Saturday, February 11, 2012


 All but three Tico women in Costa Rica are generously endowed, I swear it.  And only two seem to feel no drive to showcase.  Never in my life have I seen more breast tissue on display, even on TV, than on the streets in CR.  TV has more or less desensitized most of us to skin tight T-shirts and aureola grazing necklines, so unless you are shopping for clothes for your still-hibited self, it's pretty much ho-hum, another boob on display, so what.
Unless, of course, you are a guy.  The guys here are very good at not-drooling and disguised staring, but I have observed a few very close shaves in traffic caused by a spectacular set strolling past.  I kind of wonder if the skill the Costa Rican males have developed for seeming to ignore all this mammary glory has had something to do with the development of tighter and tighter clothing, lower and lower necklines and a cultural imperative toward the push-up bra. The population is heavily skewed toward the distaff, as all the guys head north to make money before returning to buy property and set up a family. Naturally the women would be competitive.
Be that as it may, a writer friend recently shared a paper she wrote at university discussing boob issues.  I found it so funny, so right-on, and so insightful that I asked her if I could share it with you.  Because it is rather long, I took the liberty of taking some of the more academic bits out, most notably the reference section and the introductory explanation of the work of C. Wright Mills, the sociologist who inspired the paper.  Anyone who is interested can probably obtain the entire paper by writing me (and I will ask her).  So, without further introduction, here is our guest blogger for today, Nerissa Gailey.

Who Is Afraid of the Big, Bad Boob?  Private Troubles, Public Issues, and Breast Cancer
In 2010, my husband and I took our teenage children on an odyssey to California.  Upon our return, one of my clients expressed an interest in viewing photos from our family vacation, and we spent a pleasant afternoon going through the pictures together and sharing travel stories.  My client enjoyed the vicarious trip, but in looking at these pictures as though through her 90 year old eyes, I began to doubt the wisdom of continuing to go braless at this point in my life. 
Here is an example of a personal dilemma confounded by its intersection with all kinds of hairy public issues!  My choice of undergarments is surely a private concern, but when I realized how obvious it was that my boobs were just sitting there, being themselves, I was distinctly uneasy.  Those boobs of mine were breaking the rules, instead of conforming to society’s expectations by gamely enduring a harness. A bra would coerce them into a more acceptable shape, while simultaneously disguising them, making them like Barbie’s boobs; no threat to anyone.  Two for one:  greater sex appeal and modesty are both invoked by the same garment, and those who forswear the bra must suffer the assumptions and negative sanctions reserved for the deviant (Female Intelligence Agency Examines: Why do women wear bras?, 2003-2011).  Well, I believe in picking my battles:  I went to Sears and bought myself some respectability (and anonymity, and sex appeal).
It did not work out.  I would get home from work and rip that bra off as fast as I could, but my breasts grew increasingly sore, and even the lymph nodes in my underarm area grew hard.  I treated a public issue (unacceptable bralessness) like a personal trouble, and got myself a medical problem.  Sore, lumpy boobs:  what is a girl to do?  I asked around amongst females of my acquaintance.  Fifty to sixty percent of women without breast disease exhibit “fibrocystic changes” (Santen, 2005), including  my friend Mary, my next-door neighbor, my hairdresser, and my mother, who all agree it is no big deal, but none of them had experience to parallel my own, because they were not in pain and they were all life-long bra-wearers.  At that point, it seemed sensible to me to treat this as a case of lymphatic edema.  I tried to flush out my lymphatic system by bouncing on a trampoline several times a day, as per Linda Brooks’ book Rebounding to Better Health (1995).  Once again, I addressed the problem from within my “private orbit,” (Mills, 1959, p. 1) as Mills would say, attempting to find a solution from within my immediate milieu. 
I decided that my clients probably didn’t care whether my boobs were appropriately reined in or not, and abandoned the bra.  Gradually the worst of the discomfort subsided, but my breasts did not normalize completely.  Five months after the problem began, I hurt my back wrangling a client’s wheelchair into my car, and I finally went to the doctor.  Here we have another lurking public issue: like many women, I prioritized my clients’ needs and those of my family above safeguarding my own health, and brought my doctor into the conversation only when crisis hit and I could no longer possibly cope using my own resources.
The doctor helped me initiate a claim with Worker’s Compensation for the back injury, examined my breasts, advised me to limit my (already minimal) intake of chocolate and caffeine, and scheduled a mammogram.  I spent the next four weeks horizontal, anguished about leaving my clients in the lurch, unable to face the prospect of continuing to work for Home Instead Senior Care, and scared about my health.  I read Gabor Mate’s When the Body Says No (2003), and pondered my own patterns around incapacitating myself when circumstances become untenable.  This book discusses the physiology of stress and its effects on immune function, and Mate’s vivid case studies illustrate how a threat to one’s values can become a threat to one’s life.  Mate treats this material intelligently and with great heart, illuminating the connection between stress and disease without veering off into “the cancer personality” or other blame-the-victim territory.  I examined my psyche, and my dead end, low wage job, looking for an exit less extreme than death. 
Here is more grist for Mills’ mill:  I am an intelligent, competent, creative 40 year old woman, but I have no credentials.  There I was, working as a caregiver for $10.50 an hour, while my clients paid $21.75 an hour to the agency that employed me.  The job had become unbearable due to irreconcilable differences:  the agency’s business model required each caregiver to be instantly replaceable with another, and my humanity required me to be fully present and genuinely available to each client and their unique needs.  I was much valued by my clients, largely due to the personal connection we shared, and each time the agency introduced another bureaucratic protocol, further institutionalizing the relationship, I saw no benefit for me, my clients, or the standard of care being delivered.  Mills, quoted by Mark Smith, talks about this depersonalization of work in White Collar:  “[E]ach individual is routinized in the name of increased and cheaper per unit productivity” (Smith, 1999, 2009, p. 6).  I struggled with my employer over these losses of autonomy, arguing unsuccessfully that making caregivers wear uniforms mandatorily undermines our ability to provide discreet companionship, and is a violation of the client’s right to privacy.  Bureaucracies are not known for flexibility, and this policy change with the dress code for caregivers produced untenable role conflict (Lanning, 2011):  I was not the only one of Home Instead’s most senior, award-winning caregivers to flee the agency within months of this change.
Tending to the needs of society’s aged members is “shit work” (The Transvaluation of "Shit": a political issue, 2010).  This work is necessary for society, and not intrinsically demeaning, but it was traditionally performed for free within the context of the family.  Those who can afford to outsource domestic labor often do so, and this labor is relegated to those of  low status.  The low wage guarantees that those who engage in such work remain of  low status, and have to engage in more labor than is personally sustainable, simply to meet their basic economic needs.  How do you break out of circumstances like this?  The unmitigated capitalist business model of my employer gave all control to the agency, and the non-compete clause of my contract left me unable to set up independently, were I so bold as to attempt it.  The legal ramifications of providing care outside the aegis of an agency like Home Instead are daunting enough to offset the extra income independence would provide, and franchises like Home Instead count on this fact.  The structure of our current economy requires expensive, expert training to escape the limited prospects of the high school graduate (Lanning, 2011).  No job is worth dying for, and this one certainly wasn’t.  In no position to confront the public issues involved here, I resigned from my position with all the grace I could muster, and waited for my mammogram appointment.
The morning of my mammogram, I was nervous about the procedure because I had heard that sometimes it is painful.  I was fairly confident that nothing was seriously wrong, however, since I don’t possess the commonly cited risk factors for breast cancer.  Like the general public, I was not educated appropriately about risk factors.  As Penelope Williams states in Breast Cancer:  Biography of an Illness, 75% of women diagnosed with breast cancer have no risk factors except being female (p. 20). 
A risk factor is a substance or condition that increases the chance of developing a particular cancer…The degree of risk each factor poses depends on a number of different things and can vary from person to person….It can be seen as a contributing cause, but it’s not the underlying cause.  It is established through statistical analysis of correlation, rather than any firm understanding of how it might result in the formation of cancer cells.  Correlation is not cause, but to date it’s all we’ve  got…  [R]isk factors guide much of the research; they are listed in most articles published by the popular media; they grace the pamphlets and handouts from breast cancer organizations; they are the subject of sessions at conferences; and they twist our lives into pretzels when we interpret them as causes and try to live by them. They have evolved into rules of conduct, many of which we cannot live by, and many of which we shouldn’t live by, especially since the rules keep changing.  (p. 14) 
Too unsettled to read, I scanned the waiting room.  Most of the women present were ten to fifteen years older than me, with one exception:  the youngest in the room, a tattooed  twenty-something, was obviously in the midst of treatment, being the only one with no street clothes under her hospital gown and no hair on her head.  She radiated an enviable toughness.  No one was interacting with anyone they hadn’t brought with them, and the educational display boobs (meant for practicing breast self-examination techniques) lay unmolested.  I gave those model boobs a thorough feel up, and I could detect none of the lumps supposedly in them, and they didn’t even have ribs behind them to confuse the issue!  If my breast tissue was that malleable, I would not be there:  Mauling the fake boobs was not an enlightening educational activity. 
Women are continually counseled to perform breast self-exams, even though research suggests these do not improve health outcomes. “The evidence on breast self-examination is clear, there is no benefit to breast cancer mortality and results suggest that breast self-examination may do more harm than good” (McCready, 2005).  Women are told that breast self-exams are important for early detection of breast cancer, when in fact tumors are undetectable by touch until quite late in the game.  In spite of credible research such as McCready’s, doctors continue to recommend self-exams, and the naturopath I consulted was the worst offender:  The charting system she advocated for tracking breast changes was  absurdly complex, useful to only the most technically-minded, highly dedicated boob groper.
When my turn came, I was relieved at the skillful technician’s straightforwardness, and the discomfort was minimal.  She took several views of each breast, and asked me to wait a few minutes to be sure the radiologist didn’t require anything further.  I was called back in, and this time it was like having my breast gripped in a vise, and then she rotated it!  The pain did not recede for several days.
Mammograms are controversial.  Like breast self-exams, they are recommended as a prevention measure, but they prevent nothing, and even as a tool for early detection, they are flawed.  Sidney Ross Singer, a medical anthropologist, describes the controversy from this perspective:
About 20 years ago, when I was in medical school [he wrote this in 1995 or 1996], I remember reading about the bold experiment our culture was about to undertake to deal with the rising tide of  breast cancer. Without having any knowledge as to the cause of this disease, which would allow true breast cancer prevention, it was reasoned that the best alternative to prevention was early detection and treatment. Towards this end, a massive mammogram experiment began. […] Of course, you cannot prevent a disease by looking for it. Once you find it, you've got it. Early detection means you have cancer. This is not prevention, despite claims made in the propaganda campaign to get women to comply with mammogram guidelines.  It is not usually mentioned in that propaganda that mammograms use potentially dangerous x-rays, which are known to cause cancer. Exposure to radiation is also cumulative, which means the chances of these x-rays causing cellular mutation increases with each new exposure. And recent research has shown that false positives have resulted in unnecessary surgery, radiation, and chemotherapy, not to mention the psychological trauma to women and their families resulting from a false cancer diagnosis and treatment.  There are also false negatives. Radiologists have to interpret the mammogram, and they make mistakes. Some may not see a mass, giving the woman a false sense of security.  Surely, if a woman has cancer in her breasts, it is best to detect and treat it early. That would be true for all cancers in all parts of the body. But does this justify a massive program to get women to routinely submit to x-rays as a screening procedure for disease? Would it make sense, for example, for men to routinely get their testes irradiated with x-rays to look for a tumor? Should we all get annual brain x-rays to scan for tumors? Some people may be saved by this. But most people will be harmed, not only by the x-rays themselves, but also by going through unnecessary treatment caused by false positive results.  (The Mammogram Scam)
My doctor phoned before that twisted tit had stopped smarting.  She explained that the radiologist found small calcium deposits in my left breast, and I was given an appointment for an ultrasound and a needle biopsy in four weeks’ time.  My earlier confidence evaporated.  Two days before the appointment date, the hospital (a robot, not a human voice) phoned to postpone the diagnostics an additional three weeks.  Still, all these appointments happened relatively rapidly, which led me to suspect that my health was in grave danger in spite of my doctor’s “it’s very common” and “usually nothing to worry about” mutterings.  I was given nothing on paper:  I had no specific information about my case.  The hospital gave test results to my family doctor, and I never saw them.  I requested that my naturopath receive a copy of the radiologist’s report, but this was impossible because her name was not in Capital Health’s computer.  Another public issue:  privacy laws now restrict the distribution of medical information to such an extent that sometimes the patient cannot view their own! 
The ultrasound came first, and it turned out this was for the right breast, and the technician was happy with what she saw, concluding that the area of concern was a “discrete clump of breast tissue,” and not a tumor.  All damp from conduction jelly, I trundled across the hall for my next ordeal.
Sherry, the nurse assisting the resident who was to perform the biopsy, carefully explained the procedure to me, and I signed the consent forms.  She decided the procedure would work best if I were lying down, and positioned me accordingly.  Lying there with my left breast in a clamp, I became sick with fear, and suddenly felt very strongly that the biopsy was the wrong thing to do.  They released me immediately.  The resident, who couldn’t completely suppress his amusement when I told him of my failed trampoline self-treatments, asked if anyone had shown me the films from my mammogram.  Together, we looked at the three tiny white specks of calcium in the image.  He explained that this was a “low suspicion” procedure, and that we could certainly justify waiting six months and repeating the mammogram, rather than proceeding with the biopsy under these circumstances.  Had I been given this information (in writing, with the context for my results included), I could have saved Capital Health some time and trouble!  I did wonder if that resident was disappointed because he did not get to use that fancy core sampling gun on my lightly calcium-flecked flesh, but they were very gracious about my reversal.  Informed consent is a public issue which has been addressed, and so in this case I was saved some personal misery.  I was grateful to be given enough information to judge the risks and benefits of the biopsy for myself, and no one implied that I should choose differently.  I walked away intact and empowered, and I will have a follow-up mammogram on November 28th.
What does my experience tell us about private troubles and public issues and the fight against breast cancer?  There has been much improvement over the years in the experience of being a patient, and I was saved some of the difficulties of earlier boobs.  Breast cancer has been successfully brought into the public awareness, and is no longer a taboo subject.  Cancer victims are no longer treated like pariahs; in fact, there is tremendous support available.  I meet women everywhere who have a story to tell about it, and who are living testaments to survival.  But the causes of cancer remain unclear, and the conversation around risk factors needs to change. 
Bra-wearing has been investigated as a possible risk factor (Rockel, 1996), and the research seems plausible.  I know from my own experience (and now you do, too!) that bra wearing can cause problems with breast health. But the Canadian Cancer Society dismisses this as a “myth” (Bras and breast cancer, 2011), and the authors of the largest epidemiological study linking bras and cancer describe the persistent stonewalling they have received in trying to disseminate their research (Ross Singer, Bra and Breast Cancer Cover-up)
It is difficult to continue to trust that mainstream medicine is acting in good faith when controversies like this are summarily dismissed, especially when personal experience contradicts prevailing conclusions.  If the Canadian Cancer Society objects to the research methods of Sydney Ross Singer, why aren’t they conducting their own research on the impacts of restrictive clothing on lymphatic function?  Medicine loses credibility over this kind of thing, and thousands of patients are flocking to alternative practitioners because of it.  The public is forced to gamble with health because of role conflicts within the research and treatment communities, whose allegiances to corporate funding often determine resource allocation over more patient-centered priorities.  The medical community could use a dose of sociological imagination, and would do well to heed Mills’ conclusion:  “Do not allow public issues as they are officially formulated, or troubles as they are privately felt, to determine the problems you take up for study” (as quoted in Smith, 1999, 2009 p11).