Sunday, April 24, 2011

The Language of Breast (Cancer)

I've been reading a lot of things lately that make me want to run into the street, take all my clothes off, scream like a banshee, and then poke my eyeballs out with hot needles.

Here's a sample from a commenter at Uneasy Pink's blog;

The scream of the Banshee
"I'm sorry you find the words "boobies" and "ta-ta's" offensive but you know what? What you find offensive doesn't matter to me. That's your hang-up to get over... not mine or anybody else's. I have found that women who have had mastectomies are hyper-sensitive about the fact anyway (understandably so, by the way!!).... and have a hard time when anybody makes references to breasts that they themselves don't have anymore. That's understandable & I sympathize... but unfortunately that's another hang-up to get over or be consumed by it."

Hang-ups?



Get over it?

How does one respond to this kind of thinking?  Well,  others have done a much better job than I ever could in explaining how they feel about their breast cancer experience.  Molly Ivins, noted journalist, humorist and author, in a 2002 Time Magazine article famously said;

Having breast cancer is massive amounts of no fun. First they mutilate you; then they poison you; then they burn you. I have been on blind dates better than that.
Molly passed away from Stage IV breast cancer in 2007.  If she could send us a message from the grave I'm sure she would add to the above quote and say something like;

......Then on top of all that NOT having fun, the cancer goes and kills you. 


And perhaps in response to our apparent inability to "get over it" or deal with our breast cancer "hangups", which seems to imply that some of us don't have the kind of attitude that engenders positivity or indeed a sense of lightness and  fun,  Molly might have quipped as she does in the same article;

I suspect that cancer doesn't give a rat's ass whether you have a positive mental attitude. It just sits in there multiplying away, whether you are admirably stoic or weeping and wailing. The only reason to have a positive mental attitude is that it makes life better. It doesn't cure cancer.

If you've been following the current "boobies" debate in the breast cancer blogosphere,  proponents of using sexualized slang in the context of breast cancer will tell you that it's a way of making a serious situation lighter, more palatable and makes people feel more comfortable in talking about breast cancer.    That's nice, but as The Accidental Amazon points out in her latest post;

Hooters.
Knockers.  The Girls.  Cupcakes.  Muffins.  Tits.  Titties.  Melons.  Rack.  Bags.  Milk pails.  Tatas. Boobs.  Boobies.  Jugs.
Do these words tell you anything about the reality of breast cancer?  Me either.
Nor do they tell you anything about women.  What they do tell you about is how our culture labels women.  At best, what they tell me is that humans are fond of jokes, slang and euphemisms, and at worst, that humans are also prone to slurs, innuendo and objectification when they are afraid or hateful or ignorant.

But this idea of using humor to mask the seriousness of some aspect of breast cancer, for whatever reason, is not new.   I learned this as I was reading Siddhartha Mukherjee's tome, The Emperor of All Maladies.

And this one really boggled my mind.

The disfiguring effects of Halstead's
radical mastectomy
In the 1920's a young surgeon named Geoffrey Keynes posited the idea that certain breast cancers could be treated by more conservative surgery and radiation therapy, rather than the wildly popular radical mastectomy pioneered by William Halstead in the late 19th century,  in which at a minimum, the breast, chest muscles, and all of the lymph nodes under the arm are removed.

Halstead's radical mastectomy was a grueling operation lasting six to eight hours and left patients extremely disfigured and debilitated as a result,  It could also involve removal of ribs, cracking and excavation of clavicles all in the mistaken belief that breast cancers emanated and spread from the breast in a centrifugal pattern.

According to Keynes, a more local surgery to the breast could achieve the same outcomes as the radical mastectomy and save many women from the terrible after-effects of Halstead's operation.  In questioning the  surgical status-quo, Keynes also challenged the notion that breast cancer spread in a centrifugal pattern.

So how did Halstead's followers respond? Rather than listening to Keynes theories and using his evidence to extrapolate and expound on his techniques, they instead chose to use language to trivilialize and denigrate Keynes' ideas.  Mukherjee writes;
"They retaliated by giving his operation a nickname: the lumpectomy.  The name was like a low-minded joke, a cartoon surgery in which a white-coated doctor pulls out a body part and calls it a 'lump' ".  Keyne's theory and operation were largely ignored by American surgeons..........his challenge to radical surgery was quietly buried."

After  fierce and sustained resistance from the entrenched Halsteadian beliefs of the medical fraternity, it wasn't until the 1970's - some forty years after Keynes had first hit upon the idea - for the lumpectomy to be regularly considered in the surgical treatment of certain breast cancers.

Illustration of one type of
Lumpectomy 

Why? If we are to believe Mukherjee's historical account, then we can only surmise that the Halsteadian followers' resistance to clinical challenge, and the resulting institutionalized trivialization of Keyne's treatment theory by the use of jokes and euphemism, was the cause for this long delay in finally changing the breast cancer treatment status quo.

Too bad that the butts of this particular joke, uttered in the context of breast cancer, were the hundreds of thousands of women who were subjected to the horrors of the radical mastectomy in the time before lumpectomies, and less invasive forms of mastectomy became standard forms of treatment.

Interesting isn't it?  That one little joke could stagnate real progress in the treatment of breast cancer, for decades.

All because someone dared to question the breast cancer status quo.

Could a society hung-up on using fun "boobie-like" language to describe and sell the breast cancer cause,  end up ultimately forgetting about the seriousness of this disease? Forget the fact that so little progress has been made in stemming the number of deaths from this disease?  Forget about the need to continually question and recalibrate the messages in order to move the fight forward? Will the public simply grow weary of boobie fads and move onto the next fun cause du jour? Then where will we be?

In a 2001 article discussing the work of one of the first breast cancer activists, Rose Kushner, Barron Lerner M.D. writes;
"It will be the challenge of modern breast cancer activists to continually scrutinize their strategies and, when necessary, question dogma, as Kushner did so successfully."
I am one person who is prepared to keep questioning dogma.

I will never "get over it".

And as to my "hang-ups"? Only about breast cancer. For me, a truly frightening reality.

Do you see me laughing now?





15 comments:

  1. What an excellent post, and a very salient point. What if all the joking stands in the way of actually finding a cure? What if all the money raised for "awareness" takes money away that could have been spent on actually finding a cure?

    It's been said that laughter is often the human response to a situation that if looked at seriously would make one cry. Perhaps that's part of why misguided folks tell breast cancer sufferers they should "lighten up", because they just can't deal with the inherent seriousness of the disease. Why should anyone have to lighten up about something that might kill them?

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  2. Anna,

    Well said, as always. I hadn't made that connection between what is going on now and the lumpectomy debate. Thank you for pointing that out.

    Katie

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  3. You know, one of the many things I love about knowing you are in the blogosphere, Anna, is experiencing such a tremendous sense of validation when I read your posts. One of the others is how we are all able to riff off one another. Your post has given me another idea for a blog post...

    Thanks for saying what you say.

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  4. Excellent article, Anna, with excellent quotes. I admire your energy to keep beating that drum, when so many in the media and public in general don't get it. -shelli

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  5. Haha... as usual a lovely, snarky, funny yet angry read. Thanks to my latest hospital adventure I hadn't seen all the comments so thanks for this.
    I was particularly annoyed by that comment you quoted: "women who have had mastectomies are hyper-sensitive about the fact anyway (understandably so, by the way!!)" The casual throw away exclamation marks - oh, it's all so trivial - a mastectomy!!! Book me in now!!! Why don't you take my ovaries at the same time!!! It's all so 'light' isn't it?!!! I hate all that.
    Thank you for highlighting this and continuing to keep questioning.

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  6. I hate the word 'lumpectomy,' BTW, because it's become now a medical euphemism for everything that's not a complete mastectomy. It's still an inaccurate word. I didn't know about the derisive derivation of it, but now I have yet another reason to hate it.

    And I worship Molly Ivins. She was a fantastic voice of humor, snark & reason in the realm of political and social discourse. SFBC...

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  7. Anna, Terrific post! I am so glad you are continuing to speak about this. I for one, think it's our duty to question the status quo. We owe it to those women you speak about in this post who suffered so, and we owe it to all the women coming after us. I have a post ready on this again too, because well, I'm just another one of the women who has had a bilateral mastectomy and just can't seem to "get over it" the way I'm supposed to.

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  8. I've always been uncomfortable with breast nicknames, because they're used for the most part in a derogatory way. Why? Why are we women subjected to having a part of our anatomy made the butt of constant jokes and ridicule? And if you have a lumpectomy many people assume it was wasn't 'serious', but it was CANCER. C-A-N-C-E-R. If that person making the comment in the beginning of your post would like to trade places with me right now, let's do it. YOU can deal with chemo and the I have seroma from my mastectomy, and look forward to radiation at the end of the summer. And we'll see how you 'deal with it'. Dork.

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  9. Fantastic post, chock full of food for thought. I'll be ruminating on this all day. Thanks for the reminder of how much I love Molly Ivins and how much I miss her writing. Also love the shout-out to Rose Kusher, who is the inspiration behind The Rose, Houston's breast cancer resource for underserved women (www.the-rose.org).

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  10. Anna, apparently there's no limit to the amount of conversation needed about this topic especially with people such as that commenter out there. Just when I was thinking I could no longer be shocked by someone's comments. Yeah, I'll just have to get over it.

    Thanks for bringing up the lumpectomy story. I didn't know any of that and always thought the word, lumpectomy, seemed to fall short. It would all be so fascinating if it weren't cancer.

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  11. Scream, Banshees, Scream! We're in good company as Anna reminds us.

    It's so interesting how pink culture has created an us/them scenario. You're either with us, or you're against us. The realities of the disease, unknown causation, treatment difficulties, cultural mandates, a profitable set of industries, all of these things that make up this "system" - How did they become 'untouchable?' I guess I have an answer to that... institutionalization of ideas and protocols along with an exploitation of emotion and good will.

    Scream, Banshees! We've got the evidence and the arguments. Now we need louder voices.

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  12. Yes! Yes! YES!
    Beautiful post, you are a wonderful, eloquent writer! One must ALWAYS disrupt the doxa when ever possible. This conversation needs to happen and continue to happen until results are seen/felt/heard/shared. Keep fighting the good GOOD fight! I'm in your corner.

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  13. Thanks to all for commenting. This "lumpectomy" story really blew my mind! I too had always felt that word was not an accurate description of a terrifying and very serious ordeal. It's incredible to be that they kept this terminology, because I think it's still trivializing this aspect of breast cancer. How incredibly ironic! This post has really inspired me to go and read up some more on the work of other cancer activists, but I really recommend Siddartha's book, as well as another called "Bathsheba's Breast"....fascinating reads and really help contextualize and put into perspective as to what is happening in today's mainstream breast cancer movement. As Gayle says in her comment, keep screaming BANSHEE's !!!! xxxxx

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  14. Anna:

    Had lunch with your beloved this afternoon. He directed me to your site. Blown away by your writing. It's equal parts logic, passion, and humor. Keep it up.

    Mick

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  15. Absolutely right. I'm only sorry I missed this debate before - while we laughed on twitter, there was a very important conversation going on the #cancerrebels blogs.

    I'm sorry.

    I'm here now. I'm not leaving.

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