Excerpt: 'Promise Me: How a Sister's Love Launched the Global Movement to End Breast Cancer'


Under her linen dress, her breasts were visibly misshapen and distended now. When she was naked, she could see a shadow rising to the surface. The skin became translucent purple and gradually gave way like a slit in a temple curtain. The lesions wept a thin blackish-bloody fluid. The skin crusted and opened, an unblinking eye with the slick, eel-colored tumor at its center. Her sisters tried to clean and care for her, but on a cellular level, the tumors were dying as rapidly as they multiplied, so the bulging tissue became necrotic, and the smell of death hung in the air, permeating the bedclothes, lingering in her hair. The woman's strength leaked out of her. Loved ones tried to feed her broth and soft meal cakes, but she was quickly wasting away, barely a thread of herself.

At the end, her sisters sat next to the bed, whispering to each other. Is she breathing? Did you see her eyelids flicker? They were terrified to touch her now. What if this dark disease was contagious? They had to think of their children. Lying in bed at night, they moved their hands over their own breasts, afraid to exhale. Here? Didn't she say it started here, with a bump like a small pebble?

It would be nice to think someone who loved her held her when she died.

A thousand years went by.

Four centuries before the birth of Jesus— about the time Siddhartha became the Buddha and Malachi the last of the Hebrew prophets— the Greek scientist Hippocrates observed coal-black tumors erupting through the skin of his patients and concluded that the malady was a manifestation of too much black bile or melanchole in a woman overly influenced by the element of earth, an internalization of autumn's dry cold. Tentacled tumors examined during autopsies spidered into the body, evoking the image of a crab.



There was no hope of treatment or cure, so it was better, Hippocrates hypothesized, to prolong the life of the afflicted by making her as comfortable as possible in all other respects. He discouraged his students from surgically excising tumors from their patients' breasts, based on his assumption that pervasive black bile was a systemic problem. Barring intervention by the gods, the disease would invariably return with swiftly killing insistence.

For two thousand years, his conclusions remained the conventional wisdom. There was a glimmer in 200 c.e. when Galen, a devoted follower and biographer of Hippocrates, recorded his observation that not all breast tumors were created equal; some were slow and insidious, others quick and virulent. Not all had the iconic crab legs; some blossomed deep in the bosom and remained isolated from surrounding tissue like a lily floating in a pond. Galen treated patients with opium, licorice, castor oil, and incantations, but ultimately, he confirmed the six-hundred- year-old findings of Hippocrates: Breast cancer was a systemic disease caused by the darkest humor, surgery was contraindicated, sufferers were doomed. This remained the final word on breast cancer for another fifteen centuries.

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