The Cancer Journals: what has changed since 1980

The Cancer Journals is a book Audre Lorde first published in 1980. Her publisher, Aunt Lute Books, describes it as a profoundly feminist analysis of her experience with breast cancer and a modified radical mastectomy.

The publisher says the text moves between journal entry, memoir and exposition. It also says Lorde refuses the silencing and invisibility she experienced, both as a woman facing her own death and as a woman coping with the loss of her breast.

It is not a guide. It is a personal and political account. This page does not summarize the book chapter by chapter. For that, read the book or the publisher's page.

A book from 1980 cannot tell you what to do today. Breast cancer care and screening guidance have changed since it was published. If you are making decisions about surgery, tests or treatment, use current sources and your care team.

Screening is one example. USPSTF recommends screening mammography every two years for women aged 40 to 74, as a Grade B recommendation. For women 75 and older it says the evidence is not enough to judge benefits and harms. It makes no recommendation for women under 40.

Treatment is another. NCI says breast cancer treatment depends on stage and on the tumor's characteristics. It describes triple-negative breast cancer as cancer that does not have the targets typically used to treat other types, but says treatment options are available. For stages I to III, NCI lists surgery, chemotherapy, radiation when indicated, pembrolizumab with chemotherapy, and olaparib for people with BRCA1 or BRCA2 changes. For metastatic disease it lists chemotherapy, olaparib for BRCA changes, sacituzumab govitecan and pembrolizumab.

If you are weighing surgery, ask your team about all options, including breast reconstruction and closing the chest flat without reconstruction. See mastectomy, reconstruction and flat closure experiences.

NCI's SEER program reports 5-year relative survival for female breast cancer at 91.9 percent. It says about 13.0 percent of women will be diagnosed with breast cancer in their lifetime. These figures describe large groups. They cannot predict what happens to one person, and they average across all stages at diagnosis. For the current overview see breast cancer and breast cancer screening.

This is where Lorde's argument has aged best, and least comfortably.

NCI defines cancer disparities as gaps between groups of people. The gaps show up in measures such as new cases, deaths and survival. On breast cancer specifically, NCI states that Black women have lower breast cancer incidence than White women but are more likely to die of the disease. CDC states that for non-Hispanic Black women and Hispanic women, breast cancer is the leading cause of cancer death.

NCI does not attribute this to biology alone. It names social determinants of health: income, insurance status and access to transportation. It also names neighborhood conditions, institutional racism and the chronic stress it causes, and conscious or unconscious bias from health providers. It says inherited factors or tumor biology may also play a part. The same page states that Black men are more than twice as likely as White men to die of prostate cancer. It also states that Black women have the highest death rates from cervical cancer.

Whether the book itself speaks to these gaps is for the reader to judge. See Black Americans and cancer for how this looks in practice.

It suits readers who want to think about what illness does to identity, looks and voice. It does not suit a reader who needs current information about breast cancer. For that, use the sources below and your care team.

• The Cancer Journals — publisher's page (Aunt Lute Books)
• NCI — Cancer Disparities
• CDC — Breast Cancer Statistics
• USPSTF — Breast Cancer: Screening
• NCI — Breast Cancer Treatment (PDQ) Patient Version
• NCI — Triple-Negative Breast Cancer Treatment
• NCI SEER — Cancer Stat Facts: Female Breast Cancer

This page discusses The Cancer Journals for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.