Table Of ContentPHILOSOPHY
AND
MEDICINE
The Voice of
Breast Cancer
in Medicine
and Bioethics
Edited by Mary C. Rawlinson and
Shannon Lundeen
THE VOICE OF BREAST CANCER IN MEDICINE
AND BIOETHICS
Philosophy and Medicine
VOLUME 88
Founding Co-Editor
Stuart F. Spicker
Editor
H. Tristram Engelhardt, Jr.,Department of Philosophy, Rice University, and Baylor
College of Medicine, Houston, Texas
Assistant Editor
Lisa Rasmussen, University of North Carolina, Charlotte, North Carolina
Associate Editor
Kevin Wm. Wildes, S.J.,Department ofPhilosophy and Kennedy Institute of Ethics,
Georgetown University, Washington, D.C.
Editorial Board
George J. Agich, Department of Bioethics, The Cleveland Clinic Foundation,
Cleveland, Ohio
Nicholas Capaldi,Department of Philosophy, University of Tulsa, Tulsa,
Oklahoma
Edmund Erde, University of Medicine and Dentistry of New Jersey,Stratford,
New Jersey
Eric T. Juengst,Center for Biomedical Ethics, Case Western Reserve University,
Cleveland, Ohio
Christopher Tollefsen,Department of Philosophy, University of South Carolina,
Columbia, South Carolina
Becky White, Department of Philosophy, California State University, Chico,
California
The titles published in this series are listed at the end of this volume
THE VOICE OF BREAST
CANCER IN MEDICINE
AND BIOETHICS
Edited by
MARYC. RAWLINSON
Stony Brook University, Stony Brook,
NY,U.S.A.
and
SHANNON LUNDEEN
University of Pennsylvania,
Philadelphia, PA, U.S.A.
AC.I.P. Catalogue record for this book is available from the Library of Congress.
ISBN-10 1-4020-4508-5 (HB)
ISBN-13 978-1-4020-4508-0 (HB)
ISBN-10 1-4020-4477-1 (e-book)
ISBN-13 978-1-4020-4477-9 (e-book)
Published by Springer,
P.O. Box 17, 3300 AADordrecht, The Netherlands.
www.springer.com
Printed on acid-free paper
All Rights Reserved
© 2006 Springer
No part of this work may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming, recording
or otherwise, without written permission from the Publisher, with the exception
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Printed in the Netherlands.
TABLE OF CONTENTS
ACKNOWLEDGEMENTS vii
INTRODUCTION
NegotiatingPersonal and Political Settlementswith Breast Cancer:
Women Finding Their Own Ways to Live with Human Contingency
Rosemarie Tong . . . . . . . . . . . . . . . ix
DISCOURSES OF BREAST CANCER:WHOSPEAKS FOR BREASTCANCER?
1. Personalizing the Political: Negotiating the Feminist, Medical,
Scientific, and Commercial Discourses Surrounding Breast Cancer
Susan Sherwin . . . . . . . . . . . . . . . 3
2. Power, Gender, and Pizzazz:
The Early Years of Breast Cancer Activism
Barron Lerner . . . . . . . . . . . . . . . 21
3. Breast Cancer: Dueling Discourses and the Persistence
of an Outmoded Paradigm
Gwynne Gertz . . . . . . . . . . . . . . . 31
4. Doing Things with Ideas and Affects in the Illness Narratives
Of Susan Sontag and Eve Kosofsky Sedgwick
Lisa Diedrich . . . . . . . . . . . . . . . 53
NARRATIVES OF BREAST CANCER:LIVING WITH DISEASE
5. The Breast Cancer Diaries
Anita Ho . . . . . . . . . . . . . . . . . 71
6. Breast Cancer: The Maternal Body Reflected in a Three-way Mirror
Debra Gold . . . . . . . . . . . . . . . . 89
vi TABLE OF CONTENTS
7.
Leatha Kendrick . . . . . . . . . . . . . . . 95
8. Death and the Other: Rethinking Authenticity
Gail Weiss . . . . . . . . . . . . . . . . 103
BREASTCANCER AS A MODEL IN CLINICAL RESEARCH
9. Breast Cancer Research: A Political Cause and
Paradigm for Scientific Inquiry
John S. Kovach . . . . . . . . . . . . . . . 119
10. Clinical Trials for Breast Cancer and Informed Consent:
How Women Helped Make Research a Cooperative Venture
Loretta M. Kopelman . . . . . . . . . . . . . . 133
11. The Role of Psychosocial Research in Understanding and
Improving the Experience of Breast Cancer and Breast Cancer Risk
Anne Moyer and Marci Lobel . . . . . . . . . . . 163
BREASTCANCER IN THE CLASSROOM
12. Teaching about Breast Cancer and “Common Health”
Helen Rodnite Lemay . . . . . . . . . . . . . . 185
13. Theoretical Considerations on “Reading” the Breast
Tanfer Emin-Tunc . . . . . . . . . . . . . . 195
14. Recent Developments in Breast Cancer Research
Sofya Maslyanskaya . . . . . . . . . . . . . . 203
ACKNOWLEDGEMENTS
This book grew out of a conference on breast cancer sponsored by the Program
in Women’s Studies at Stony Brook University in 2002. Professors Sherwin, Lerner,
Kovach, Diedrich, and Lobel participated in the conference which was organized by
Helen Rodnite Lemay and Mary C. Rawlinson.
The editors would like to thank Lisa Rasmussen, the Managing Editor of the
Philosophy and Medicine book series, for her generous support and assistance in
bringing the volume to publication.
INTRODUCTION
ROSEMARIE TONG
NEGOTIATING PERSONAL AND POLITICAL
SETTLEMENTS WITH BREAST CANCER
Women Finding Their Own Ways to Live with Human Contingency
Yesterday as I was pushing my shopping cart up and down the aisles of the grocery
store, my eyes glanced over to the tabloid rack. I immediately noticed that the
feature story in the Globe was an exclusive interview entitled “Jacklyn Smith Wins
Battle with Breast Cancer” (Globe 2003). Making sure no one I know saw me, I
plunked my money down for the scandal sheet and took it home where my prurient
interests got the best of me. I read the whole issue, although I had initially planned
to read only the Jacklyn Smith story. Not surprisingly, Smith’s breast-cancer story
had a familiar plot line. Her narrative began with her fears about disfigurement and
even death; progressed to her “courageous” decision to consent to a lumpectomy
with subsequent radiation; and ended with a radiant (and very sexy) Jacklyn Smith
holding up her “clean bill of health” as she returned full force to her work and
relationships. Why, I wondered, is the Globe making it sound as if Smith’s
experience is somehow extraordinary and exceptional, when 220,000 new cases of
breast cancer in the U.S. were reported in 2002 alone? Far from being unique,
Jacklyn Smith’s story is increasingly the one many breast-cancer patients tell. And
yet, despite the fact that more women are living well with breast cancer than dying
badly from it, American women continue to fear breast cancer much more than the
actual number one killer of American women: cardiac disease.
In large measure, this anthology, skillfully assembled by philosophers Mary
Rawlinson and Shannon Lundeen, explains the many reasons why breast cancer in
particular continues to occupy U.S. women’s attention. In the lead essay,
philosopher Susan Sherwin addresses the politics of cancer in her probing chapter
entitled “Personalizing the Political: Negotiating Feminist, Medical, Scientific, and
Commercial Discourses Surrounding Breast Cancer.” Sherwin begins by
highlighting the “dualisms” that characterize breast-cancer debates; it’s largely
ix
x ROSEMARIE TONG
genetically-determined…no, it’s mostly environmentally-produced; it’s being
cured…no, it’s on the rise; be a cheerful cancer patient with a smiley face…no, be a
realistic cancer patient with eyes wide open; and so on. Sherwin’s multiperspectival
analysis of breast cancer is informed by her feminist sensitivities. In particular, her
thoughts are guided by the omnipresent question, “Who benefits and who is harmed
by the existing policies?” Is it women with breast cancer? Or is it researchers who
want to be famous; pharmaceutical companies who want to increase profits; and/or
politicians who want to be elected?
Sherwin reminds us that in the 1970s women helped politicize the personal—in
this instance, the very personal experience of breast cancer. Among others, Shirley
Temple Black, Happy Rockefeller, and Betty Ford told their breast-cancer stories in
public. They thereby encouraged women to bring the breast cancer they had hidden
in their bedrooms and bathrooms out into the public domain. Soon thousands of
women were talking to each other and to anyone else who would listen about their
disease. Various segments of the public started to “racing” for the cure, participating
in fundraising marathons and lobbying Congress for higher breast-cancer-research
appropriations. Women were urged to self-exam their breasts and to get
mammograms on an annual basis. Breast-cancer support groups multiplied, and,
eventually, a whole month was devoted to increasing breast cancer awareness. But
breast cancer’s acceptance into the public domain was not without its problems.
Sherwin observes that cancer became so political that many women felt that their
own breast cancer—their own personal worries and pains—had to be experienced in
a certain way. Sherwin claims that two metaphors—that of breast cancer as an
enemy against whom war must be waged, and that of women’s bodies as the terrain
on which the enemy advances—created a framework of “danger, urgency, and fear”
(p. 12). Women were expected to fight the enemy with the weapons in medicine’s
arsenal. To fail to fight the enemy to the finish was to be viewed as either a crazy
woman or a coward.
While recognizing the role of biomedical tools in arresting breast cancer’s
assault on women’s bodies, Sherwin notes that the breast-cancer establishment has
focused on surgery, radiotherapy, chemotherapy, and pharmacotherapy without
exploring in any real depth other ways to treat breast cancer, some of which may be
found in the annals of alternative and complementary medicine, for example. Nor
has the breast-cancer establishment, at least of late, focused enough attention on the
possible environmental causes of breast cancer. Could it be that there is more money
to be made and fame to be had in finding a spectacular cure for breast cancer than in
quietly preventing its inception? In other words, could it be that it is more glamorous
to wage war on an acute disease than to make peace with a chronic disease—to live
as well as one can with it?
Sherwin encourages each woman who has breast cancer to feel free to
“depoliticize” her breast cancer and to come to terms with it in her own unique way.
It is not irrational for a breast-cancer victim to refuse radiotherapy and/or
chemotherapy; nor is it weird for her to refuse breast reconstruction subsequent to
breast-cancer surgery. Different people have different priorities and values, and
