Marjo Kaartinen examines breast cancer in England and Scotland during the eighteenth century, paying attention to both the medical profession and the suffering of patients. Describing the public's perception of breast cancer as a lethal disease, she also writes about what was understood by physicians as well as how cancer was diagnosed and treated. The book is not just a work about the history of breast cancer, but focuses on human suffering, especially how women dealt with emotions as the disease progressed. Kaartinen draws from personal accounts of patients with breast cancer through private letters, diaries and caregivers' notes. She uses the patients' words to give scholars a personal account of the disease. These sources, from repositories such as the British Library and Huntington Library, help her argue that ‘the patients remained agents of their lives until the very end’ (p. ix).

The book has four main parts that focus on diagnosis, treatment, women as active decision-makers, and the emotional aspects of living with breast cancer. In reviewing cancer literature, Kaartinen looks at how surgeons and physicians defined cancer, but notes that owing to the prevalence of medical self-help books, ‘Laypersons too were considered to be able to recognize certain kind of growths as being cancerous' (p. 3). Physicians' diagnoses were full of uncertainty and accomplished by ‘sight, feel, touch, smell and, occasionally, taste’ (p. 5). Largely considered to be a women's disease, there were debates about whether breast cancer was hereditary or contagious and everything from old age to celibacy, ‘barrenness', menopause, injuries, ‘hysterics' and even breastfeeding children was believed to be a factor contributory to the cancer. Regarding treatment, Kaartinen describes a shift from the consensus that breast cancer was incurable to a growing number of people ‘who believed in the greater effectiveness of the knife’ (p. 23). She reviews available treatments – including diet, mercury, electricity, carbonic acid and different types of risky surgery – and debates about their use. In the section on mastectomies, described as ‘the most feared’ type of surgery, Kaartinen writes that there was no assurance one would survive the surgery and ‘no method of treatment could promise a cancer patient a cure’ (p. 42). She examines debates about the usefulness of surgeries, such as the goal of cutting a tumor out before it became cancerous, and explains that many women survived the surgeries due to the skill of the surgeon and careful bandaging.

In the third part of the book, Kaartinen focuses on the decisions women were faced with after finding a lump on their breast, emphasizing agency, and their mindset before, during and after the horrors of an eighteenth-century surgery. She explains how women ‘often searched for a cure with great determination when they discovered a small kernel or lump in their breast’, and argues that ‘in becoming a patient the sufferer did not compromise her independence’ (p. 55). Women were makers of ‘cancer remedies', with recipes taken from books and usually involving a poisonous substance, and were reluctant to divulge the ‘secret’ of their illness. There are interesting details about attacking ‘quacks' who fed off women's fears by offering an easy and painless cure for their condition. Finally, the author discusses the overwhelming fear of surgery, pain and the unknown among breast cancer patients. Examining cases of women suffering from the lasting pain of a mastectomy without anaesthesia, she looks ‘at the many meanings of cancer pain and the various forms in which it manifested itself’ (p. 96). The cases show that ‘cancer patients were generally treated with awe and admiration: their sufferings made them heroic’ (p. 107). In exploring a range of feelings as women faced death, she also looks at the role of friends, family and neighbours in the patients' lives, to offer a fuller picture of the impact breast cancer had on eighteenth-century women.

This book not only traces the evolution of breast cancer treatment from primary-source material, but also delves into the lives of those suffering from the disease. Importantly, the book is written for a general audience and carefully avoids the use of overly technical terms. While the book contains insightful details about those who had and treated breast cancer, it would be interesting for future studies to compare the British experience with those of other countries. It goes without writing that our knowledge of breast cancer has grown immeasurably since the eighteenth century, but it is still important to examine the status of science and of breast cancer hundreds of years ago. Historians of science, particularly of cancer, as well as scientists who study breast cancer, will find the product of Kaartinen's research an important book.