Breast cancer rates may be down in the U.S., but the literature of breast cancer metastasized at a steady pace in 2008, continuing what one scholar has called “a veritable torrent.” Breast cancer memoirs have become such staples—reliably displayed during Let’s Wave Pink Ribbons for Breast Cancer month—that it’s hard to remember a time when women didn’t document their journey from onset through the catalog of treatments to restored health, stabilization, or imminent death. But it wasn’t always thus.

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Humor is a component of most of the more recent breast cancer memoirs I’ve read, too, and I’ve been thinking about why. Laughter diffuses stressful emotions, of course, and humor is a near necessity if these books are going to appeal to cancer-free readers. But it’s mandatory, often, for the health of the memoirist herself: “Cancer humor is like a Zen laugh,” muses Katherine Russell Rich in her 1999 book The Red Devil: A Memoir About Beating the Odds. “[I]t’s a way of gathering back forces, a means of breathing in absurdity, darkness, and pain and blowing them out in one great, joyous guffaw. It is, finally, a form of power, laced with machismo. Fuck you, death. I laugh at you.”

A number of the memoirs include a final chapter in which the author reflects on the gift of cancer—how it brought meaning and depth to her life. Fortunately, that view has spawned a comic backlash. “If it is a gift,” writes Shelley Lewis in Five Lessons I Didn’t Learn From Breast Cancer (and One Big One I Did), published in 2008, “don’t come to my birthday party.” And cartoonist Miriam Engelberg refutes the soul-purifying attributes of cancer in her “memoir in comics” from 2006, Cancer Made Me a Shallower Person.

Sometimes you can feel the forced humor seeping through the page, covering up true emotion: Sprightly, stoic, and vain, Lucas describes weighing her options for breast reconstruction. One method involves taking fat from her buttocks to fill in the breast shape—but she doesn’t want to “lose a piece of ass.”

“‘If you could have seen us at Auschwitz, when we were all together, naked, shaven, tattooed. There were some who started crying, but… we began to laugh, and I mean laugh!’”