon: Columbia & U of North Caroline, Chapel Hill; epidemiologist; headed 2004 NCI for Congress (mandated 1993); found no conclusive evidence
• Mark Skolnick: at Myriad Genetics; isolated BRCA1 & 2 genes 1994.
• Charlotte Haley: First idea for breast cancer ribbon, 1991
• Nancy Brinker: founded Susan G. Komen Breast Cancer Foundation, 1982
• George Beatson: Lancet report 1896 started ovarian removal as cancer treatment
• Elwood Jensen: U of Chicago chemist; concluded estradiol interacted with enzymes to affect reproductive organs; concluded some breast cancers field by estrogen
• Craig Jordan: ICI chemist; tested use of morning-after pill (tamoxifen) as breast cancer treatment
• Arthur Barclay: botanist, US Dept of Agriculture, project with NCI to find anticancer compounds in nature; found bark of Pacific yew tree 1964, developed Taxol chemotherapy drug
• William Peters: Duke Medical Center oncologist, studies of high-dose chemotherapy; led to 1999 ASCO meetings (after 3 studies) that concluded high dosage not more effective
• Larry Norton: Sloan Kettering, head of breast cancer from 1988; developed model for tumor research; promotes use of anthracyclines;
• Cuthbert Dukes: developed staging system for [rectal] cancer 1932
• Pierre Denoix: developed staging system for solid tumors
• Michael J. Bishop/Harold Varmus: UCSF microbiologists; in 1970s discovered all animals have oncogenes, cells that can trigger cancer
• Axel Ullrich: Genentech; proved that mutated version of HER2 oncogene caused cancer
• Dennis Salmon: UCLA; 1987 published research showing HER2 proteins caused cancer; led to development of Herceptin from Genentech; approved 1998; expanded in 2006 to women with HER2-positive breast cancer
• Sara Hurvitz: director breast oncology program, UCLA
• Andrew Da Lio: current chief of plastic surgery, UCLA; operated on Pickert
• William W. Shaw: former chief of plastic surgery, UCLA; pioneered autologous-reconstruction
• Helena Chang: surgical oncologist, director of UCLA breast cancer center, taking over from Susan Love; originally from Taiwan
• Fanney Burney: English novelist; wrote first long description of mastectomy experience (without anesthesia) in 1810; lived to be 87.
• Stephen Paget: 1889 Lancet article theorized that breast cancer cells spread throughout body.
• William Stewart Halsted: addict and head surgeon at Johns Hopkins; promoted radical mastectomy (before he died in 1922)
• 1896: Emil Grugge first to treat breast cancer with radiation
• Geoffrey Keynes: British doctor who tried radiation and smaller scale surgeries
• George Crile, Jr.: Cleveland doctor 1953 pioneered partial mastectomy; NSABP study concluded in 1981 that partial no less effective than radical
• Armando Giuliano: LA surgeon; mapped lymph nodes
• Monica Morrow: chief breast surgeon Sloan Kettering
• Richard Pazdur: head of FDA’s cancer division, instituted reforms in how research funded and organized

Therapies
Pickert touches on a range of therapy options, from hormone therapy to chemotherapy. She goes into depth in the development of a handful of treatments and drugs, such as Herceptin, a first generation HER2 drug; Perjeta and Kadclya, which cut the chances of recurrence in half; CDK4/6 enzyme inhibitors; and the oncotype DX test for tumors, which determines the probability that breast cancer will recur after hormonal therapy. She does not cover any alternative therapies—all of her examples fall squarely within biomedicine.

Current Controversies

Pickert brings up two areas in which there is disagreement within the field. The first is mammogram screening before age 50. The second controversy concerns the choice of the chemicals. Sloan Kettering and other East Coast centers generally recommend the use of anthracycline-based therapies to treat certain cancers, such as Pickert’s DCIS. UCLA, and institutions in the West Coast in general, recommend the use of a taxanes. Anthracycline is stronger but there is increased risk it may lead to congenital heart disease. Both are forms of chemotherapy. In the past patients usually left it to their oncologists to decide. This is changing, says Pickert, as patients become more involved and knowledgeable.

The most moving chapter describes the metastatic patients who experience relapse. Even women who are diagnosed early can relapse. And once the cancer spreads to the bones, brain, lungs, or liver it is usually fatal. So even a cancer-free diagnosis is no guarantee it will not recur. Women (and men) with breast cancer live under this perpetual cloud. Sometimes cancer has spread to the bones already, but this is not found during the original focus on the breast.

Pickert in the end is optimistic. She pins most of her optimism on new drugs and progress in treatment regimes. Many of the currently available treatments were only developed in the last ten years, she writes. In addition, patients are becoming more forthright, and treatments are becoming more targeting. As a cancer survivor with a better than 95% chance of no recurrence, she still acknowledges the immensity of the changes the cancer has brought about in her life. Clearly, the breast cancer industrial complex she describes so carefully, despite its cumbersome protocols and sometimes barbaric past, has been an essential element in her battle against the disease.

[Ricky · Rating 4 out of 5]

I enjoyed this book especially when the HER2 was mentioned and talked about, since the lab i work at does a lot of HER2 testing.

[Jamie Fuller · Rating 4 out of 5]

Pickert does a beautiful job of tackling a complex and emotionally intense subject in language and vignettes that make it easy to access and process for the lay reader. She covers both the history of breast cancer and its treatments (and the massive controversies along the way) and the latest, most up-to-date technology, including projections for future treatments and methodologies.

The book is incredibly educational, in terms of busting myths and misconceptions about the disease, its victims, and the treatments they are prescribed. As a survivor herself, Pickert offers a comprehensive, up-close-and-personal view of life in treatment and out of it. It also taps into the deep emotion around the subject, and the author does a commendable job of giving opposing parties fair treatment, laying out everyone's views with respect and leaving readers to make their own judgements.

As someone who trained as an alternative health practitioner, the only thing I was disappointed in while reading this book was the fact that the author confined her discussions and research solely to the realm of mainstream medicine. Although I understand why she might have chosen this, I felt like (whatever her ultimate opinions of them), it would have been strongly aligned with the mission of her book and informative to readers interested in the subject to at least touch on the alternative treatments and disease theories that so many cancer patients turn to or seek out in the face of fear about traditional options or after those options have failed them. Everything from keto to the chemically-based treatments illegal in the US that patients go to other countries to receive - Pickert ignores them completely.

That said, everything that the book covers it addresses adeptly, and the information it offers is well worth the time and emotional investment it takes to read.

[Chloe A-L · Rating 2 out of 5]

This is one of those books that is so bafflingly cis and perisexist that I desperately wish I could just add three words to the title so reading it wouldn’t bother me so much. In this case the words are “of cis women”.
This book completely ignores the existence of non-women who get breast cancer, which like, fine, ok, it’s awful but I understand how a cis woman could fall back on the culturally omnipresent fallacy that there are two sexes and not stop to consider it, but this book barely mentions even that CIS MEN ALSO get breast cancer, which feels inexcusable. It took 128 pages for her to mention this, out of a 336 page book (with the last 50 pages being footnote) and then it literally never comes up again.
For this book to (rightfully!) express concern about the lack of accurate knowledge about breast cancer in the wake of 90s era “awareness” campaigns and then go on to state that “99 percent of breast cancer cases are inextricably tied to (cis female hetero normatively-reproductive) motherhood, or, more precisely, the potential for (cis female hetero normatively-reproductive) motherhood.” (Parentheses my addition) feels short sighted, irresponsible, and a case of the author using her own experience to define a disease that encompasses more than just her and other cis women.
This book isn’t a history, cultural study, or scientific paper on breast cancer in America. It’s a book about how breast cancer effects cis women, and not even a particularly good overview of that. She briefly mentions the issues around the intense sexualization that pervades the cultural message around breast cancer, the concerns that “pink washing” focuses on having healthy women with nice breasts as the end goal, but never really dives into it, or related social/societal issues like the statistically huge amount of men who leave their breast-cancer-afflicted wives. She makes an attempt to think about the broader personal, social, and societal consequences and the societal understanding of breast cancer, but is ultimately unable to deconstruct her own assumptions and biases enough to say anything particularly meaningful on that front, leaving a book that’s more “poorly disguised memoir” than anything that could be described as “the science, culture and history of breast cancer in America.”

[Heidi · Rating 2 out of 5]

This is a book that started out strong and, unfortunately lost its way. There are things the author did really well, and that actually makes the bad parts stand out more. Although the book was clearly well-researched, and the author did a fairly good job of describing the methods used in scientific research and some of the studies, she also made it seem as if there is only one BRCA 1 and one BRCA 2 mutations - which is not accurate - there are several and they impact breast cancer risk in different ways. The author did a great job of explaining the controversy around mammograms, but a very poor job in describing some of the controversies and criticisms around funding and breast cancer charities. I was expecting more about the politics of funding and research, even knowing the size of the book before I started reading - clearly to approach being comprehensive, it would have it to have been more like The Emperor of all Maladies in size. 280 pages is nowhere near enough to touch on everything. That being said the book, at times veered too much into a memoir for me. At the beginning, I thought the author was just trying to humanize the data and experience, but as I continued reading, I really felt more and more that she should have split it out and written two books, this one, and a memoir if she wanted include information about herself. Too often the stories she told about herself didn't really fit in with the chapter or add any understanding to the topic being discussed at that point in the book. She did do a much better job of blending in the experiences of other women into the narrative of the book. Again, this is a bit of a double edge sword, as the inclusion of her stories alongside those of the other women, made clear that this was about one slice of the culture of breast cancer. The book completely left out the experiences of poor, un- or under-insured women and those who can't get a cancer diagnosis and take grand vacations. There are a lot of women out there who have to find a way to still go to work every day, or face homelessness due to their diagnosis. Their stories, their experiences, and their history were completely left out.

[Carolyn · Rating 5 out of 5]

Cancer is, for many people, an extremely intimidating topic. You'd be hard pressed to find a person whose life has not been touched by it in one way or another. And yet, despite its ubiquity, we rarely talk about it in a frank, rational manner. As the author notes, there is so much emotion and fear tied to the disease that we don't actually learn anywhere near as much about it as we should. Breast cancer may be the clearest example of this phenomenon. And, as she proves in each chapter, we do ourselves, our loved ones, and the rest of the population a disservice by simplifying the illness into a big, pink monolith.

As a journalist specializing in health care topics, Ms. Pickert was no stranger to the complexities of the American medical system. And yet, as a young woman staring down a breast cancer diagnosis, she found herself in the same frightening position as any other patient. Fortunately for readers, she applied her research and analytic skills to the disease that interrupted her life, and has provided an invaluable resource in this book.

Pickert addresses breast cancer from a great number of angles. Her research reveals a rapidly changing landscape of treatment protocols, including radiation, surgical intervention, chemotherapy, and other drug therapies, and touches on the "cultural differences" between leading oncologists with conflicting treatment preferences.

Through her own experience and those of other women, she explores options to ameliorate some of the most unpleasant parts of treatment, and encourages patients to ask questions and be active in the decision making process about their cancer treatment. Using primary written sources, she profiles the historical pitfalls in surgery, anesthesia (or lack thereof) and aftercare.

She also sheds light on the dogma and politicking that have invaded this branch of medicine. This includes a look at the original idea of a ribbon awareness campaign (launched by a single woman hand making and distributing hundreds of peach-colored ribbons, inspired by the red AIDS awareness ribbon campaign), its co-opting and morphing into the pink ribbon used by so many companies and charities.

Also explored is the debate over the diagnostics that we have grown so accustomed to, especially mammography. While emotions still run high on the subject, multiple impartial studies have called into question the efficacy of annual mammograms in women under 50, as well as its usefulness as a tool in detecting certain types of tumors in dense or very dense breast tissue. She talks to experts who are evaluating other technologies, such as abbreviated MRI and ultrasound, which may improve testing accuracy and prevent the emotional and physical trauma of unnecessary procedures.

Overall this is an excellent book that covers an enormous amount of information and encourages us all to have a more active role in understanding breast cancer. The writing is comprehensive but accessible, and I would love to read more from this author.

[Suzy · Rating 4 out of 5]

I loved Radical: The Science, Culture, and History of Breast Cancer in America by Kate Pickert. This book is a thorough review of large breakthroughs in breast cancer research, including the evolution of our basic understanding of breast cancer, the mainstay treatments, and our increasing ability to personalize risk and treatments. It also provided an overview of how advocacy efforts have grown and changed in recent years. After reading The Undying by Anne Boyer earlier this month, which provided searing commentary about pink ribbons and the detrimental impacts of treatments, a detailed history like this was perfect for filling in the blanks about why these things are the way they are. In particular, I was fascinated by the chapter discussing the rise and fall of Susan G. Komen.

Pickert was diagnosed with invasive breast cancer at age 35. I enjoyed her small memoir sections, which were woven through the chapters to provide personal experiences. However, I would have liked if they had more clearly guided the book’s narrative. It sometimes felt like there was no driving force from chapter to chapter, since each chapter covered a distinct topic.

As a health-care journalist, Pickert does not shy away from controversial topics in breast cancer research. Population-wide breast screening practices have been a point of contention for years, and I thought that her coverage of the topic was nuanced and compelling. She did not appear to be biased in her reporting, and I don’t think she expected readers to come away with one clear answer on any of these complicated issues.

This book would be very accessible to someone with little to no scientific knowledge. I was already familiar with today’s treatments and controversies. I still found this book to be a refreshingly approachable way to learn more about the history of the field. This was an ambitious book, and it was very well executed.

Thank you to Little, Brown Spark and NetGalley for providing me with an ARC in exchange for my honest review.