BOOK REVIEW

The Feisty Woman’s Breast Cancer Book

Elaine Ratner. Alameda (CA): Hunter House, Inc., 1999. 276 pp., $14.95. ISBN 0-89793-269-2

Merle O’Rourke Thompson

Correspondence to: Merle O’Rourke Thompson, Ph.D., 6012 Morgan Ct., Alexandria, VA 22312 (e-mail: merlethompson{at}compuserve.com).

In her introduction, Elaine Ratner tells us that this is "not a book of medical facts, or a political call to arms or a diary of a brave woman’s struggle against a terrifying disease." She states that it is instead a personal book about a contrary woman’s struggle against the prevailing popular views about breast cancer. From 18 questions on emotional and psychological issues that she confronted during her bout with the disease in 1995, she has framed the answers into the chapters of the book.

In Ratner’s first chapter, "Free Yourself from the Breast Myth," she discusses quite thoroughly the paradox of our culture’s emphasis on the value of women’s breasts and the fact that breasts are not vital organs. Ratner’s own ambiguity arose quickly during her own diagnostic procedures for her cancer. She was upset with the surgeon who recommended breast reconstruction immediately after her mastectomy (strongly suggested because she had two lesions), believing him to be an advocate of our culture’s obsession with breasts. Thus, she established a warning that persists throughout the book: When you are diagnosed with breast cancer, be sure that your medical team knows what you need. Speak up, be feisty. The phrase "what a woman needs" arises often, since Ratner believes that the condescending medical profession assumes that they know women’s needs and pressures women to accept their choices.

Endnotes reveal Ratner’s extensive reading on the subject, although there is no emphasis on the fact that the term "condescending" was quite recently used to describe the doctors who offered no choices, putting their patients under anesthesia for a biopsy that might proceed to the removal of the breast tissue and underlying muscle without the patients’ knowledge or consent. Evidently Ratner has written a book whose time has come, since women of the boomer generation get breast cancer. These women don’t necessarily know that my generation, the one just ahead of hers, fought long and hard to move doctors into the two-step process, into reconstruction, and into adjuvant chemotherapy.

Ratner is on target on a lot of issues. She advises women with breast cancer to stand up for themselves—for example, to change doctors if needed to find one who is psychologically compatible and to research treatment options before making choices. Angry with a doctor–author who advises patients to focus on their disease, she advises women to continue their social interactions with friends and family. A highlight of the book is Ratner’s discussion of her interaction with her 8-year-old daughter after diagnosis of the disease. Many books deal with the wonder of supportive husbands, but few deal with the joy and comfort provided by supportive children.

In these pages, I have often mentioned that I think the often-stated "positive attitude" wished on cancer patients is a heavy burden for them to carry. Although Ratner devotes an entire chapter to this issue and often quotes Deepak Chopra’s and the Simontons’ alternative theories on the mind–body connection, Ratner and I both agree that the best attitude for breast cancer patients is to carry on—to get up, go out, have as much fun as they are able to have, while continuing as many responsibilities as possible. I was back teaching 10 days after simultaneous mastectomy/breast reconstruction, and I missed not one day of teaching during 6 months of chemotherapy. Ratner went to a sports event 3 days after her mastectomy, putting her drains into a purple fanny pack. Now that’s a positive attitude.

In the chapter on choosing treatment options, Ratner divides the options into three categories, ranging from least invasive to most invasive (i.e., local, regional, or systemic). Having chosen mastectomy because it was local, she insists that mastectomy is not a barbaric procedure. Convinced that women have been misled by the statistics showing equal outcomes for lumpectomy and mastectomy, she chose the latter because of its local effects. She quite properly quotes Dr. Susan Love extensively on all of the possible adverse side effects of the radiation (a regional treatment) that accompanies lumpectomy. Although she tells the readers that the choice is up to them, she stacks the deck for her choices by omitting the probability that, after a mastectomy, one fourth of the upper body will likely be numb or that most women do not develop most of radiation’s unpleasant side effects. Using the same technique of choosing the most local treatments, she vigorously defends her choice to refuse chemotherapy (systemic) by citing Dr. Love again on all of the damage that chemotherapy can do to the body, but she does not discuss the various levels of toxicity falling under the word "chemotherapy." Most adjuvant chemotherapy offered to women after breast cancer surgery will not send their immune system into retreat, and new drugs prevent nausea for virtually all patients. During 6 months of chemotherapy, I never experienced any side effects; I didn’t even lose my hair. But then Ratner was much luckier than most women in having a small lesion with clear margins and no cancerous lymph nodes. Her choices, including refusing tamoxifen, would not be wise for many women after surgery.

When I think how long it took us to get plastic surgeons to consider breast reconstruction and to work at doing it well, I’m particularly unhappy with Ratner’s discussion of this subject. She portrays breast reconstruction as a money-making scheme on the part of plastic surgeons, who coerce insecure women into having it, with its resultant ugly disfiguration. Of the many breast reconstructions I have seen, none has looked nearly as horrible as those she describes.

Despite her protestations, Ratner has written a one-sided political recount of one woman’s struggle with breast cancer. However, knowing as I do several women in her age bracket (mid-40s) who don’t want to take even an aspirin, who have grown into maturity being skeptical of medical science, and who are eager to try alternative therapies, I believe this book will appeal to them. Social workers and medical professionals who meet women like Elaine Ratner will be glad her book is there to recommend.



             
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