Breast cancer represents a real health concern for the female population and due to its estimated high prevalence and risk factors is currently referred to as an epidemic. This perspective conveys the distorted message that all women are at risk of developing breast cancer. The risk is rather seen as a background reality becoming salient in specific circumstances (such as: annual medical check-ups, routine medical control, or the news that someone close or an acquaintance has been diagnosed with cancer), or a more pervasive and prevalent presence when the individual is being identified as carrying the actual risk.
In the medical field, the risk is based on epidemiological statistics, and refers to the probability that a certain disease will develop while its occurrence carries with it a negative outcome. Therefore, the risk of breast cancer, similar with the risk for many other medical conditions, is predicted through an epidemiological risk-factor assessment. While this practice aims to standardize the risk detection process, it seeks to facilitate early warning signs, and provide a “formula” style guideline to reduce the overall risk, it fails to consider factors that are not part of statistical measures. Such factors refer to personal experience, risk-taking behaviors, cultural beliefs, personal values, and social practices. In doing so, the disease is rather seen as a biological manifestation and less as a psychological entity with social ramifications.
As a biological entity, the medical discourses on breast cancers communicate incongruent messages. While the mainstream belief (reinforced by the current health consciousness mindset and the individualistic Western culture) considers individuals to be generally healthy and able to defeat any problem (regardless of its nature), the health message emphasized to the public is that by focusing on specific risk factors and engaging in appropriate behaviors and practices (e.g. breast self-examination), breast cancer can be personally prevented or detected in its incipient stages. Since lifestyle factors such as weight, diet, and exercise are a common presence in the scientific literature as cancer risk factors, the need of self-care became the foremost responsibility to protect oneself from cancer. This reductionist association has resulted in a de facto causal relationship between the occurrence of the disorder and the individuals behavior. The individual risks the chance of being held culpable and responsible for their disease, although it is not concrete or exactly clear how lifestyle factors contribute to breast cancer or any other type of disease. On the other hand, medical evidence attests that breast cancer caused by the BRCA1 and BRCA2 genes cannot be prevented. By detecting the genes, a woman cannot forego the risk and is left only with the alternative of engaging in early detection practices to ensure a better outcome.
For the most part, the medical discourses (formal viewpoint) tend to objectify the individual. Through the use of medical and disease-bounded terminology, the individual is being reduced to their body parts and organs, especially the ones that are diseased. The power and legitimacy of these discourses are strongly determined by the physicians affiliation with the institution of medical science. Medical professionals are seen as having both knowledge and an omniscient view, as well as high expertise regarding all aspects of the breast cancer experience – but only the scientific, medical aspect of it, not the psychological or emotional effect of the disease.
The implication of the terminology and language used extends far beyond the medical field, and touches the personal, social, and cultural meaning of the disease. Breast cancer invades the privacy of a womans body and medicalizes female sexuality. It is not only a threat to the individuals physical health, but also a threat to their psychological health as well. The breast represents one of the most visible signs of femininity, and its meaning ranges from the biological connotation of fertility to the social understanding of motherhood. It also carries moral meaning, and implies the notion of sexuality and sexual power. Based on these various meanings, the response and attitude exhibited by the women faced with a treatment decision when the disease is present will vary. Women can choose to have their malignant breast removed or pursue other less invasive paths of treatment and maintain their physical identity intact (while risking their life at the same time).
Concepts such as self-esteem and self-confidence are highly correlated and dependent to ones physical appearance. Once the physical appearance is jeopardized, the self-esteem and self-concept is also altered. This is particularly evident in women, for whom the concept of attractiveness is linked to their physical appearance in which the breasts play a major role. The breasts are part of a woman’s sense of self and represent a source of identification with the female role. They constitute necessary attributes that establish the desirability and acceptability of a woman. Accepting the reality of how the esthetics of the breasts will change drastically during treatment is a psychological struggle for all women with breast cancer.
Although surgical intervention on the breasts in order to remove the tumor initially carries a survival necessity, once the threat is not imminent the altered breast anatomy or the loss of the breast takes in additional meanings closely linked to the womans identity as a female and sexual being. The surgical intervention disfigures the womans physic, alters their body image, reduces self-perceived attractiveness, diminishes the sense of femininity, and causes ambivalent feelings.
Since 1960, when breast cancer joined the war on cancer movement, the emphasis was placed on expanding funds and knowledge to research and treat the disorder. Although needed, these efforts are not enough to address the extensive ramifications of suffering and surviving breast cancer after the fact. It is obvious that women affected by breast cancer not only fight the disease but they also have to fight the effects of the cancer treatment on the physical appearance. Although these devastating anatomical effects dont have the same life-threatening connotation, they carry complex and long lasting psychological consequences that affect the mental and emotional health of a woman long after the cancer is gone.
