There was a time when no one was allowed to laugh about breast cancer -- much less wax sarcastic or cynical, ironic or arch about it -- because breast cancer usually meant disfigurement and often meant death.

Then came better diagnostics, better treatment, better survival rates, feminism -- and the ubiquitous pink ribbon.

Now, if you are writer-cartoonist Marisa Acocella Marchetto, it's OK to depict cancer cells as tiny bearded terrorists and represent one's anxieties with breast-shaped eyeballs.

Marchetto, who appears Sunday at Miami Book Fair International, became Cancer Vixen, reluctant star of a graphic novel (Pantheon, $16.95) that follows her transformation from career-and-style-obsessed New York yuppie to disease and treatment-obsessed cancer patient. She is 48, five years post-diagnosis and blissfully happy with the Italian restaurateur who married her in the midst of her ordeal.

The Vixen conveys a wealth of serious medical information and a ton of heavy emotion in what's essentially a 211-page comic book, a format bound to strike some as cavalier.

But because breast cancer ``is everywhere, it's in our face and people are so open about it, it allows for different dialogues,'' she notes.

S.L. ``Sandi'' Wisenberg's The Adventures of Cancer Bitch (University of Iowa, $25), supports Marchetto's point. The book evolved from her blog of the same name, and -- snarky title aside -- offers a more somber vision, darkened by depression, lifelong asthma, Jewish soul-searching and the relentless specter of death.

A Miami Herald reporter for three years in the 1980s, Wisenberg, who appears at the book fair Sunday, teaches at Northwestern University, and as befits a feminist academic, couches her personal story in a broad cultural context.

She is 54 and was married just a few years when she got her diagnosis in early 2007.

No stranger to illness -- ``I've always had asthma, so I've been used to this body that can't just be let alone. It's got to be monitored and medicated'' -- she was nonetheless infuriated by cancer's invasion of her world.

``I have to hate something out there,'' she writes. ``I hate Elizabeth Edwards because she is not screaming, screaming: This is unfair. I don't deserve this. We don't deserve this.''

She blogs that The Vixen scared her.

``She makes me afraid of the horribleness of chemo, the cold in your veins, the nausea, the fatigue, the very long needle. . . . and the way that shot feels like it's filling your whole body up with concrete.''

Still, the two writers have much in common -- as do all breast-cancer patients, to a point. Both underwent chemo and radiation, though Wisenberg also had a mastectomy. Both found plenty to criticize along the continuum of medical care. Both deal honestly with the hope and confusion that attend a life-altering disease, as well as with the hierarchy of suffering among women battling it, the exasperating barrage of unsolicited advice and horror stories.

For The Bitch, losing her prodigious head of hair -- and friends that she thought she could count on -- is traumatic. She henna-tattoos her bald head. The Vixen worries about predatory women tempting her husband, damage to her drawing hand, and the possibility of recurrence.

Both torment themselves about what might have caused this: Environmental pollutants? Processed food? Bad karma?

And both want to move on, book-promotional activities notwithstanding.

`'I'm sick about writing about cancer,'' confesses Marchetto, who draws cartoons for the New Yorker and Glamour. ``I don't want to talk about it anymore. But I definitely feel like I have a mission: `No breast left behind.' ''

She established the Cancer Vixen Fund at St. Vincent's Hospital in New York, to pay for poor women's breast care, and does artwork for the Breast Cancer Research Foundation.

A Lower Manhattanite, she reported on 9/11, which, like cancer, altered her world view profoundly.

``You realize one minute you're here and the next you're not -- how fragile life is.''

Elinor J. Brecher is a Miami Herald staff writer.