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'.
This book traces the changing definitions and understandings of breast cancer.
Robert A. Aronowitz studied linguistics before receiving his M.D. from Yale University. After finishing residency in Internal Medicine, he studied the history of medicine as a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania. Dr Aronowitz is currently Associate Professor in the History and Sociology of Science Department at the University of Pennsylvania. He continues to practise medicine, holding a joint appointment with the medical school's department of Family Practice and Community Medicine. Dr Aronowitz was the founding director of Penn's Health and Societies program. He also co-directs the Robert Wood Johnson Health and Society Scholars Program, a post-doctoral program focused on population health. In 2005–6, he was a Fellow at the Wissenschaftskolleg zu Berlin. Dr Aronowitz's central research interests are in the history of twentieth-century disease, epidemiology, and population health. He is the author of Making Sense of Illness: Science, Society, and Disease (Cambridge, 1998). Dr Aronowitz is currently working on a historical project on the social framing of health risks, for which he received an Investigator Award in Health Policy from the Robert Wood Johnson Foundation.
"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
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