‘Fiona Farewells Her Breasts’: A popular magazine account of breast cancer prevention

Abstract

In this paper, the authors examine a popular media account of prophylactic mastectomy—the surgical removal of ‘healthy’ breasts for preventive purposes—focusing on the ways in which the account works to normalize what might alternatively be considered extreme preventive health behaviour. Although the procedure remains controversial, prophylactic mastectomy is increasingly presented as a treatment option for women considered to be at high risk of developing breast cancer. A discursive analysis focuses on how one woman's ‘decision’ to undergo prophylactic surgery of this type was accounted for in terms of two broad identity constructions or positionings: as ‘mother’, and as ‘certain to die of breast cancer’ in the absence of such surgery. It is argued that constructions of prophylactic mastectomy, such as that depicted in this account from a popular women's magazine, can be seen to draw on traditional gendered discourses, and on notions of responsibility central to the new public health. Such media accounts thus promote general acceptance of the procedure, and risk management more generally, as enterprising actions that reasonable, morally responsible, ‘at-risk’ women should undertake to maintain their own health and to care for their families.

Acknowledgement

The authors would like to thank Victoria Dennington, Danielle Every and Katherine Hodgetts, as well as two anonymous reviewers, for their useful comments on an earlier version of this paper.

Notes

Notes

1. The concept of ‘risk’ is controversial, and is the subject of widespread scholarly debate (see Lupton, 1999; Petersen, 1997; Petersen & Lupton, 1996). In contrast to mainstream approaches in medicine and psychology which treat ‘risk’ as an objective, quantifiable entity that can be used to inform rational decisions about health behaviours, we adopt a constructionist approach to ‘risk’ in this paper. In constructionist approaches, as Lupton (1999, p. 2) writes, ‘what are identified as “risks”, by “experts” as much as lay people, are understood as inevitably the outcome of sociocultural processes. Further, such risks tend to serve certain social, cultural and political functions.’ This is not to argue that there may not be any identifiable or preventable dangers but, rather, that those dangers which we come to understand as ‘risks’ are best understood as socially and historically constituted.

2. As a result of work on the Human Genome Project, a genetic link to breast cancer has been ‘discovered’. Two breast cancer genes have been identified: BRCA1 and BRCA2. Inherited genetic mutations are reported to have been associated with approximately 5–10% of breast cancer cases (Easton et al., 1993).

3. Indeed, a recent high-rating television current affairs programme in Australia drew on the current conflicting opinions of medical experts in relation to preventive mastectomy to depict one young woman's decision to undergo such a procedure as ‘ill-informed’ and ‘unnecessary’ (60 Minutes, 3 March 2002).

4. It is important to note that current scholarly understanding around the identified ‘breast cancer genes’ (BRCA 1 & 2) is that ‘testing positive’ for these genes associates an individual with an increased lifetime ‘risk’ of developing breast cancer, but does not mean that this individual will definitely develop the disease. Correspondingly, even if a person tests ‘negative’ for these genes, the future occurrence of breast cancer cannot be ruled out.