The Politics of Breast Cancer
by Marj Plumb
Marj Plumb has been a lesbian and gay health advocate for more than 15 years. She is the former director of the NYC DOH Office of Lesbian/Gay Health. Presently she serves as Lesbian health consultant for the National Center for Lesbian Rights, and works for the Lesbian and Gay Medical Association.
The words "Breast Cancer" have become the mindless mantra of some gay men looking to say something real about lesbians and the rallying cry of some lesbians looking to forge an empowered movement for our own lives. But the elevation of breast cancer to the primary issue of mortality for lesbians is wrong, and not helpful in building a movement to eradicate cancer or in understanding our health risks.
The concept of an "epidemic" of breast cancer among lesbians really took off when a National Cancer Institute (NCI) researcher analyzed some lesbian research data, applied what NCI considers risk factors for breast cancer, and made a presentation at a health conference concluding that lesbians may be 2 -3 times more likely to get breast cancer than non-lesbians. An Associated Press reporter then reported that lesbians had a one in three chance of developing breast cancer (because women in general had a 1 in 9 lifetime incidence at that time). Early on, lesbian health activists were clear when they pointed out that the NCI researcher didn't say that lesbians had a 1 in 3 chance of getting breast cancer and that while the attention on breast cancer was important (and about time!) it should be extended to all cancers and other health issues as well. However, some in the lesbian and gay media, so desperate for anything to report on lesbians, continued to hype the 1 in 3 report until "lesbianbreastcancerepidemic" became a new queer household word.
Lesbians do get breast cancer and the media-hype about the increased risk of breast cancer for lesbians has focused more attention on lesbian health issues and I believe has probably encouraged more lesbians to get to their friendly neighborhood gynecologist for that all important pap test and mammogram. But the research is clear on one thing -- and one thing only -- breast cancer is an epidemic among all women and is most highly associated with being female and being over the age of 50, regardless of sexual identity. The majority of women with breast cancer have none of the other "suspected" risk factors such as, never having given birth, high alcohol consumption or higher body mass index, which were used in the lesbian analysis by the NCI researcher. If you want to have a good, but perverted time, choose a breast cancer risk factor and ask a group of breast cancer researchers to comment on it -- then step back.
Another problem with the data used by the NCI researcher to make her analysis was that it, again like so many reports, included predominately white, middle class, well educated, "out", self-identified lesbians. That's fine if you are a white, middle class, well educ...well you get the picture. The assumption that all subgroups of women who call themselves lesbian are similar to the white lesbian in behavior, lifestyle and pregnancy histories -- that we all had the same options, the same desires, the same struggles (or lack thereof) -- is patently absurd. The media reported a Lesbian Breast Cancer Epidemic and at the same time that we all reached out to touch our loved ones (you can take that however you wish) we were left to consider the implications of this news on our lives by ourselves, without all the facts. And many of us freaked.
And why wouldn't we? Our reaction is, unfortunately typical. Many women worry more about breast cancer than, let's say, heart disease - which kills about ten times more of us each year. Some of the fear is surely related to our breasts, with which we have a very different relationship than internal organs like our heart (thank you, very much). Some of the fear is related to the sensationalized estimate of "1 in 3 lesbians may..." which many lesbians think of as an absolute figure of any one in three lesbians each year (even if you believe the NCI researchers' analysis, it actually refers to a life time risk of lesbians who reach the age of greater than eighty five).
And, of course, I think the other reason this epidemic theory has been so embraced by so many is that, for the invisible, visibility at any price is worth it. I see the word lesbian in the cover story and I want to believe what ever it is I find printed there. We have been living in a gay and lesbian nightmare of death from HIV, so visible and consuming so much community energy, that the thought of more death is not a large leap to take. In fact, breast cancer has become
"the other epidemic" thus reinforcing a "his and her" health crisis for our community. This continues to ignore that many women and men in our community die from many, many different diseases and conditions, not just AIDS and breast cancer - and some lesbians die from both.
There are many, many lesbians battling this awful disease. They need as much economic and emotional support, health care and activism as we have been able to generate for the fight against HIV. We don't need to inflate lesbian risk, or make it the only lesbian health issue. to generate the right community response.