An epidemiology of women's lives: the environmental risk of breast cancer

Abstract

The dominant discourses of breast cancer risk are individualistic and biological, tending to emphasize personal life history, genetic predisposition and ‘lifestyle’ factors. Statutory programmes to reduce risk are correspondingly concerned primarily with early detection, and not with primary prevention of a disease whose incidence rate continues to rise in the UK and the USA. Against this, the breast cancer movement is working to emphasize the collective narrative of breast cancer aetiology, applying an ecological approach to public health protection, and basing its demands on a precautionary approach to environmental hazards. This paper considers how the breast cancer/environment movement in the US and UK asserts the legitimacy of activists’ alternative expertise, and challenges the biomedical foundation of traditional epidemiological practices. Activists’ knowledge claims are, additionally, understood as embodied, lay expertise, predicated in feminist epistemology which has argued that the personal, the subjective and the partial count, and that such situated knowledge makes for stronger science. These dimensions of the breast cancer/environment movement shape what is here termed ‘citizen expertise’, as activists present a ‘transformational vision’ of the physical, political, social and economic environments that currently contribute to breast cancer.

Notes

1. My work in relation to this paper is bifocal, both academic and activist. I am involved in what I term here the breast cancer/environment movement, currently in the UK as a member of the Ban Lindane Campaign and of the ‘free radicals’, and with strong links to women in the Bay Area of California engaged in similar work, particularly Marin Breast Cancer Watch. I have also studied and written about breast cancer from a broadly social science perspective, and have undertaken research with the Women's Environmental Network for their project Putting Breast Cancer on the Map. This paper is based on time spent working in these groups and discussing our activities and strategies with other, similarly involved women. The work will be continued under a recently awarded ESRC grant in the Science in Society programme.

2. Known and suspected environmental factors implicated in the aetiology of breast cancer are best summarized in Rachel's Environment and Health Weekly (1997) pp. 571–575; more ‘lay-friendly’ accounts are available in the Women's Environmental Network's project reference booklet, Putting Breast Cancer on the Map (1997), and in Sandra Steingraber's chapter ‘The Environmental Link to Breast Cancer’ in Kasper & Ferguson (eds) (2000). One particular group of chemicals perhaps needs mentioning specifically in the context of this article, those that are endocrine disruptors (EDCs) and so particularly implicated in breast cancer aetiology and the focus of international campaigns.

3. A recent lead editorial in the British Medical Journal (Harrison 2001), does, however, discuss the role of endocrine disruptors and human (reproductive) health, and suggests the need to investigate environmental causes of disease, citing phthalates and bisphenol A as of specific concern. Perhaps such recognition will mark the turning of the tide.

4. A large number of chemicals are oestrogen mimics—at least 52 have been identified as interfering with our endocrine system and many of those are also carcinogenic. Synthetic compounds that have shown hormone-like activity in laboratory tests include organochlorines, which are used in a vast variety of everyday products from pesticides to plastics, detergents and cosmetics to bleaches, shampoos and other chemically based materials; pesticides, including those such as DDT, Aldrin and Dieldrin, long since banned in most Western countries but which still persist in our bodies and our environment; combustion and waste by-products (furans and dioxins); surfactants used in pesticides, paints and cleaning products, and in paper and textile production (alkyphenol polyethoxylates); synthetic resins used in can linings and dental fillings (Bisphenol-A); plasticizers in food packaging, and plastics (polychlorinated phenyls and phthalate esters).

5. The UK Advisory Committee on Pesticides (ACP) acts to advise ‘the Pesticides Safety Directorate (PSD), an agency of the Department for Environment, Food and Rural Affairs (DEFRA), which deals largely with agricultural pesticides; and the Biocides and Pesticides Assessment Unit of the Health and Safety Executive (HSE), which deals largely with non-agricultural pesticides and biocides’ (DEFRA, 2002, p. 17). The PSD is responsible, on advice from the ACP, for ‘the evaluation and processing of applications for approval of agricultural pesticides … for advising Ministers on development and enforcement of pesticide policy and legislation’ (ibid.).