DATE: Wednesday, June 4, 1997               TAG: 9706030070

SECTION: DAILY BREAK             PAGE: E7   EDITION: FINAL 

TYPE: Book Review 

SOURCE: BY BERYL LIEFF BENDERLY, THE WASHINGTON POST 

                                            LENGTH:   90 lines

SCARE TACTICS SINK BOOK ON BREAST CANCER

BREAST CANCER, it goes without saying, is a dreadful disease, exacting a huge toll in undeserved suffering and death.

But is it in any sense uniquely terrible? More awful than lung or colon cancer, each of which kills more people and a higher percentage of victims? More lethal than heart disease, the leading killer of women? More horrific than AIDS, the leading killer of young, urban women? More excruciating for victims and their families than Alzheimer's or schizophrenia? More unfair than cystic fibrosis or Huntington's?

Such preposterous and distasteful comparisons, I regret to admit, came to mind early in Karen Stabiner's account of life in the breast cancer clinic headed by the prominent surgeon Susan Love, just about when I learned ``how bad it is: Every breast cancer patient, even (the) privileged women (described in this book), faces a lifetime of apprehension.''

Well, so does nearly everyone who's had any other form of cancer, not to mention heart disease, stroke, juvenile diabetes, hemophilia, MS, Parkinson's, lupus, and scores of other degenerative or incurable ailments. Breast cancer is not uniquely dangerous or uniquely prevalent, but it has become uniquely fashionable, especially, Stabiner admits, ever since a ``generation spoiled by easy medical answers came face to face with a foe that had so far defied the doctors . . .

The media told us we could be vibrant well into middle age, even beyond, while breast cancer snickered and plucked women off that path at random.

I hope I do not seem callous. I count among breast cancer's victims far too many close friends, both living and deceased, and thus know something of the suffering it brings. I have no objection whatsoever to Stabiner's urgent effort to understand a disease that threatens so many; nor to her research, which is earnest; nor to her sympathy for the patients, which is deep and sincere. But I cannot abide her hyperbolic, almost paranoid tone.

Breast cancer is not an anthropomorphized villain but one of many intricate malfunctions of the human cell. That doctors cannot reliably predict a particular case's course indicates not ``deception everywhere,'' but their lack of knowledge about a condition that involves the breakdown of the most basic processes of life itself. No ``civilized conspiracy'' has ``hobbled medicine's progress against breast cancer since the mid-1880s'' but rather the error and caution normally characteristic of human beings faced with a problem beyond their power to solve or even to comprehend.

Indeed, far from suffering, as Stabiner implies, some perverse and unique vulnerability to reproductive malignancies, women - and not men - have benefited from the greatest advance in cancer prevention in human history, a procedure so effective and so pervasive as now to be essentially invisible. Until the mid-1940s, cervical/uterine cancers claimed more lives each year than breast cancer. And then, suddenly, that death rate plunged nearly out of sight. The Pap smear, widely available since the early 1950s, removed the threat from virtually everyone who gets even marginally competent health care. Were some such quick fix available for the far less accessible abnormalities of breast tissue, you can be sure that doctors would rush just as fast to apply it.

``I am not a medical writer by specialty,'' Stabiner announces with apparent pride, adding, ``I consider it an advantage, in this case: women who worry about breast cancer are not specialists either, and it was my job, writing from a reporter's perspective, to translate confusing information into a form they could comprehend.''

In some reportorial situations, Stabiner might be right; the outsider's fresh view often can yield revealing insights. But in a field as subtle, technical and emotionally fraught as breast cancer, women need not breathless flashbacks or hero worship but clear explications and, above all, a sense of historical and scientific proportion. Stabiner herself notes that the disease scares women ``out of all proportion to statistical reality.''

Her approach, however, does nothing to allay that dangerous fear. Fine medical reporters, she seems not to realize, deploy deep sophistication and cool skepticism in the cause of detailed, measured and knowledgeable writing, which, in the hands of masters like the late Berton Roueche, can be both astonishingly illuminating and a pleasure to read.

But Stabiner makes mistakes that call into question her essential understanding of issues.

It is, of course, a perfectly wonderful idea for women to understand the real threat that breast cancer poses, to take what steps they can to protect themselves, to work for improved remedies and an ultimate cure, and to treat with the utmost respect and compassion all those afflicted. But it does no one any good to foment panic, paranoia or self-pity in the guise of raising awareness. ILLUSTRATION: Graphic

BOOK REVIEW

``To Dance With the Devil: The New War on Breast Cancer''

Author: Karen Stabiner

Publisher: Delacorte. 518 pp.

Price: $25.95.

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