Breast Cancer and the Discourse of Risk

Abstract

This thesis explores the role of values in risk assessment for breast cancer. Why? First, breast cancer poses a serious health threat to women, yet currently has no known cause. This means the discussion of risk becomes central to this disease. Second, K.S. Shrader-Frechette has shown that values enter in at each stage of risk assessment. These stages are the choice of topics, methods, and evaluation. By using Shrader-Frechette's framework for analysis of such areas of breast cancer as mammography, prophylactic mastectomy, tamoxifen and the role of estrogen, research routes, and prevention, it can be shown that certain values dominate the risk assessment. These values are the technological imperative, individual causation of disease, and reductionism. This thesis argues that the dominance of these values has led to a narrow and biased view of breast cancer risk. This view leaves women with fewer legitimate choices for the management of breast cancer risk and in many ways excluded altogether from its risk discourse. As breast cancer advocacy groups have gained in strength, attention has been drawn to the fact that there are competing values which can be used in risk assessment for this disease. These competing values are a low-tech/high-preventative, holistic, care-oriented approach to disease. These values can provide a viable alternative assessment of risk in breast cancer. Furthermore, this alternative risk picture is more desirable than the current one, because it helps to redirect and widen the focus on risk in breast cancer and gives women a central role in its risk discourse.