Unless you’re living under a rock, you’ve probably heard about how a panel was convened to look at the breast cancer screening recommendations, and taking new evidence into account, they suggested the screening should start for most women at 50 instead of 40, and that self-exams were ineffective. I knew this would be taken by some feminists as an outrage—believe me, there are some feminists who are prepared to believe the worst at all points in time—but I was surprised how much of the feminist blogosphere went into pure rage mode immediately. Why was I surprised? Because feminism has a long tradition of critiquing the over-medicalization of female bodies, producing excellent must-read texts like Our Bodies, Ourselves and For Her Own Good. Feminist critiques of over-medicalization of female bodies have produced much good: the introduction of midwifery, the willingness of therapists to take women’s concerns seriously instead of just drugging them, the legalization of emergency contraception, the promotion of breast-feeding, the end of the use of twilight sleep for childbirth, the invention of safe abortion techniques that can be performed even without electricity. It’s also produced some bad, from overreaction: paranoia about the birth control pill and the HPV vaccine and bullying women who aren’t willing or able to tough out completely drug-free childbirth come to mind. But the fact that we even have to control for overdoing it shows how firmly committed feminists generally are to pushing back against over-medicalization. So why was there so much anger about recommendations that fit so neatly into feminist critiques of medicine?
Luckily, some skeptical voices have emerged to defend the panel, and their ideas are really enlightening as to why there was so much anger about the recommendations. As Echidne gently explains, it’s a result of that ongoing human tendency to favor anecdotal evidence over the more illuminating statistical evidence.
One of those is the way a survivor of breast cancer would approach it. She had a mammogram, a tumor was found and treated, and she is alive. To then learn that other women are told not to get the mammogram sounds blasphemous to her. Horrible, even. At the same time, perhaps her cancer wasn’t the type which progresses very rapidly? Perhaps it wasn’t the early screening that saved her life? Or perhaps it did. We just don’t know at this stage, because we don’t have the ability to look at a tumor and classify it based on how dangerous it is. That is the research that should be carried out now, by the way.
In other words, we construct narratives that rationalize our past, for good or for ill, but while our rationalizations may be important for our mental well-being, they don’t tell us anything about statistical realities.
Another reason that there was a knee-jerk hostile response to the recommendations is that it came from a panel of doctor types, and women are used to doctor types patronizing us, and so it was assumed this was more of the same. Indeed, this was Feminst Law Professors’ unfortunate take, which was bothersome, because in order to get there, they minimized the very real pain and suffering women experience from over-screening and false positives. Luckily, Rebecca at Skepchick stepped in to defend those of us who think being poked and biopsied and squished is not no big deal. You are not a weak person if you don’t want a doctor digging around in your tit, nor are you a baby if you think that’s painful.
Part of the antagonism was due to an increasingly outdated belief that the medical establishment is hopelessly male-dominated, and therefore doesn’t take women’s lives seriously. Rebecca also addressed this, pointing out that cries that this is male conspiracy don’t make sense when the majority of the panel is female. Taken with the new interest in rolling back the amount of screening done for cervical cancer, some worried that this was just about saving money by robbing women of care. But as Sir Charles pointed out, prostate screening has also been reconsidered in the same way. Why didn’t that raise as much alarm? Sir Charles has a theory:
Not to engage in gender essentialism, but I think this may have to do with the fact that men are always comfortable with a recommendation that reinforces our tendency toward denial in these kinds of matters — oh the test is no good — great, I’ll skip it. (Or maybe I’m just projecting.)
I have a slightly different take. I think it’s because our culture respects men’s right to view their bodies as inviolate, and thus we sympathize with men who don’t like being poked and prodded at the doctor’s office. But we assume, incorrectly, that women should just suck it up because the over-medicalization of female bodies is just one example in a long line of examples of treating female autonomy and personal boundaries as insignificant. So yes, I think that far from being patronizing, it’s respectful to think about how women might not like to have our tits squished and biopsied for no statistical survival gain any more than dudes might not like having their buttholes prodded and their ability to get erections threatened put in danger for the same lack of statistically significant benefit. Of course, this is assuming people pay attention to the recommendations, which make exceptions for people with risk factors.
I think the final reason this caused such a shocking reaction is that we’ve been told so long that screening is prevention that we’ve started to believe it. All those pink ribbons! All those ads for screening that classify it as “prevention”. But the truth is that even if you benefit from early detection—and whether or not you will seems to increasingly depend on what kind of cancer we’re talking about here—that still means that you got cancer, and it was not prevented. Now, most of the time, you couldn’t have prevented it if you wanted to, and that’s just all there is to it. But that doesn’t mean it’s wise to fold up screening into prevention, because in some cases, we have reason to believe that people are substituting screening for prevention.
For instance, I’ve gotten into arguments with people who think we don’t need the HPV vaccine because we have the Pap smear. But the vaccine is prevention—stops cancer from forming—and at best, the Pap smear can be used to stop cancer from forming at great personal risk and a whole lot of pain. And the possibility that you may never have children if you want them, because scooping out precancerous cells can sometimes weaken the cervix until carrying a pregnancy is impossible. And that’s if they catch it before it’s cancer. Some of the time, the Pap smear finds actual cancer.
We have to remember, as we’re fighting for more access to health care, that more access is a different thing than more health care. More access, so that you can get it when you need it, is a good thing. But simply piling more care onto a person doesn’t necessarily mean you are making that person healthier. In many cases, over-medicalization can actually hurt people’s health. For instance, doctors overprescribe antibiotics, sometimes even for diseases that are untouched by antibiotics (like the flu), because they know that people will get mad if they go to the doctor and don’t walk out with a prescription. But taking antibiotics when you don’t need them is not only bad for you, but is likely contributing to the development of superbugs. In this case, more care is making people more sick.
My first inclination—that feminists should be happy to find that the medical establishment is responding to criticisms about over-medicalization—didn’t turn out to be a total bust, however. It turns out feminist medical organizations have been demanding for a long time that the over-screening of pre-menopausal women be rolled back. As with this newest panel, the feminist critique incorporated the understanding that high risk women should start at a younger age, while being aware of the dangers of a false positive.