Breast Cancer: A Cultural History

(air whooshing)- Today, of course, we are talking about breast cancer, the cultural history of. I'm not a doctor here. And where do we want to start? I want to take you back to 1971. September 1971. Ebony Magazine published this remarkable article that broke so many taboos. A survivor of breast cancer wrote candidly about her diagnosis, including undergoing a radical mastectomy and her journey of recovery afterwards. Now, as the leading magazine for the African American community, it was an extraordinary article due to the way that it addressed black women's experiences of breast cancer at a time when cancer charities and professional medical organizations were almost exclusively white. Now, the title of the article is "I Was a Cancer Coward." And it was authored by 66-year-old Era Bell Thompson. She was actually an editor at the magazine. And she was scathing about physicians who were reluctant to tell their patients that they had breast cancer. She noted that some doctors even admitted to telling patients deliberate medical mumbo jumbo. Others broke the news, not to their female patients, but to their husbands. One husband who was told the diagnosis responded by shouting at the doctor. You are not going to cut up my wife. The preferences of women themselves were too often simply ignored. Now, clearly, in her article, physicians were cancer cowards, but actually, when she was talking about cancer cowards, she was not talking about them exclusively. The cancer coward in her title was, of course, Era Thompson herself. She admitted that her overwhelming emotion when she was diagnosed with breast cancer was shame. She felt, her words, unclean, guilty of some unknown sin. She furtively booked herself into the surgical world of a hospital, taking pains to ensure that I would not be recognized and hanging a no visitors sign on the door. Thompson's article was unique for the time, not only because of her willingness to speak openly about her emotional responses to breast cancer and radical mastectomy, she was also, but also because she was really sensitive to questions of gender and heterosexuality. Unusually, she also wrote about African American men who had breast cancer in defiance of the stigma attached to male breast cancer survivors due to the fact that the illness is somehow seen as effeminizing. She even published their names and a big photograph. Sexuality also haunts her article. Thompson's account of surviving breast cancer is preoccupied with heteronormative concerns about sex. She spoke to numerous other black women who had been diagnosed with breast cancer, and as a result, claimed that one of their central anxieties was whether a mastectomy would make them less sexually attractive to men. This anxiety was followed by, and what will she tell her children? In a, I think, really revealing passage, Thompson described how a woman who had a breast removed would religiously wear a padded bra around the house. Sorry. Thompson then went on to describe how a, quote,"small son of one mastectomy," a term that's often used at the time alongside other harsh terms like amputee, had looked over the shoulder of his dad who was reading Playboy, and pointing to some voluptuous bunnies, cried out,"Look, they have got two." This anecdote was intended as kind of light relief for her readers rather than a critique of heteronormative standards of female beauty or, indeed, of male consumption of pornography. Thompson's intellectual vision, in other words, did not extend to sexual or gender minorities. However, Thompson's 1971 confessional account of breast cancer and mastectomy did break a major taboo relating to that constructed category of race. It is the earliest example that I can find of a woman of color speaking in a very public form about breast cancer. Historians have uniformly given this accolade to the singer Minnie Riperton, who was diagnosed with breast cancer in 1977, and in the two years before her death, was the public face of the disease. And I just want you to look at a clip of an advert that she did at the time, telling the world that she had breast cancer, that she had a mastectomy. And this advert became really, made a real splash. Let's see if this works. And for those of you too young to know the song that is being played, you have missed out on a world of pleasure.♪ Lovin' you is easy ♪♪ 'Cause you're beautiful ♪(record scrubbing)- It happened that abruptly. I got cancer, I lost a breast, but I saved the rest of my life because I examined myself early. Now I'm healthy. I've picked up my life where it left off.♪ Stay with me while we ♪- [Narrator] Minnie Riperton, she lost a breast, but saved the rest of her life. Help us cure cancer in your lifetime.- Isn't that a beautiful song? Anyway, the attention paid to this musical star, Riperton, who died at the peak of her career aged 31, rather than the Ebony editor Thompson, 66 years old when she died, or 60 years old, sorry, when she published her article, and lived to the age of 81, is I think a reminder to all of us of the politics of voice. Thompson's distinctive writing style was appreciated by readers of Ebony, who were almost exclusively people of color. Riperton's voice, however, was that of a singer at the top of pop charts. Indeed, many of her listeners were not even aware that she was a woman of color since her musical genius did not lie with souls or blues, thought to be black genres at the time. It is, in other words, Riperton's voice, not Thompson's, that has echoed through time. But let me just take a detour from from all of this before I will return to the questions of race, gender sexuality, and voice. I think the main question that, well, I asked myself when I proposed to write this talk is, why in the world should we be interested in the history of breast cancer? Now, the most obvious answer to this question is that it affects one in every eight women in Britain and America. Breast cancer, of course, takes many forms. It can be located in ducts or lobules. It can be invasive and non-invasive, detected at an early or late stage. It responds very differently depending on a patient's age and menopausal status. The ancient Egyptians certainly knew about it. 8 of the 48 cases described in Edwin Smith's surgical things, written around 3000 BC, are related to breast tumors or ulcers. This unknown surgeon contended that there were no treatments for this affliction. The crab, cancer's etymological root, is Carcinus, or the jaws of, you know, a crab, has always incited fear. In the words of Pierre Dionis, as he wrote 1710,"The wars and plagues kill in less time. They don't yet to me seem so cruel as the cancer, which is certainly, though more slowly, carries those afflicted with it to the grave with all causing such pains as to make them everyday wish for death." Now, the question that all of these physicians asked is, what caused this affliction? Well into the 18th century, the views of ancient Greek and Roman philosophers and physicians were influential. Their views cannot be understood without knowledge of humoral theory, which continued, incidentally, to hold sway up until the 19th century. So according to humoral theory, nothing to do with ha, ha, nothing to do with comedy here,

phlegm, black bile, yellow bile, and blood. Disease, or diseases, were the result of disequilibrium or imbalance of these four humors. In the context of breast cancer, Galen contended that the cancer was caused by an excess of black bile or melancholia. This was why women were so susceptible to the disease. Their cold bodies, their moist bodies made them vulnerable because these bodies were prone to soak up, if you like, the bad humors. Excessive black bile was normally, it was believed, flushed out of the body through menstruation, which was why they thought that vulnerability to breast cancer increased after menopause. As "The Compleat Midwife's Practice," 1898 put it,"the canker precedes from a feculent and gross humor, which being gathered together in the spleen is chased away from fence after it grows too hot, which when nature cannot void, it most commonly in women empties itself upon the breasts, by reason of their cavernous and spongy nature. The matter of it is a hot, melancholy blood, and it is known by its crooked windings and retorted veins that are about it, stretching out long roots a good way from it, being sometime blackish and sometime inclined to black and blue." Although surgery was an option, mastectomy, by the way, was mentioned as early as the fifth century, it was, of course, extremely hazardous at the time, not only because of infection and shock, both of which were extremely common in a period prior to anesthetics and antiseptic agents, but also, and this is important, because many surgeons we're still talking about the ancient period, the 18th century, many surgeons believed that cutting into the tumor spread the disease. This is why Dionis reminded his readers that "cancers are not to be touched, for in touching them you aggravate the evil, and hastened the death of the patient." Instead of surgery, then, what we get is specific plants were believed to expel the humor, melancholy, black bile. So certain plants did that expelling. The body could also be purged using poisons and other purgatives. Bloodletting, of course, was highly recommended. Strong, salty foods, not very good wine. Even worse, hot foods very bad. Because 18th century physicians believed that cancer was actually a sentient being. Wolves, they believed, were inside the body, or worms. One treatment was to feed the internal beast. So Dionis, for example, provides a good example of this view. In his words,"some believe that the ulcerated cancer is nothing else but a prodigious multitude of small worms, which by little and little devour all the flesh of the part: What made room for this opinion, is, that with the microscope we have sometimes discerned some of those insects in cancers." Consequently, he recommended putting a piece of veal on the ulcer. I don't why it has to be veal. I've never worked that one out. But anyway, placing a piece of veal on the ulcer, which will result in the patient feeling, quote, "less pain; because, say they, these worms then feeding on the veal, leave the patient at rest for some time." Now, he himself, in fact, by the way, was less convinced by this. Like other physicians, however, he debated whether breast cancer was contagious or hereditary, what were causal factors. Menopause, hysteria, breastfeeding, and barrenness were all suspected. While physicians might turn to the use of mercury, carbolic acid, and later, electricity, women themselves widely shared their own recipes, unorthodox recipes, sometimes it has to be admitted, containing poisonous chemicals. Now, the 19th century saw the really big change in this narrative that had been going on for centuries. So the change is of a shift from these kind of constitutional explanations for breast cancer to more localized ones. Now, when physicians increasingly understood cancer not as a disease of the entire body, for example, the body was imbalanced in terms of humors or physiological disruptions caused by menopause, so not those, but when they started to believe that actually it was just confined to particular organs, then excising those organs through surgery became much more attractive as a cure. Surgery had also been made much safer by the use of antibiotics to prevent postsurgical infections, combined with the increase safety of blood transfusions, especially after 1900 when an Austrian physician discovered the three human blood groups. And of course, it goes without saying, surgeons themselves were keen to promote their discipline and raise their status. Promoting surgical operations at that stage was a means to a rather profitable end. Now, the most influential, isn't he lovely and distinguished, the most influential proponent of surgery for breast cancer was this guy here. William Stewart Halsted based at Johns Hopkins University. Today, his late 19th century operation for breast cancer survivors, breast cancer sufferers, is known as the radical mastectomy because it involved removing not only the breast itself, but the auxiliary lymph nodes and the pictorial muscles, both major and minor, behind the breasts. The removal of such a large amount of tissue was explained by his belief that, again, this is an old belief, that when you cut into cancerous tissue, it releases cancerous cells into the rest of the body. That's what he believed. That's why he was recommending this radical surgery. This was also the rationale for what has become notorious, and that is his one-step surgery. That is, a woman would be anesthetized, a biopsy taken and tested, and if it proved cancerous, then the mastectomy would take place before the patient woke up. So one-step surgery. In other words, women would not know in advance if they were going to wake up for surgery with or without a breast. Radical mastectomy and one-step procedures were dominant for 80 years. 80 years. Even until the 1980s, early 1980s. Well, much critical ink has been spilled about the physiological and emotional costs of radical mastectomies and one-step surgery. The keenness with which some surgeons wielded the knife against women's breasts, especially the breasts of older women, has been widely condemned. In 1955, the surgeon, a well-known surgeon called George Pack, known as Mack the Knife, maintained that surgeons had a duty to divorce the patient from his cancer, and should be constrained solely by the ability of the human remnant to remain. For many surgeons, even at the time, this was nothing short of humanectomy. So why did an operation that left millions of women barely able to comb their own hair, why was it performed for so long? Okay, well, there's lots of explanations. I think. Halsted's own personal reputation I think plays some part here. He had the institutional backing of the extremely prestigious Johns Hopkins University, and was responsible for the most successful surgical training course in the US. In a book called "The Breast Cancer Wars," Historian Barron Lerner also points out that Halsted was, shall we say, less than fully transparent about his success rates. The ideological milieu of the time was another factor. The radical procedure was consistent with the militarism unleashed by the two World Wars and then the Cold War. In the US, the power of the insurance industry also meant that surgeons were often too timid to attempt fewer radical procedures, fearing that they might be sued if a more minimalist operation resulted in a recurrence of the disease. It was financially advantageous as well to engage in invasive procedures. Now, we get the second main change. The first main change is late 19th century with Halsted and radical mastectomies. The second major change is 1970s and 1980s, where the radical mastectomy comes under sustained attack led by surgeons George Crile Jr. and Bernard Fisher, but also by patients, by feminists, and activists. Fisher really important here because he carried out randomized controlled trials, which allowed him to prove that lumpectomy in combination with radiotherapy, chemotherapy, and/or hormonal treatments was as effective as the radical mastectomy. However, the status of the radical mastectomy was most effectively counted in, or counted by, new social movements focusing on the rights of patients. The Patients' Association, for example, was started as early as 1963. But also, it was counted by other new social movements, such as the those looking at the injustices of racial inequalities, and the need for women to be liberated from paternalistic healthcare practices. Consumer protections, concerns about ethics also rose to the top of the medical agendas. Like Thompson, Activist Rose Kushner came to public prominence by fighting to be allowed to disrupt the one-step procedure. And she's largely credited with igniting a really large debate about informed consent for patients undergoing surgery. They had the right to be told of all the options. In Kushner's words,"Our lives are at stake, not the surgeons." Well, it's hardly surprising to observe that a racist imaginary, or a racist imaginary of race, was also at the heart of these new debates in this period. Socially dominant medical professionals were white and shared the racist prejudices of their peers. And this included beliefs that women of color were not susceptible to breast cancer. The explanation that they gave was due to three racist dogmas. First, women of color possessed more primitive bodies. Second, they were closer to nature. And third, they were physiologically robust. No one, I think, has done more to help us understand this dynamic than Keith Wailoo. If there's only one book that you have time to read, this is the book. His book called is called"How Cancer Crossed the Color Line." And in it, I mean, it's a very subtly argued and just beautiful, beautiful book. In it, he explains that racist tenants included the belief that, quote, primitives and savages had neither the modern cancer-causing dangers to dodge, nor the inner capacity to address their new situation. Okay, so as we saw in the last lecture, for those of you who were here for the last lecture on polio, people of color were assumed to be immune from diseases such as polio and breast cancer. Scientific racists insisted that their risk only increased when they migrated to the big cities, where they caught cancer because their bodies were not adapted to urban lifestyles. Such prejudices were effectively challenged during the civil rights era. But knowledge that cancer was a racially democratic disease did not automatically translate into greater representation of people of color in cancer literature or in treatment regimes, let alone in mainstream activist movements and charity organizations. Talented editors like Thompson could write all they wanted in Ebony, and Audre Lorde, who I'm going to be talking about shortly, could rail against the injustices in her writings, but breast cancer awareness remained conspicuously white, especially in the medical specialism of oncology. Now, what makes this remarkable, well, there's many things that makes this remarkable, but one thing that makes this remarkable is that it was obvious to anyone who thought about it that people of color, the poor, and other minoritized peoples, minoritized groups have higher than average levels of breast cancer morbidity and mortality. All forms of cancer disproportionately affect the poor and the disadvantage disenfranchised, specifically because they are more likely to live in hazardous environments. Take, for example, the so-called "cancer alleys," towns such as Convent in Louisiana, home to the petrochemical and industrial factories, populated mainly by African Americans and Latino. Cancer morbidity and mortality there is exceptionally high. Take Bayview-Hunters Point in San Francisco, populated predominantly by non-white and severely impoverished residents, where women are 87% more likely to die of breast cancer than women living next door in the same city. Environmental pollution is largely to blame, combined, of course, with the fact that their racialized identities and poverty means that they are more likely to be diagnosed with the disease at latest stages, less likely to possess medical insurance, high-quality medical insurance, and of course, when they do, they have access to poorly equipped clinics and hospitals. No one understood these inequities better than writer and civil rights activist Audre Lorde. For Lorde, oppression cannot be understood through concentrating on only one vector of identity. Intersectionality is crucial. Those of you who've been to my other lectures know this is one of the themes. One of the earliest expositions of this insight was a statement made by the Boston-based Combahee River Collective, a black, feminist, lesbian group established in 1974. In their defining statement, they declared themselves actively committed to struggling against racial, sexual, heterosexual, and class oppression, and see as our particular task the development of integrated analysis and practice, based upon the fact that the major systems of oppression are interlocking. The synthesis of these oppressions creates the conditions of our lives. As black women, we see black feminism as a logical political movement to combat the manifold and simultaneous oppressions that all women of color face. And the person who's popularized this in more recent years is, of course, Kimberle Crenshaw. And I use her in other lectures, so I won't go into her work more here. But basically, in order to understand inequalities and illness acquisition and illness management, attention must be paid not simply to sex discrimination or to racial prejudices, but the compounding effects of race, sex, gender, class, caste, religion, disability, age, generation, and so on. Now, in relation to breast cancer activism,

Her account of breast cancer,"The Cancer Journals," published 1980 after her 1978 mastectomy, and "A Burst Of Light," 1988, after her cancer had spread, remain classics. And again, I really, really, really recommend these. When she was diagnosed with breast cancer, Lorde reflected on the middle-class, heterosexual whiteness of nearly all commentaries on the disease at that time. Lorde admitted, "On and off I kept thinking,'I have cancer. I'm a black, lesbian, feminist poet. How am I going to do this now? Where are the models for what I'm supposed to be in this situation? There were none. That's it, Audre. You're now on your own.'" But Lorde did more than draw attention to the compounding injuries inflicted because of her intersectional identities. She also had, I think, had really powerful things to say about the privatization of cancer. That is, the tendency to view it solely as a personal or individual trauma, while ignoring, in her words,"the function of cancer in a profit economy." Lorde also challenged her physicians, insisting that they take seriously her ownership over her body. Her initial attack was on the one-step process. She complained that doctors were treating her as resistant to their diagnosis as a personal affront."But it's my body and it's my life and goddess knows I'm paying enough for all this, I ought to have a say." She observed that medical power was further alienating women from their own bodies. She was particularly incensed by the American Cancer Society's Reach For Recovery program, a representative of which encouraged her to pad out her bra with a wad of white lamb's wool. She swore that "either I would love my body one-breasted now, or remain forever alien to myself." For Lorde, the cultural fetishization of the breast had negative impacts for women who underwent mastectomies, and were an additional insult for women from minoritized communities because the ideal breast was imaged or imagined white. Lorde was defiant, stating that "I refuse to hide my body simply because it might make a woman-phobic world more comfortable." This was a political statement as much as an aesthetic one. She contended that by accepting the mask of prosthesis, one-breasted women proclaim ourselves as insufficient, dependent upon pretense. The result was a reinforcement of women's isolation and invisibility from each other, as well as the forced complacency of society, which would rather not face the results of its own insanities. She observed that the socially sanctioned prosthesis was merely another way of keeping women with breast cancer silent and separate from each other. Now, Lorde has been criticized for sometimes framing her diagnosis in the context of a war against cancer. When a nurse told her off for not wearing a prosthetic breast, she said that "Not appearing at the clinic without a fake breast was bad for the morale of our office." Lorde insisted that she was a warrior, and this was an honorable thing that she was doing. She states, "For me, my scars are an honorable reminder that I may be a casualty in the cosmic war against radiation, animal fat, air pollution, McDonald's hamburgers, and red dye number two. But the fight is still going on, and I am part of it." She refused to be reduced, in my own eyes, or in the eyes of others, to be a victim. Now, part of the problem that Lorde is identifying here is the prioritization of aesthetics. She was offended by the assumption that you're as good as you were before because you can look exactly the same. Lamb's wool now, a good prosthetic as soon as possible, and no one will ever know the difference. This was abhorrent to Lorde, not only because of the assumption that beauty was dependent on looking two-breasted, but that the beauty being promoted was white or light skin colored. The intersectionality of Lorde's identities compounded her oppression for her race, black; femininity, one-breasted; sexuality, queer. Now, like Thompson and Riperton, Lorde's words are, I think, a powerful reflection on illness, on race, and harmful assumptions about women's bodies, femininity, and beauty. These women transformed the visibility of the disease amongst black men and women and encouraged the ignored acknowledgement that visibility is a political and ethical act. But they went further. Never enough. More was needed. And for them, this meant activism. Now, they were joined in their endeavors by the explosion of pathologies. That is, illness narratives and autobiographies written by breast cancer survivors. These included the memoir written by Betty Rollin, whose "First, You Cry" embraced a feminist bile, and Rose Kushner, who we've already mentioned,

A Personal History & Investigative Report" railed bitterly against the malevolent, male-dominated medical profession. These writers insisted that breast cancer was a political issue. And they castigated political and medical elites for ignoring the ways that women's bodies were being polluted and poisoned by corporate interests that contaminated the environment. And the works of this generation of writers contrasts really starkly with the highly individualized accounts of breast cancer that have emerged in more recent decades. This genre assumes that, as women, we are living in a post-feminist world, where consumer choices related to their breast cancer diagnosis are part of their liberation. In these pathographies, breast cancer is tightly linked to beauty and fashion industries. Fairly typical example includes Lucas' "Why I Wore Lipstick to My Mastectomy," which encourages readers to also perform this act of courage. That is, wearing red lipstick to a mastectomy. In some additions, Lucas asks,"Isn't attitude everything?" That's on the front cover. And words like "guts" appear on the back cover. And for those of you who have followed my lectures, in the one on polio, I also discuss this issue of guts. You've got to have guts when you're sick, and the tyranny of comportment. Pathologies tend to follow a really, particularly, I think, invidious narrative of quest, implying that self-knowledge is acquired to undergoing particular trials. Patients were required to perform a kind of stoicism or even positivity. As Kushner put it,"Patients are expected to enact the red badge of courage. They are told that they should glue a stylish wig on your pate, choose some Rolaids, and grin and bear it. Never hint to the doctor that the breast cancer medicine is the reason you feel so sick." So unhappiness requires some kind of apology. Erased from these more recent pathologies is issues such as fear and anger. For such groups, the emphasis was on the return to normality rather than a political identity. Women who experienced breast cancer were expect to return to their safe, suburban lives afterwards. Now, as such things suggest, suffering from breast cancer could be stigmatizing, similar to other diseases. Women could be blamed for refusing to follow their natural and eugenic destiny as mothers, or for having been so obsessed with beauty that, for example, they didn't breastfeed. Chemotherapy caused many to lose their hair, women's shining glory. As Catherine Lord, a different Lord, Catherine Lord put it in"The Summer of Her Baldness,""On a woman of my age, pate smells invalid. Even admitting to feeling pain could be seen as shameful or humiliating." And there's this really interesting survey done in the early 1970s of patients who found that more than 1/3 admitted that they didn't speak about the pain because of negative, it would lead to negative social laboring. They say things like,"I rarely discuss pain unless someone asks me.""I'm not one of those hypochondriacs.""No one likes a complainer." Even organizations dedicated to helping women suffering from breast cancer could perpetuate harmful sexist messages. And I'm going to show you one example here from the Breast Cancer Fund of Canada. And just so you know what's going to be happening, in it you have this young boy, young man called Cam who's offering to do breast exams for anyone who wants it. Okay, let's see if this is going to work. So Cam's breast examination.- Are you too busy to do your monthly breast self-exam? Unsure of the right technique? My name is Cam, and I'd like to help. Let me examine your breasts for absolutely free. I'm highly trained and highly motivated, so call the number on your screen. Call takers are standing by, so put your breasts in my hands. Let Cam do your breast exam.(upbeat music)♪ Give me all your love ♪♪ Baby do it right ♪♪ You're holding me tonight ♪- Isn't that shocking? (laughs) Anyway, let Cam do your breast exam. Joking and sexualizing breast cancer is, of course, unfortunately not rare. Okay, how have American and British authorities, charities, and activists sought to educate people about breast cancer? And I think historically there are two really major responses, different official responses. In the US, the response is placed on public education, the main mantra being "Don't delay." So yeah. In contrast, in the UK, after the founding of the NHS, which was then free at point of access, there were fears that this approach would not work. That it would overwhelm the NHS with women panicking about whether they might have cancer. Would public information inflame anxieties, hypochondria, a British affliction, and cancer phobia? Would it encourage unnatural, unrealistic, sorry, expectations from physicians and surgeons? So unlike in the States where it was public education, in the UK, in this earlier period, it was much more focused on educating physicians rather than the general public. This also meant that British organizations were much more committed to research over public education in comparison to their US equivalent. In terms of public advocacy, it's also possible to see that there are two very different responses, or different forms, if you like, of advocacy. In shorthand, these are the green versus the pink approaches. Green advocacy emphasizes prevention through environmental change. And they have developed stringent critiques of pharmaceutical and chemical corporations, and have often got really strong ties with global feminisms and AIDS activism. The, in contrast, pink advocacy is much more consumer based, focusing on raising funds for research and treatment of breast cancer. And they have generated some really powerful critiques. Pink bows and balloons, cuddly, pink teddy bears, pink coffee mugs, pink broaches, coloring books complete with crayons not only infantilized women, but present consumption as a solution for breast cancers, often caused by the same companies donating a usually minuscule share of their profits to cancer projects. So in other words, this approach has been termed pink washing. That is, the corporate exploitation of breast cancer in the name of profit. And pink washing is the main focus of the Think Before You Pink campaign. The unholy alliance that the British Cancer Action identifies between corporate greed and breast cancer also has a medical component. And that is the breast reconstruction and plastical cosmetic surgery industries, which make huge profits by playing on heterosexist, patriarchal ideas about normal women's bodies. These industries are heavily promoted by professional cosmetic surgery organizations, as well as companies that manufacture breast implants. And these surgeons are highly influential in deciding what constitutes the ideal or the correct, as they see it, breasts. Ignoring vast differences in the normal appearances of breasts, these surgeons laud precision, uniformity, measurement, downplaying all of the risks. And today in Britain, something like 30% of women who experience a mastectomy have breast reconstruction. Now, to conclude, we don't actually, I like this image, we don't actually need Foucault to.... I'm going to keep that image a little bit longer. It's nice. We don't need Foucault to tell us that knowledge is power. As he put it,"Power produces effects at the level of knowledge. Far from preventing knowledge, power produces it." In the context of breast cancer, it's important to look at who and what are invested in knowledge about this disease. What are the effects of the types of knowledge produced? Specifically, the fact that the biomedical emphasis today focuses on risk factors communicates a great deal about power and vulnerability. Risk is individualized. That is, it assigns culpability to the patient who fails to regulate diet, eliminate toxins, such as nicotine or alcohol, entering the body, remains skinny, fail to remain skinny and exercise, fail to reproduce at a young age, and fail to breastfeed infants. Many of these risks are, of course, tightly tied to notions of being truly feminine and female. Most obviously, they're also tied to notions of feminine beauty, slender, and the natural female body as the reproductive one. In its most, I think, dangerous form, it stigmatizes women who stand against heteronormativity. It relegates other causes of a breast cancer, such as environmental ones, to lesser positions. In the words of one women writing to Betty Ford, of course, one of the famous women who came out publicly to talk about breast cancer and mastectomy, a woman writing to her said,"Remember that your attitude is most of the battle. Never think about defeat, only about winning, and you will win." These were what Era Bell Thompson, Minnie Riperton, and Audre Lorde were protesting when they stepped out of the cancer closet and changed their worlds. They were important in the movement from the Foucaultian docile bodies subjected to the disciplining regiments of medicine to being subject engaged in their own illness, recovery, and dying. That's it. Thank you.(audience applauds) And just to say that, in a month's time, we are going to be talking about HIV/AIDS. 16th of February. And that will be followed a month later by sickle cell disease and two months later by dementia. So I hope that you can come to those. Does anyone have any comments or questions that they would like to raise?- [Audience Member] First, I'd like to thank you very much for really enlightening lectures. I wasn't expecting that, but that was beautiful. Thank you.- Thanks.- [Audience Member] I've learned a great deal. I'm thinking historically that this concern about cutting surgery spreads cancer cells is perhaps something we ought to keep in the modern period because this, you know, there seems to be a shift for things like thermographies. So perhaps some of the history is useful for today.- Yeah, thank you. You know, I'm not intending, and I hope I didn't give the impression I was intending, to be prescribing any particular form of treatment. For one thing, I'm not a medical doctor, I'm not a surgeon or a medical doctor in any way whatsoever. So I wouldn't dare do that because other people know much better than I do about that. But also, I think the important thing that I am insisting upon is that it's women ought to be making their own decisions about what for them is the right and proper procedure for the way they live their lives. And I think that is the important thing. And that is what has so often, historically and today, been lost in all of these debates. And this is why I think that the, particularly the four activists that I was talking a lot about here today, that was their main fight in the 70s and 80s. And they changed the way doctors worked. I mean, physicians themselves also, as I mentioned, also had a say in that change by doing, you know, random controlled, you know, trials and everything. But, you know, at the same time, that was really pushed by these women who were saying,"It's my choice, and I want to know all the facts that we have in whatever period of history that are the best information that we have." And I think just as a footnote to that, I think as a historian of medicine myself, I think there's always a risk of assuming a sense of progress. Aren't we getting better? We know more now. And I think that really has to be, as you in fact just indicated, that really has to be resisted very strongly. And one of the reasons I love history is because it gives us other ways of looking at the world and thinking about alternatives. And sometimes they may include, as you suggest, going back to something that was learned or was known in an earlier period and kind of lost. And sometimes it doesn't. So yeah. But thank you for your comment. That's great. Yeah.- [Audience Member] I was just going to say that was a really great talk. I'm a molecular biologist myself and a lesbian. And I wrote my dissertation on similar malpractices and women being overlooked definitely in the medical field, and how we continue to see that well into the 20th century. I suppose my question would be to you, just out of interest, what do you think is the next step in increasing representation within the medical field or increasing representation just in society? Just that curiosity.- Yeah. Thank you very much. And I'm really pleased that you're here because there's a longer version of all of my talks, by the way. So there's a script that you can pick up as you go out. Because in that longer version, one of the other things I talk about is, well, I don't talk very much, just a few sentences, but is about it was also really important that women started to go into the medical profession, and particularly into oncology. That, you know, one of the things that really was helping hearing women's voices was the fact that you were increasingly having female doctors, female surgeons. And that was a very, very important thing. And as you say, they're still, you know, highly underrepresented in a lot of medical fields. And that is a fight that we really need to keep at all the time. And I published a book actually just this year, and this may sound like it doesn't answer your question, but it kind of does, which is actually a history of sexual violence globally. It's called "Disgrace." But the reason I'm mentioning sexual violence in a talk about breast cancer is because the last chapter of that book says,"We can have a world that is better. We can have a world that is rape-free." And then it goes through systematically the ways we create better worlds, okay? Now, the same response to how we create a rape-free world is also how we work to create a world of greater equality more broadly. The same things, the same principles, the same practices, the same ideas work for the broader question, not simply sexual violence. And yeah. And, you know, it's a long chapter, but I think one of the central arguments is that there is not one way forward. We want to increase female representation in these fields. You know, it's not enough. It's too simple to say,"Well, if we do this, then it'll solve the problem." Rather, you know, we all have to use our own specific talents, our proclivities, our realms of influence in different ways to address the same problem because these are major problems. So there's not simply one answer. Yeah. Okay. Question online. Okay. There's actually now a few. Okay. The first one I received says this. Cancer is often presented as a fight to be won, whilst my mom also experienced fun and face pack sessions when in hospital and enjoyed them. Is what you point out as a capitalist approach to cancer also gendered? Really, really good question. It's very much gendered. Ooh. It's very much a gendered approach, as we saw, I mean, most obviously in terms of the pink washing. There's highly gendered ways of doing this. And the infantilization that you see with female breast cancer treatments, you know, it's just a world away from male breast cancer, and indeed, other forms of cancer treatments, and the way they alleviate that. So absolutely is my answer to that. Is there anyone else who has a question or comment? Okay, there's one more online here. What do you think has been the greatest impact of present breast cancer medical care? I'm going to choose to answer this one not in terms of medical procedures because that's not my field, but I do think that the return to a much more politicized way of thinking about breast cancer treatments and dealing with breast cancer is, I think, the really good way forward. Yeah. Okay. Thank you very much, everyone. I really enjoyed talking to you.(audience applauds)