Book Review: Anthropologies of Cancer in Transnational Worlds

Anthropologies of Cancer in Transnational Worlds. Holly F. Mathews, Nancy J. Burke, and Eirini Kampriani, eds., New York: Routledge, 2015, 269 pp.

In Anthropologies of Cancer in Transnational Worlds, the contributors offer readers windows into the worlds of patients, caregivers, health care providers, and researchers grappling with cancer in a variety of countries and contexts. From rural villages to genetic testing centers to hospice programs, the essays explore intimate human themes of meaning-making and sociality associated with cancer. The collection importantly emphasizes the ways that people, ideas, technologies, and resources move across borders in response to the disease.

The volume is a significant addition to historical and contemporary literature about cancer, most of which to date has been based in high-income Western contexts where biomedical interventions strongly shape interpretations of the disease. Along with popular and media portrayals of cancer, this literature has generated a collective understanding of the disease among lay educated people and scholars in the Global North. As described in the Foreword by Anastasia Karakasidou and the Introduction by editors Holly Mathews and Nancy Burke, in high-income countries, scholarly and lay popular models view cancer as a life disruption, which can threaten and reorient an individual’s identity. Shared identities are expected to emerge among those suffering from cancer and their loved ones, fostering novel communities and forms of advocacy. Language of hope, metaphors of warfare, and discourses of survivorship abound. The preservation of life is valued at great, if not all, costs, and the search for the cure is constant.

While some essays in the volume resonate with these themes, as a whole, the book departs from this or any single understanding of cancer. Indeed, this is the most significant way that this volume moves scholarship about cancer forward: by forging what Karakasidou calls an “alternative biography of cancer” (p. ix), through which multiple meanings, associations, and trajectories become possible.

The accounts in the volume derive from authors’ ethnographic research in a variety of settings. Importantly, several authors extend anthropological research on cancer into the BRICS countries: Anna Lora-Wainwright provides an account from China; Sahra Gibbon and Waleska de Araújo Aureliano from Brazil; and Alison MacDonald and Kristin Bright from India. From middle-income countries, Natalia Luxardo draws from fieldwork in Argentina and Benson Mulemi from work in Kenya. Continuing to generate new insights on cancer in Western contexts, Aline Sarradon-Eck draws from fieldwork in France, Fiona Harris in Scotland, Julie Armin and Nancy Burke in the continental United States, and Karen Dyer in Puerto Rico.

The volume begins to forge an alternative biography of cancer in two major ways. First, many of the accounts of local interpretations of cancer in low-resource settings contrast starkly with dominant understandings of how cancer shapes identity. As Mulemi writes, in Kenya, where the majority of cancer cases among the poor are detected at late stages, cancer does not necessarily represent a life disruption. Rather, it becomes yet another burden for individuals whose lives are already otherwise full of suffering. Similarly, in rural China, Lora-Wainwright shows how villagers afflicted with stomach cancer conceptualize “fighting” to live not as a new struggle that will end in disease remission, but as a continuation of struggling to survive a lifetime of poverty, physical hardships, and vast sociopolitical change. Second, contrary to Western accounts of people with cancer assuming, prioritizing, and organizing around a disease-based identity, the authors describe how political structure, ethnicity, and gender mediate biosociality. For example, as MacDonald writes, in Mumbai, India, women conceal rather than share identity around breast cancer survivorship, as the diagnosis is stigmatized and can compromise social standing. As Sarradon-Eck describes in France, advocacy does not emerge around survivorship groups, in part due to a socialist emphasis on sameness over group-specific needs. Several essays additionally highlight how people prioritize various social identities—as immigrants, as productive members of the household, as mothers—over cancer-based identities as victims or survivors.

The volume also directs readers’ attention to cancer as a transnational phenomenon. The authors situate cancer within global flows of people, ideas, and resources across national borders. Citizens in low-resource settings are increasingly demanding from public health systems access to technologies such as genetic testing and assisted reproduction, as described by Gibbon and Dyer, respectively. Migration affords access to cancer treatment, whether through remittances sent from family members working abroad, as discussed by Bright in India, or through temporary relocation across borders, as in Armin’s moving tales of undocumented Mexican immigrants unable to obtain cancer treatments in the United States. Scholars of global health will be particularly interested in these essays, which reveal the creative pathways to care and novel forms of rights-based advocacy increasingly employed by health seekers in the post-Alma Ata landscape.

This book also adds to scholarship about caregiving, particularly as it relates to kinship, gender, and emotions. The authors provide rich descriptions of the tremendous emotional burdens faced by people—particularly women—with cancer who struggle to maintain their roles as caregivers, a phenomenon at the heart of de Aráujo Aureliano’s work in Brazil. Informal caregivers struggle with bitterness and resentment over increasing and overwhelming responsibilities toward loved ones, as Natalia Luxardo writes from Argentina, and formal caregivers find themselves blind to the existential suffering of the dying, as Fiona Harris describes in Scotland.

In her insightful Afterword, Lenore Manderson writes, following Levi-Strauss, that cancer is “good to think with” (p. 241). Indeed, this book can serve as a teaching tool for undergraduates, as the stories within illustrate many basic concepts of interpretive and critical medical anthropology. Instructors of global and public health courses will also find the volume useful, as its transnational focus highlights health disparities and opportunities for improving access to care for vulnerable populations.

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