In L’usage de la photo, a book published in 2005 and written by the French writer Annie Ernaux and her then-lover Marc Marie, we can read that Ernaux has always wanted to keep a visual trace of what remains after an intimate encounter. This desire gave rise to the idea of photographing the clothes and the misplaced domestic objects left behind by the couple after their intimate encounters, and these pictures are the starting point of the reflections in the book. However, on the following page, immediately after the description of the genesis of the project, another fundamental piece of information, very different from the previous one, is offered to the reader: in 2002, Ernaux was diagnosed with breast cancer. Her reaction to the diagnosis is described as a mixture of astonishment – no other woman in her family has ever had breast cancer – and resignation, since breast cancer is another of those things that happen to women. In the portrayal of the relationship, breast cancer is sometimes at the centre, more often in the background. Still, the reader knows that Ernaux's love story and her cancer treatments are unfolding together. The overlapping of these two fundamental aspects of life – love and illness – that the book vividly presents, reflects how breast cancer creeps in and alters, without erasing, the romantic, social and professional life of the women I interviewed.

In this chapter, I explore the ramifications that a breast cancer diagnosis can have, offering further an overview of the strategies women use to reconfigure their lives. The consequences of breast cancer bring women to reassemble social and sentimental experiences (see Lahti and Kolehmainen, 2020) as well as professional pathways (cf. Bend and Priola, 2023). This dimension can be understood through the concept of relational assemblage – while all assemblages are based on relations between humans and other components, here I use the concept to describe what are usually understood as interpersonal relationships, while emphasising that the formation, transformation and decline or interruption of different relationships can be understood as specific assemblages (Lahti and Kolehmainen, 2020). In this sense, the assemblages go beyond the interaction between patients’ bodies, treatments and biomedical tools, extending to social roles and relations. Breast cancer can profoundly alter the relationship that women have with their partners, but also with their children (if they are mothers) and with other family members. Cancer does not erase traditional gender roles within the family. They continue to define the kind of support women can receive while they are still expected to provide care and fulfil their duties as wives and mothers. Women's efforts in managing their illness, planning their treatments and continuing to take care of their family are often invisibilised and undervalued (Pritlove et al., 2019). Professional identities and careers are also reshaped: breast cancer can disrupt career progressions but can also bring patients to rethink their priorities, reducing their engagement with jobs while they explore other options and opportunities. And it is not just the family and professional life: cancer alters women's social identities and social lives, and old friendships may not withstand the brunt of the disease. In the friendships that do persist, the roles are reconfigured, as sometimes friends become part of the support available to patients. New forms of biosociality (Rabinow, 1996), that is, social relations created around patients’ groups, advocacy or simply around everyday experiences linked to the same diagnosis can be created and replace the disrupted network. However, the post-diagnosis reconfiguration of romantic, professional and social life requires essential work from women. The support available for rebuilding fundamental aspects of life is often limited, and those who cannot rely on personal resources struggle the most. Building on the analysis presented in Chapter 5 of the uncertainties brought by the disease and of patients’ partial biographical assemblages to deal with their possible futures, in this chapter, I explore the processes of assembling social roles, relationships, working experiences and emotions. I show how patients use these new assemblages to find a necessary, albeit often precarious, balance after the diagnosis.

The couple in the aftermath: heterosexuality and breast cancer

The impact of the diagnosis on couples (especially heterosexual couples) has been the subject of various research projects, with contradictory results. Several studies support the idea that a cancer diagnosis can have negative repercussions on relationships (Kirchhoff et al., 2012), while others suggest that cancer is not in itself a reason for divorce (Carlsen et al., 2007) but it might accelerate the separation of partners with difficulties pre-existing the diagnosis (Taylor-Brown et al., 2000). The variability in the experiences of women can explain these discrepant analyses. Further, the attention to the ramifications of breast cancer within heterosexual couples is linked to the image of breast cancer as a highly sexualised disease (see, e.g., Lupton, 1994) that is often considered an attack on womanhood (Ericksen, 2008), with medical professionals in some instances reinforcing the perception of breast cancer as a threat to femininity and the heterosexual norms (see Greco, 2016d).

The philosopher Sandra Lee Bartky introduced the concept of fashion-beauty complex, defining it as ‘a major articulation of capitalist patriarchy’ (Bartky, 1982: 135), the goal of which is to emphasise how adherence to beauty norms is an indispensable requirement for women in many spheres of life, from the romantic to the social and professional. At the same time, love relationships are increasingly becoming commodities hinged on the neoliberal system (see Illouz, 2007). In this context, the aesthetic and emotional changes produced by the disease can profoundly affect the sentimental life of women. Dr Frédéric, a French cosmetic surgeon specialised in breast reconstruction, for example, told me during the interview that if the patient is in a relationship, he prefers to discuss the details of reconstructive surgery with her partner (whom he always referred to as ‘the husband’) present. This is because, according to him, the outcome of a breast reconstruction operation concerns the couple and not just the woman. This idea was expressed in different ways by other medical professionals. Dr Véronique, an oncologist who worked in the Paris region, discussed the importance of undergoing breast reconstruction, in particular for younger patients:

The oncologist could not understand the patient's decision to live in an asymmetrical body, and her attention went to the patient's husband, who might have been suffering from living with a woman with an asymmetric body. In this vision, the centrality of the man in the couple emerges as an element that should orient patients’ behaviour, pushing them to a stricter adherence to gender norms by undergoing a breast reconstruction so as to normalise the body.

The complexities of how different factors can redefine or interrupt a relationship have led Lahti and Kolehmainen (2020) to approach breakups as assemblages. Some of the women whom I interviewed had seen their relationships brought to an end by the disease and/or by different aspects of their post-diagnosis lives. Josiane, a French woman in her fifties, whose breast reconstruction proved problematic, requiring several interventions, told me that her husband had reacted badly to the disruption brought by the cancer. Josiane agreed to go to couples therapy to try to resolve the situation, but, unfortunately, the efforts were in vain and her husband left her. The bodily changes seemed to have been one of the main reasons for the break: ‘my husband left me because of this. He took it very badly that I had breast cancer, he couldn't touch me anymore. He met someone else and left.’ Josiane's situation was not unusual, and this probably partly explains the emphasis that some medical professionals put on breast reconstruction: their approach, while reinforcing oppressive body norms, can be grounded in their everyday experience with women with breast cancer and their partners. The impact of the disease on married life goes beyond the physical changes and includes a different way of relating to the world which can create a rift in the relationship, pushing partners in opposite directions. Other women have discussed how breast cancer has exacerbated incompatibilities and accelerated a breakup. Letitia, a British woman in her early seventies with metastatic breast cancer, thought that her divorce was partially linked with her diagnosis because, as she said, ‘my husband was always one for making plans, always going for new things, and [after the diagnosis] I became more hesitant about long-term planning’. Some doctors and representatives of patient organizations whom I interviewed have said that separations are sometimes also initiated by patients, who, following the disease, see their relationship through a new lens. Béatrice told me that her ex-husband had always had a negative attitude, but that it was only after her diagnosis that she found the courage to leave him, saying that, after having gone through the experience of breast cancer, she could not tolerate the pessimism that he was bringing into her life.

However, breast cancer can also reveal the richness and capacity for containment (see Greco, 2023; and Chapter 2) of romantic relationships. Stéphanie, a French woman in her sixties, told me how difficult it was to cope with her relapse, living alone and with her children abroad. At the time of the diagnosis, she already knew her partner, but she thought the relationship could not withstand the shock of breast cancer. However, her prediction turned out to be wrong, and Stéphanie and her partner married at the end of the treatments:

Stéphanie was not the only patient in a happy relationship with a supportive husband. Sandrine said:

Annarita, an Italian woman in her fifties who received a diagnosis at thirty-eight, said that her mastectomy was ‘a tragedy’, but that her husband, despite not being a perfect partner, had never considered her post-surgical body a problem:

Annarita and Sandrine acknowledged their husbands’ support in dealing with the mastectomy; however, both claimed they could not have a new relationship with another man. For Sandrine, this was a hypothetical thought, but for Annarita, who was divorced and not in a relationship at the time of the interview, this choice had an impact on her life. Annarita felt she was missing something, making it impossible for her to think of having a man in her life. Sandrine and Annarita's experiences illustrate the powerful interplay between cancer and the socio-cultural context of the disease. Both women were grateful to their partners for accepting their bodies, but, in a society that values women for their appearance, neither would feel comfortable with another man. It is also not by chance that Annarita is the most insecure, considering that, as I discussed in Chapter 4, the Italian context reinforces the perception that a woman's worth depends on her appearance.

However, structural aspects of healthcare systems can also contribute to reshaping the relationship. For example, in situations of scarce resources, partners often find themselves cast in the role of supporters and advocates. Mary's experience can illustrate this aspect: she told me that a few years after the end of the treatments, she began to have severe back pain that did not subside with the painkillers prescribed by the GP. One afternoon the pain was so unbearable that she was forced to go to the emergency room with her husband. When she arrived, the staff on duty tried to persuade Mary to go home and keep taking the painkillers, but her husband intervened and insisted that further tests be carried out. Unfortunately, the tests revealed that the cancer had returned and that Mary's pain was caused by bone metastases. She said that without her husband's intervention, she would have been too tired to advocate for herself.

Mary was not the only one who talked about her husband's support in dealing with treatments and mediating with medical staff. Other women expressed gratitude to their husbands and partners and discussed the importance of the material, financial and emotional support their partners gave. Franca, for example, said that her husband had always been a source of support for her: ‘My husband has always been very close to me, he has helped me a lot, he has always been a very pragmatic man and I think that in some ways he has helped me more than the psychologist.’ These flexible reconfigurations of partners’ roles can help a couple resist the shock caused by the disease. However, for women with metastatic breast cancer the reconfigurations are more precarious and need to take into consideration what will happen to their partner after they are gone. This was expressed by Olivia, who said:

This tender description of the daily life of Olivia and her husband shows how the disease disrupts the balance and the strategies that couples, especially those in long-term relationships, put in place, and forces them to revise them. In Olivia's story, we can see yet another example of how breast cancer alters the present and the future of women's lives. For Olivia, the primary concern is ensuring her partner's well-being after her departure, and ensuring that the division of roles that worked so well for them does not hurt her husband.

Reassembling the family: between motherhood and patienthood

The sentimental and couple's life is not the only aspect that breast cancer disrupts. The gendered nature of the disease extends to how care is redefined within one of the most gendered of contemporary institutions: the family. The contradictions within the family have been at the centre of feminist analysis at least since the 1970s. The abolition of the family has been a dominant feature of many feminist reflections (see, among others, Lewis, 2019 and Weeks, 2023), and while this institution is far from having been abolished, significant cultural, financial and legislative transformations taking place since the late 1960s have changed its functioning, and the roles and expectations of its members. However, modernising tendencies coexist with a more traditional organisation, making the family a place where genuine love and affection intersect with the need to perform unequal care work and emotional labour. Family relations can be a form of support for women with cancer while, at the same time, entailing demands that they keep caring for other people – children, partners, older relatives – even while unwell. Women try to balance their need for self-care brought on by the disease and the need to care for others. This balancing act (Sulik, 2007) is essential and often expected, as the domestic work and emotional labour that women perform do not simply support their household but are also crucial to the survival of capitalistic and neoliberal systems (Federici, 2014). While wealthier women can outsource a portion of care work to other people, usually women from a lower social class, many others cannot do that. Moreover, regardless of their class position, most women must continue to perform at least part of that work, even when living with breast cancer (Mackenzie, 2014). The diagnosis does not erase traditional roles and relations, but they may be altered and eventually recomposed according to new balances. Emotions and affections are essential in shaping and influencing women's role in their family – which we can consider as a specific kind of relational assemblage. As Price-Robertson and Duff remind us, ‘family assemblages […] do not depend on human capacities exclusively, and must be understood in terms of complex associations between human and nonhuman entities’ (2019: 1039 – in this case, one of the nonhuman entities is cancer itself). In this section, I trace the contours of these new family assemblages and new reconfigurations brought on by a cancer diagnosis. Women are often extremely worried about both the disease and the impact it might have on their children. Annarita, who was diagnosed when her children were younger, told me that the only thing she wanted was to live long enough to raise them: ‘I would pray every day [saying] “Dear God just give me the possibility to raise my children” and now [I am relieved] as they are adults.’ For women with small children, there is little practical support available to help them fulfil their parental role while trying to take care of themselves. For example, Kelly, a British woman in her early forties, said that during the months of chemotherapy, when she was unemployed, one of the greatest difficulties was not feeling well enough to look after her two children and, at the same time, not being entitled to any financial help to subsidise childcare. The young woman said that she had to ask her parents for financial help to pay for external childcare. Kelly's story exemplifies how existing ideologies and political approaches shape family assemblages. The UK has been historically characterised by a reluctance to establish a universal offer of public childcare and continues to fund such services at lower levels than other Western European countries (Saxonberg, 2013). More generally, childcare has always been seen as a provision the main aim of which is to encourage low-income parents – especially women – to work in order to decrease their dependence on the welfare state. In this context, a situation such as that of Kelly's, an unemployed mother too sick to take care of her children while undergoing debilitating treatments, was simply not taken into account. Kelly and her family were left alone in a moment of vulnerability because, in a neoliberal system, the scarce forms of support are there not to protect individuals, but to assure the protection of the neoliberal economic system itself. The ambivalent feelings of gratitude and guilt that Kelly expressed toward the financial support received from her parents are also a powerful illustration of the role of the traditional family. With the retreat of the state and the reinforcement of traditional roles, the family simultaneously offers protections that the state has stopped supplying, and legitimates the neoliberal ideology of self-reliance while emphasising traditional gender roles.

The welfare state and childcare support are historically more developed in France, and although many of the women whom I met there expressed concern about the impact that the disease could have on their children, none discussed difficulties similar to those Kelly had encountered. In Italy, the childcare support provided by the welfare state is slightly better than that in the UK (cf. Saxonberg, 2013), but situations like Kelly's, in which the family offsets the lack of state support, seem to be common, often producing the same feelings of ambivalent gratitude towards family members, especially parents and in-laws.

Financial uncertainty is often compounded with the biomedical uncertainty explored in Chapter 3, and this puts increased pressure on mothers with breast cancer. As Annarita's story shows, women do not know how much time they have left, and they feel the need to maintain a normal life for their children, limiting the upheaval that their illness can bring into their life while trying to share as many good moments as possible with them because they know that there may not be other opportunities in the future (see Bell and Ristovski-Slijepcevic, 2011; Mackenzie, 2014). Kathy had similar concerns, which were amplified by the fact that her metastatic diagnosis made it much more difficult to determine how much time she had left, and how to share this with her children. During the interview, she said that after her diagnosis, she began to put together memory boxes and write letters for her children in order to be there for them after her death. While disruptions are exacerbated for women with small children, women with older or young adult children also need to rethink the relationship with them, and how their role as parents might need to change in the time that remains. Many of the women whom I interviewed were worried that they might not be around to guide their teenage children toward adulthood, and were sad at the idea of not witnessing them reaching important milestones in their life. Moreover, mothers of older children were also struggling to make the most of the time they had left. For example, Daisy told me she was uncertain about how to use her money. She first thought of leaving it as an inheritance for her daughters, but then eventually decided to use it to travel with them and build good memories for the future. Another example of how women want to create a link with their children's future is the story of Sylviane. During her interview, she said that, despite being in remission, the diagnosis made her realise it was time for some important conversations. So Sylviane asked her daughter whether she would prefer her mother to be cremated or buried. Sylviane's own mother had been cremated, following her wishes. Sylviane said that her mother's ceremony had been very touching, but added that the absence of a physical place where she could gather herself (se recueillir) to honour her mother's memory weighed heavily on her. On the other hand, her father had been buried, and, although she was not religious, going to her father's tomb helped Sylviane remember him and the good times they had spent together. Sylviane said that she asked her daughter about her preferences in this matter because preparing for a good death – in her words – meant thinking not only about oneself but also about the needs of the people who would remain afterwards (le gens qui sont la après vous).

While greater attention was given to how to communicate the diagnosis to younger children, several women whose children were teenagers or young adults also described difficulties in discussing the diagnosis with them. In some cases, women choose to manage the impact of the disease by hiding it, or at least some aspects of it, from their adult children, in particular from sons. Adeline, a French woman who was in her sixties at the time of the interview, and had had two mastectomies due to cancer in her forties, said that she did not reveal the real nature of her illness to her teenage children, and as a way to protect them tried to wear an external breast prosthesis to hide her flat chest. Adeline was one of the many patients I met who tried to normalise their body to keep the disease hidden. However, this practice has its limits, as Franca's experience shows. She told me that it was extremely difficult to explain her health problems to her children, who were upset to see their mother tired and without hair, and how, even several years later, she felt the effects of the disease on the relationship: ‘I have two children, before there was a [different] relationship with them, now I find it difficult even to hug them, because I have this breast as hard as a rock.’ For Franca, the physical alterations of the disease were a stark reminder that the relationship with her children had been altered.

For some women, however, the changes caused by the disease were alleviated by the acceptance that family members showed (see Greco, 2023). Annamaria, a southern Italian woman in her sixties, was moved as she described an episode in which her daughter helped her to overcome the hair loss caused by chemotherapy by offering to cut her hair: ‘my daughter once picked me up and said “come here, come here, [I'll cut your hair]” ’cause I was gonna wash my hair. I'm pretty strong, I try to take things in a good spirit let's say, but it's a trauma to see this hair that has fallen out.’ Ida, another southern Italian woman in her sixties, was grateful to her sons, who, in a short time, learned to take care of themselves and help her while she went through treatments. Ida was particularly proud of her sons as in southern Italy is less common for men to do domestic and care work, and the fact that they were willing and able to do that to support their mother was interpreted as a clear sign of love and affection.

These different cases illustrate how the disease simultaneously extends and disrupts the structure of the traditional family. The difficulties women face show the fragility of the family institution in neoliberal societies and expose the lack of social protection, especially for women with younger children who require more support. However, the strategies that women implemented seemed to reinforce the importance of the family, not only as a place of affection but also as a support system. Breast cancer and, more generally, the experience of illness does not seem to have the potential to contribute to the abolition of the family, but it is certainly an experience that reveals its cracks and contradictions. And, as we will see in the following sections, the disruption a cancer diagnosis brings can also extend to social and professional life.

The social life after cancer: friendship and new forms of support

After a diagnosis, the social life of patients can be reassembled according to new balances and needs. As seen in Chapter 2, the disease pushes many women to engage in activism. Meetings, conversations and participation in various initiatives are often also a way to meet people with similar difficulties and create more informal forms of support. Many of the patients whom I interviewed described positively the connections resulting from activism. Some women found it difficult to talk about their experiences with friends unfamiliar with cancer. They were afraid of being boring or burdening others with the weight of their difficulties, ¹ or that their interlocutors might not fully understand them. On the contrary, talking about their experiences with someone who was going or had gone through a similar path could be easier, as in many cases there were similar experiences and a shared vocabulary that facilitated the conversation.

However, even this form of sharing had its drawbacks, and some patients told me they preferred not to participate in associative activities and meetings. Poppy, who, as we saw in Chapter 2, did not find support groups helpful, preferred to cultivate relationships with friends and family. She often mentioned that friends were available to accompany her to radiotherapy or chemotherapy or to visit her and spend time with her, whenever she decided not to go out due to fatigue and the risks of infections caused by chemotherapy. Franca was another interviewee for whom friendship had been a source of support, and she said that among her friends there were those ‘who accompanied me to have chemotherapy, who accompanied me to buy a wig. Maybe I preferred to involve them rather than my mother or my husband, who was at work.’

Other patients, especially those with school-age children, said they had little time and energy and wanted to dedicate what they had to the care of their children, and that for this reason they preferred to limit contact with other patients and their involvement in patients’ activities. For example, when I asked Josiane if she had the opportunity to share her experience with other patients, she replied:

This excerpt shows, on the one hand, the need to continue taking care of one's children even during treatments, and, on the other hand, the desire to refuse the sick role and maintain a ‘normal life’ as much as possible. Women negotiate their role as patients with caution, as external factors can intervene to influence how much they can push back and hide their status as cancer patients. One of these factors is the effects of the treatments on the body. Abby, a British woman in her fifties with metastatic breast cancer, said that, prior to her diagnosis, she had an active and rich life. She used to be self-employed, but the disease and the side effects of the treatment significantly reduced her ability to work. She had difficulties walking, and, while describing the impact of the disease in her life, she said: ‘I feel like [my life] has shrunk, it was very expansive before and now, I mean, it's just tiny, I barely walk up the road, and I have to get a taxi for almost everywhere I go.’ Abby was not the only patient who thought her life was drastically changed. Daisy, for example, when I asked how her life had changed with the diagnosis of metastatic breast cancer, replied: ‘I try to get up every day even if it is just for a walk, having said that the first four or five days after chemotherapy I cannot do anything.’ The pain and fatigue caused by both the disease and the treatments severely limit the activities that patients can do, and daily actions such as taking public transport or driving, even when possible, were now only undertaken when necessary, as many patients had limited energy. In this context, having a support network was essential. As we saw in the previous section, for many women, this network was the family, but friendships played this role in many cases. Lucrezia, an Italian woman in her forties, underlined how friends were particularly important in the post-operative phase: ‘My [female and male] friends have been extremely close to me, also because when I left the hospital and went home I wasn't good for anything [she laughs]. [They helped me] with everything …’. Other interviewees, especially those with a metastatic diagnosis, needed more long-term support. When I asked Daisy if there was anyone who could help her, she said:

This extract shows how Daisy was surrounded by friends she could count on, but, as I discuss below, friendships and the capacity to maintain specific forms of sociality do not always withstand the impact of the disease. Furthermore, in particularly complex situations, when there are multiple needs, women can find themselves carefully assessing when asking for help is necessary and when it is better to try to get by on their own, albeit with difficulty. This was the case for Muriel, whose diagnosis of breast cancer followed that of lymphoma by a few years:

For Muriel, talking about her experience with lymphoma was more painful than talking about breast cancer. The former was a period of extreme difficulty in which she was forced to ask for constant help, and the people around her provided a ‘daily support system’. During the active phase of the treatments for breast cancer, Muriel felt it was not possible to ask for the same support and tried to get by on her own as much as possible, asking for help only when absolutely necessary. From Muriel's words, we can see not only the gratitude for the help received but also the awareness that support from friends might be a limited resource, to be drawn on when strictly necessary. For her, this meant spending most of the time alone.

Muriel was not the only one who worried about the impact that the disease can have on the people close to her. Camilla stated repeatedly during the interview that she had a solid network of friends and family with whom she could talk. However, she was careful not to burden them, and felt guilty that her diagnosis could negatively affect those close to her. In the same way, Clothilde discussed towards the end of the interview how some dear friends had never reached out to her after the diagnosis, not even through a phone call. She was saddened by this behaviour, but at the same time she understood that underlying it there might have been a fear of illness and death, which in some cases could be difficult to manage. The experiences of the women interviewed show how the disease affects not only their professional and sentimental life but also their social life. Friendships were altered, and friends often became indispensable caregivers. The help of friends, like that of family members, contributed to making up for the lack of institutional support networks and represented a necessary emotional and practical help for many women.

The working life and the life beyond work of women with breast cancer

The difficulties that women face in professional life are well documented (see, e.g., Jenson, 2018). Gender biases, asymmetries of power and the difficulty in balancing professional duties with family responsibilities are just some of the obstacles women encounter (see, e.g., Maruani, 2018). In this already complex situation, a breast cancer diagnosis introduces further obstacles. Several aspects of professional life are reconfigured by the disease (see O’Brien, 2005 for a general overview on disability and working life; Rolland et al., 2023 for the situation in France; and van Maarschalkerweerd et al., 2020 for the situation of patients with breast cancer), and this section explores these reconfigurations. The new, rearranged, post-diagnosis professional lives and identities are influenced by the organisation of different welfare systems, the availability or absence of protective measures in case of illness and the values that each woman attached to their working self before the diagnosis. In this sense, the working lives of patients are a further kind of relational assemblage, involving at least the patient, their skills and needs; the employment context, with its demands and accommodation; and the broader components of state regulation of work and welfare, public attitudes to disability and other elements (cf. Bend and Priola, 2023).

Several patients told me that they continued working during the active treatment phase, and in most cases by choice, because maintaining the pre-diagnosis routine was helpful. However, these women also recognised that continuing to work was possible because the working environment offered them the support and flexibility – part time, shorter hours, understanding line managers and colleagues – that allowed them to adapt their schedules and tasks to the new needs introduced by the diagnosis.

Several women in their late fifties and sixties among those interviewed told me that they were offered the opportunity to take early retirement, and often they had accepted it with enthusiasm, as the disease had shifted their priorities and needs. Clothilde, for example, when I asked for how long she had to take her hormonal treatment, replied: ‘I'm finishing in a month and I've just retired, and I hope everything will be fine now and I'll be able to move on.’ In her answer, the end of treatments and the end of work are joint, to mark a turning point and the beginning of a new chapter in her life. Mireille, a French woman in her late fifties, said during the interview that she tried to return to work but that the sequelae of the treatments made resuming her professional activity difficult, to the point that the occupational therapist who was following her case advised her to ask for early retirement on health grounds. Although this move reduced her monthly income, Mireille described it as the best possible option and said that, in the end, she was satisfied with this opportunity because not working allowed her to use her energy for other, more fulfilling activities, including the initiatives she was carrying out as a patient-activist.

Émilie, another French woman in her fifties, had also been on medical leave (arrêt maladie) for two years at the time of the interview, and she told me that she was unsure whether to return to work. Before her illness, she worked in accounting, and she described her job as one ‘where you cannot make mistakes’. At the time of the interview she was unsure whether she could return to that level of responsibility, as she felt weakened by the disease and the treatments. During the interview, she told me that as the end of the period of leave approached she was uncertain whether to retire early or return to part-time work. In the meantime, Émilie kept herself busy by participating in the initiatives of an association of cancer patients and by engaging in new activities, such as painting and sculpture, and she told me that she was happy trying new things.

Early retirement was a prospect that produced contradictory reactions. On the one hand, there was the frustration of having to face further limitations related to the disease; on the other, there was the relief of having more time to recover and the pleasure of discovering new interests, including forms of patient activism. The situation can, however, assume different meanings for women with metastatic breast cancer: the terminal diagnosis changed how they viewed the future, as the possibility of enjoying a new turn in life seemed reduced, and the changes were seen more as a sacrifice than an opportunity. Nicole, describing her life shortly after being told that her cancer had spread to various parts of the body, told me: ‘I do a weekly chemo since August. I stopped working […] and it's probable that I will not work anymore, my life has been seriously shaken (bouleversée). Here you see me on my feet; I manage to do some things, but still it's not a normal life.’ Nicole did not choose to quit her job; she loved it, but it was too demanding, and her physical condition did not allow her to cope with its rhythms. Mary also had to leave her job and struggled to adapt to post-diagnosis life. She said quitting her job had altered her role in society and added: ‘I feel now that I just look at the world. I watch others rather than participate.’ Camilla also expressed similar feelings:

While Camilla was aware that she could no longer continue to work, as her job was very demanding, she also emphasised how her identity was tied to her professional role. Further, she added that the difficulties she was experiencing in coping with these changes impacted on the people close to her. For women with metastatic breast cancer, stopping work meant giving up an essential part of their existence and having to reconfigure their role in life without the opportunity to seek out new experiences (see also Alfieri et al., 2022). The experiences of Mary and Camilla reflect the suffering and struggle to live when some element anchoring one's identity has vanished. Their comments show the significance of employment in creating one's identity and social life. For women with metastatic breast cancer, it is possible to slow the course of the disease, and many people alternate challenging times with periods of improvement. However, it is highly improbable that they can return to their pre-diagnosis health condition. This implies a significant change in the lifestyles of many women. This sense of irreparability intensified the disorientation expressed by Mary and Camilla.

Another important aspect is the age at which the diagnosis is received. The effects of a gradual worsening of labour conditions have been experienced especially by younger workers, and the vulnerability deriving from the fact that younger women are more likely to be in temporary and more precarious positions (see Jenson, 2018) is emphasised further by a cancer diagnosis. Older women were likely to have had less experience with fixed-term contracts, and to have spent more years in the same workplace. For many younger women whom I met, continuing to work was a necessity and not a choice. Morgana, for example, told me that after the diagnosis she returned to work with a part-time schedule because the side effects of her treatments (discussed in Chapter 5) made it impossible for her to resume her role full time. The fatigue of working while coping with the debilitating effects of hormone therapy, combined with the significant reduction in salary, made Morgana question whether she should continue. However, given her age, she hoped that at the end of the treatment her personal and professional life could resume at a fuller pace. Younger women can indeed have their professional lives altered in multiple ways, with ripple effects, the impact of which is visible even after years, as Kelly's experience shows. Diagnosed with breast cancer in her early thirties, shortly before the diagnosis Kelly had left the company where she had worked for fifteen years to embark on a new career path, which unfortunately had not been successful. Kelly was therefore unemployed while undergoing active treatments. The young woman returned to work a few years later, but the time spent unemployed, combined with the fatigue of the treatments, pushed her to accept a position below her qualifications. Kelly said that, on the one hand, it was necessary, from both a personal and a financial point of view, to return to work, while on the other hand she felt that she did not want ‘to go back to work to that level of responsibility’ (the one she had before the diagnosis). For several years Kelly was satisfied with her job, the flexible hours of which fitted in well with her family commitments, but closer to the time of the interview she had started to view her professional life differently:

Kelly's experience shows that the disease can not only limit opportunities but also change the relationship with work in ways incompatible with the rigid organisation of working life in most sectors.

Kelly was not the only woman to reconsider her priorities after a diagnosis. A French woman, Louise, had a similar and perhaps more radical experience. When I met Louise, she had just turned fifty, had three children and was in remission from a breast cancer diagnosed a few years earlier. A few months before her diagnosis, she had been fired by the company where she had worked for several years as an executive. The loss of her professional status and her diagnosis suddenly plunged her into the precarious world of the unemployed and the sick. However, the disruption of her previous identity opened up new opportunities for Louise, as she said that the disease had allowed her to reassemble her life and ‘go towards other centres of interest’. Before the diagnosis, for example, Louise had already started to look for another job, but the disease had altered her job search in several ways, as she explained:

Many younger women felt that a diagnosis of breast cancer and the side effects of treatment, often resulting in early menopause, had pushed them towards physical and emotional changes usually experienced later in life. However, Louise's interview shows another facet of these transitions, as she felt that the diagnosis had realigned her life with her actual age. Louise used the illness to reorient her life and reposition her priorities, and she concluded that the precariousness of the existence she had experienced through her cancer diagnosis was incompatible with the demands of the professional life she had led before the disease. For Louise, however, this realisation was not brought about just by the disease but by the combination of illness and unemployment. Louise underwent a mastectomy, but no surgical reconstruction. The question I asked before she started discussing her working life was whether she was thinking of undergoing a breast reconstruction. Interestingly, toward the end of the interview, she said: ‘So we are moving away from mastectomy, but I think that my reconstruction is there first. I think I need to rebuild myself, but it doesn't go through the physical.’ Louise thought that a reconstruction after the disease was needed, but, for her, reconstructing just a breast was not enough and probably was not even necessary. Instead, she stretched the boundaries of the term and, in the same way, stretched the boundaries of her experience with the disease, using it as an opportunity to rebuild her life, priorities and place in the world in a new way. The will to use breast cancer as a catalyst for change was also mentioned by Sylviane, who was relatively young when she was diagnosed: ‘[cancer] helped me to avoid postponing things to the next day… to [avoid saying]: “I want to do that and I'll see when I retire”. Now I tell myself, “it's not when I retire, it's today”. And that helped me a lot.’ For Sylviane, cancer was an invitation to live more fully in the present, not to postpone experiences and activities for a future time – her retirement – that may not exist. The idea of wanting the disease to be a way to improve their life was expressed in different ways by other women whom I interviewed. For some women, cancer has been a way to understand who the important people in their lives are – and this for both friendships and relationships – while others have said that the diagnosis had prompted them to rebuild the relationships with loved ones – partners or adult children. In Chapter 2, I have discussed the new rhetoric that is constructing cancer as an opportunity for moral growth and self-improvement and how the expectations that cancer can lead to a better life can be a form of cruel optimism for some patients. However, there is a substantial difference in how Sylviane and Louise used their cancer experiences to change their lives, as they, especially Louise, show what can be defined as a form of political and critical growth. Louise and Sylviane were challenging in different ways the strong link in capitalist society between professional identity and personal value, reclaiming the importance of a life not entirely dominated by work. This approach, in a way, contrasts with the simplistic idea that cancer can make people appreciate more the life that they have, as it shows how, on an individual level, the disease can bring significant changes in the social and political perspectives of patients and trigger a willingness for changes that challenge the neoliberal work ethos.

Conclusion

In this chapter, I have presented the different forms of disruption of the women's sentimental, social and professional lives and further explored their strategies of recomposition as processes of relational assemblage. I consider relational assemblages as attempts to define new relations and social roles in response to both the disruption introduced by cancer and the transformation of social roles that the status of cancer patient entails. A fundamental element of these reconfigurations is cancer. Marc Marie defines the relationship with Ernaux as ‘un ménage à trois’ (Ernaux and Marie, 2005: 103), as cancer is constantly present, altering their plans and dictating what the couple can and cannot do. Women living with cancer know well how the disease recomposes family roles, alters the balance with their partners and children.

The family is an ambiguous terrain: in a neoliberal system that offers limited state support, for many women the main or only source of help was that offered by partners, parents, siblings or adult children. But this help can come at a price, as it was often emotionally and practically difficult for women to ask for and accept it, as they were used to seeing themselves as the ones providing support (and often found themselves still doing so after the diagnosis).

In many cases, marital relations were redefined. Partners found themselves providing material and moral support; new roles and new balances emerged and coalesced around the disease. In still other cases, older children provided support. Despite the contradictory role of this institution, women who could not count on the support of the family found themselves in an even more fragile situation. For some of them, their network of friends turned into a support system. The changes linked to the illness also affected the professional sphere, where the problems induced by the disease added to job insecurity and uncertainty. In some cases this led to a change of approach towards professional roles – what I have defined as political growth.

The concept of biosociality allows us to capture the new connections and relations that emerge around the shared biomedical identity. However, a disease also breaks down and transforms existing relations, for example, with friends who stop calling or partners who leave. The resulting absences leave traces that become part of the recomposed family and social landscape in which women with cancer find themselves living. Women's experiences are heavily influenced by the position assigned to them in society. It is, for example, well known that even nowadays women still find themselves with more care responsibilities than men. The roles of mother, partner and worker intersect, often limit each other and are strongly reshaped by the disease. In this case as well, the experiences of illness, although strictly individual, cannot be separated from the context in which women live and the social roles assigned to them. The disease disrupts a balance that is already very precarious for many, especially for mothers and workers. In this sense, breast cancer is a female disease not only because it involves a strongly gendered part of the body but also because it forcefully resurfaces the precariousness of the female condition. And it is precisely this precariousness of the pre-illness experience that makes the attempts at recomposition described here necessary.

Reading the recomposition after the disruptions caused by the disease through processes of assemblage allows us to grasp the contingent and dynamic nature of these rearrangements that women used to create new affective and pragmatic configurations in which they located themselves as wives, mothers, friends, workers and breast cancer patients. This new piece of identity alters how women perceive their place in these spheres of their lives. These new practical and emotional reconfigurations were necessary to recompose and continue their life after a breast cancer diagnosis.