Wednesday, May 31, 2006

Breast Oncology

I'm nearing the end of a two week breast oncology attachment. Its been an interesting time. Primarily, I have experienced a complete desexualisation of the breast - in fact, for some women, their breasts come to represent a source of fear, uncertainty and loathing. It may well incur negative outcomes for patient's sex lives, especially coupled with alopecia and other side effects of chemotherapy.

I have attended Breast Clinics in the past, and experienced high levels of emotion and worry by patients presenting with a lump. This is a stark contrast to the hardened patients who come to the oncology clinic for treatment of recurrence, taking it all in their stride, almost emotionless and matter-of-fact about their disease.

Feeling a patient's lump, and realising what I was touching - and what it represented - made me consider a woman's relationship with her lump. Personally, I'd want rid of the mass as soon as possible (which explains why many patients go privately to have earlier surgery). But patients with a large tumour have neo-adjuvant chemotherapy to shrink their tumour down to an operable size, and thus live with the lump for some weeks before it is removed. This must give them some form of psychological acceptance of their cancer - possibly explaining later matter-of-fact attitudes.

However, given how disfiguring the results of lumpectomy, wide local excision or mastectomy can be, it is no wonder that these women adopt such a stoic attitude to their cancer. Thankfully there is an incredibly extensive support network for breast cancer - if anything, perhaps over-representing the disease somewhat in terms of mortality (although one in ten women will get breast cancer in their lifetime).

Jo Spence documented her breast cancer experience, and here is her picture of her undergoing mammography, and her feelings about it:

"Passing through the hands of the medical orthodoxy can be terrifying when you have breast cancer. I determined to document for myself what was happening to me. Not to be merely the object of their medical discourse but to be the active subject of my own invesitgation. Here whilst a mammogram is being done I have persuaded the radiographer to take a picture for me. She was rather unhappy about it, but felt it was preferable to my holding the camera out at arm's length and doing a self portrait."

Readers can see a review of 'Ruth Picardie's Before I Say Goodbye', which documents her diagnosis and eventual death from metastatic breast cancer from the archives.


Ghost Writer said...

This is really interesting AJ. Jo Spence was pretty radical in her time and as for Picardi's book, well I read it about nine years ago and cried all the way through. I think with Picardi you tread a fine line between pleasure and pain in the reading. It is such a painfuol story to read so why do we keep on reading?

Giskin said...

Jo Spence is interesting because she turned the camera on herself at a time when breast cancer was still something of a taboo subject, especially in visual culture. She was adamant that one should record the bad times as well as the good - family photo albums are more revealing about the 'gaps' than how the visually represent people.

I have spent a lot of time thinking about why we read pathography. I'll admit I wouldn't have read Ruth Picardie unless I felt obliged by my job. But I am glad I did. I think it was life-affirming as all pathographies are to well people, but I learnt so much from it about the impact of illness on the family. I like to think I will be better prepared for dealing with serious illness if/when it comes my way as a result.

However, why people read 'misery memoirs' ('A Child Called It' for example) I don't know. I am sure that it must act as some sort of catharsis. Of course one doesn't have to 'enjoy' reading a book to make it valuable.

Jason Walker said...

Hello, I'd like to present you interesting articles about this disease:
Breast Cancer
Breast Cancer: Trends and Incidence
Breast Cancer: Risk Factors
Breast Cancer: Effective Universal Preventive Interventions
Breast Cancer: Effective Selective Preventive Interventions
Breast Cancer: Effective Indicated Preventive Interventions
Breast Cancer: Practice and Policy Implications
Breast Cancer: Future Directions

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