In the early nineteenth century in the United States, cancer in the breast was a rare disease. Now it seems that breast cancer is everywhere. Written by a medical historian who is also a doctor, Unnatural History tells how and why this happened. Rather than there simply being more disease, breast cancer has entered the bodies of so many American women and the concerns of nearly all the rest, mostly as a result of how we have detected, labeled, and responded to the disease. The book traces changing definitions and understandings of breast cancer, the experience of breast cancer sufferers, clinical and public health practices, and individual and societal fears.
1. Introduction; 2. Cancer in the breast, 1813; 3. Pessimism and promise; 4. Taking responsibility for cancer; 5. Living at risk; 6. 'Do not delay': the war against time; 7. 'Prophets of doom': skeptics of the cancer establishment at mid-century; 8. Balancing hope, trust, and truth: Rachel Carson; 9. The rise of surveillance; 10. Crisis in prevention; 11. Breast cancer risk: 'waiting for the axe to fall'.
2008 Choice Outstanding Academic Title
"Providing extensive research and case histories, including that of author and environmentalist Rachel Carson, Aronowitz presents his findings here to a national audience."
- Library Journal
"From the perspective of a physician who is also a trained historian and social scientist, and a gifted narrator, Robert Aronowitz has written an illuminating and moving account of what has, and has not changed in the knowledge and understanding of breast cancer, its diagnosis, treatment, prognosis, and prevention, and in its lived experience in American society over the course of the nineteenth and twentieth centuries. Drawing principally on rich case studies of women with breast cancer, and the clinical records and correspondence of physicians who have been pathmakers in this field of medicine, he vividly demonstrates the entwined influence of scientific, technological, social, and cultural factors on this history. He does it in a way that not only provides first-hand insights into the attitudes and values of patients afflicted with breast cancer, their suffering and decision-making, but of their doctors and families as well."
- Renée C. Fox, PhD, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania
"A fascinating and thought-provoking study of the clinical experience of breast cancer patients and their physicians. Through an imaginative reconstruction of that experience, Aronowitz shows how culture -- in terms of values and medical ideas and practices -- has changed over the past two centuries, while shaping the perceived choices of both doctor and patient. The author wants us to think critically and circumstantially about how we evaluate risk and he succeeds admirably; this is an outstanding contribution to our understanding of medicine past and present."
- Charles Rosenberg
"Fear, risk, and the biology of disease are all critical actors in Robert Aronowitz’s path breaking new assessment of breast cancer in American society, Unnatural History. He brilliantly demonstrates how the experience of disease cannot be “resected” from time, place, and culture. Patients, clinicians, and historians will greatly benefit from his insight and compassion."
- Allan M. Brandt, Kass Professor of the History of Medicine, Harvard University
"The evolution of medicine's understanding of the biology and natural history of breast cancer as well as societal attitudes toward its detection, prevention, and treatment is a fascinating story. Dr. Aronowitz's erudite and relatively unapologetic and honest account of how 'the more things change, the more they stay the same' offers a sobering testament of how this story has unfolded over the past 2 centuries. It reflects the frustration of trying to drive at night without headlights (i.e., managing breast cancer in the 1800s, without sufficient understanding of the biology of the disease), and the delicate dance between physician and patient with respect to managing this disease during a time of growing, but often conflicting data.
Both those involved in the care of breast cancer patients, and patients and their families should find the journey that Dr. Aronowitz's book takes them on to be most illuminating."
- Andrew D. Seidman, MD, Attending Physician, Breast Cancer Medicine Service Memorial Sloan-Kettering Cancer Center
"Dr. Aronowitz has written a compelling and rich history, so much so that a review can barely skim the highlights. In addition, he wants us to think critically about risk evaluation. Aronowitz hopes that knowledge of this history will help clinicians and patients respond more thoughtfully to the challenges presented by the many options we have for confronting breast cancer."
- Shelf Awareness, Marilyn Dahl
"In his new book, Unnatural History, Robert Aronowitz, a clinician and historian of medicine at the University of Pennsylvania looks at how breast cancer was understood and experienced in the USA from the early 19th century to the present." -Alison Bateman-House, Lancet Oncology
"Unnatural History traces how breast cancer was transformed over the last two centuries from an object of fear, dealt with privately and in isolation, to a matter of enormous individual and collective concern. Robert A. Aronowitz, who is a clinician as well as a historian, draws on lively personal anecdotes as well as more standard archival sources to produce an account with both historical sweep and analytic depth." -Samantha J. King, Journal of American History
"...a superb book..." -James S. Olson, The Journal of Interdisciplinary History
"Breast cancer has a singular history, but the approach of this author would serve analyses well as we expand our historical view from the individual to culture and society." -Linda E. Sabin, Nursing History Review
"[Its] ability to balance physicians' accounts with patients' stories and experiences is the main strength of this book. Aronowitz skillfully finds a middle ground between hagiography and demonization of leading cancer surgeons and researchers."
journal of social history, Heather Munro Prescott, Central Connecticut State University