In her lyrical account of breast cancer, Anne Boyer writes about ‘mortality and the gendered politics of illness’. Her book is provocative and while much of what she discusses will be familiar to those inculcated into the extensive and wide-ranging literature on the cancer experience, in places she departs from the well-worn narratives and offers radical critiques of healthcare and society. Diagnosed with chemotherapy-resistant triple-negative breast cancer at 41, Boyer recounts her experience of living with an illness with no targeted treatments available. Accounting for between 10 and 20 percent of breast cancers, her form of the disease had significantly poorer prognoses than others and is responsible for a disproportionate number of breast cancer deaths. It also disproportionately affects black women and accounts – although only in part – for the discrepancies between their survival rates and the survival rates of white women in Europe and North America. This discrepancy is also caused by racist healthcare services and healthcare professionals and by the untenable and unconscionable correlations between sickness, survival, and poverty in both nationalised and insurance-based healthcare systems.
Anne Boyer returns to these themes – politics, poverty, and the provision of healthcare – repeatedly in her book. As a single mother, ‘living payslip to payslip’, her condition was ‘both a crisis and an initiation’ into new ideas about what it meant to be ill in the United States of America. For those familiar with the genre of cancer-writing, these are well-trodden themes. In her 2013 article about black women and breast cancer in Memphis, Tennessee, Tara Parker-Pope begins with an anecdote, ‘After her doctors told her two months ago that she had breast cancer, Debrah Reid, a 58-year-old dance teacher, drove straight to a funeral home.’ Parker-Pope argues that for these women, and in contrast to pervasive narratives of survivorship and remission, cancer remains an incurable disease. ‘Incurability’ is an unstable concept – one that gestures towards more than just the fact of prognosis. After all, whether it kills them or not, the diagnosis brings with it the spectre of death. Incurability is an identity that cancer has struggled to shake – regardless of improvements in treatment.
The question and inconsistency of cancer’s incurability permeates The Undying. Boyer deals with these themes with unusual nuance and literary skill. She describes her treatments – more toxic than the disease itself – by making clear their very real nature as poisons:
“To administer the medicine [Adriamycin], the oncology nurse…must dress in an elaborate protective costume…The medicine destroys tissues if it escapes the veins: it is sometimes considered too dangerous to everyone and everything else to administer by drip. It is rumoured, if spilled, to melt the linoleum on a clinic floor” (p. 57).
In my own research into malignant disease’s history, I argue that cancer was constructed as an incurable disease in the nineteenth century. Then as now, incurability was not just a biological observation, but a rhetorical tool and identity quite separate from individual people’s actual prognoses. Nonetheless, the language we now use to talk about cancer – the language of remission – obscures the essentially palliative nature of most of the treatments doctors deploy. Oncologists, researchers, and cancer organisations use an obfuscating array of statistics and rates of recurrence to elide the precariousness of cancer survivorship. Cancer Research UK, acknowledges the liminal phase that cancer survivors occupy, ‘Unfortunately, it isn’t usually possible for doctors to say for certain that cancer has been cured…Living with this uncertainty is one of the most difficult things about having had cancer.’
Indeed, many of the themes that Boyer explores in The Undying are familiar chapters in the twenty- and twenty-first-century cancer story. Gender, chemotherapeutics, politics, poverty, and environment have long been touchstones for patients and activists who have taken to literary forms to advocate for awareness and change. This is, after all, a profoundly political book and Boyer takes issue with the public image of breast cancer as dominated by smiling white survivors, ‘Only one class of people who have had breast cancer are regularly admitted to the pinkwashed landscape of awareness: those who have survived it’. She critiques the individualised nature of these narratives, ‘To tell the story of one’s own breast cancer is supposed to be to tell a story of “surviving” via neoliberal self-management – the narrative is of the atomized individual done right, self-examined and mammogramed, of disease cured with compliance, 5K runs, organic green smoothies, and positive thoughts’ (p. 9).
In contrast, the account Boyer offers is thoroughly social and thoroughly structural. She blames ‘industrial capitalist modernity’ for having made, or ‘worried’, cancer into (or out of) existence (p. 28) and laments the specific and exclusionary social and familial model of medical care that the health system presumes, ‘In the United States, if you aren’t someone’s child, parent, or spouse, the law allows no one else guaranteed leave from work to take care of you’ (p. 29).
It is in her discussions of these social and structural conditions of cancer that Boyer departs from familiar narratives of the disease and offers her most intriguing contributions to the genre. This is a book about labour and work as much as it is a book about disease. She pays unusual attention to the non-clinical staff that occupy her hospital experience and examines their contributions to her care:
“The word “care” rarely calls to mind a keyboard. The work, often unwaged or poorly paid, of those who perform care…is what many understand to be that which is the least technological, the most affective and intuitive…Care seems as removed from quantification as the cared-for person’s sensations of weakness or pain seem removed from statistics class…But strange reversals reveal themselves during serious illness. Or rather, what appears to be reversal becomes clarification” (pp. 53-54)
In doing so, she calls on us to reconsider the nature of work and the labour of care. There is a pervasive idea that hospital work is not work at all, but a vocation, calling, or ‘labour of love’. Boyer engages with the widespread assumption – in both Britain and the United States – that the ideals and practices of managerialism and bureaucracy have superseded those of care and compassion in contemporary health services. She, however, demonstrates that bureaucratic and managerial practices than also be caring and compassionate – even in the places where we least expect it.
 Tara Parker Pope, ‘The Cancer Divide: Tackling a Racial Gap in Breast Cancer Survival’, New York Times, (20 December 2013).
Agnes Arnold-Forster is Research and Engagement Fellow for Surgery and Emotion, Department of Humanities, University of Roehampton. Recent publications include: ‘A Small Cemetery: Death and Dying in the Contemporary British Operating Theatre’, in Medical Humanities (2019), and ‘Mapmaking and Mapthinking: Cancer as a Problem of Place in Nineteenth-century England’, Social History of Medicine, (2018).
Anne Boyer’s book, The Undying: A Meditation on Modern Illness (2019), is published by Allen Lane.