Breast cancer received little attention until the 1990s when women began to criticize the lack of public awareness as well as research funding. Breast cancer activism emerged across the globe, ranging from feminist grass-roots movements, to initiatives by health organizations to corporate activities, the most famous being Pink Ribbon. Feminists have been critical of Pink Ribbon, decrying what they call the ‘pink-washing’ of breast cancer through consumerism and the insistence that breast cancer survivors should ‘look good in order to feel (...) good’. In this article, I explore activism that makes breast cancer visible without silencing its traumas. This activism takes the form of artistic projects – fashion, art, photography, and other forms of aesthetic expression. Drawing upon the work of the queer theorist Dina Georgis, I ultimately turn to the SCAR Project as example of a ‘better story’ about living with the post-mastectomy body and show how it can inspire a transformative feminist politics of the body. (shrink)

Since the late 1990s, the use of contralateral prophylactic mastectomy to treat unilateral breast cancer has been on the rise. Over the past two decades, dozens of studies have been conducted in order to understand this trend, which has puzzled and frustrated physicians who find it at odds with efforts to curb the surgical overtreatment of breast cancer, as well as with evidence-based medicine, which has established that the procedure has little oncologic benefit for most patients. Based on the (...) work of Annemarie Mol and John Law, this paper argues that these efforts to understand increased CPM use are limited by the “epistemology problem” in medicine, or, in other words, the tendency to view healthcare controversies and decision making exclusively through the lenses of objective and subjective forms of knowledge. Drawing on public discourse about rationales for choosing CPM, we argue that this surgical trend cannot adequately be understood in terms of what doctors and patients know about breast cancer risk and how CPM affects that risk. In addition, it must be recognized as the outcome of how specific practices of screening, detection, and treatment do or enact the bodies of patients, producing tensions in their lives that cannot be remedied with better or better communicated information. Recognizing the embodied realities of these enactments and their effects on patient decision making, we maintain, is essential for physicians who want to avoid the paternalism that haunts breast cancer treatment in the US. (shrink)

This paper poses the question, “what are providers’ obligations to patients who lie?” This question is explored through the lens of a specific case: a 26–year–old woman who requests prophylactic bilateral mastectomy with reconstruction reports a significant and dramatic family history, but does not want to undergo genetic testing. Using a conversational–style discussion, the case is explored by a breast surgeon, genetic counselor/medical geneticist, clinical psychologist, chair of a hospital ethics committee and director of a clinical ethics consultation service.

Research on mastectomy recommends better preoperative counseling to manage struggles with body image. This article problematizes the popular concept of body image and instead describes body imaging as an embodied and ongoing process that involves a multiplicity of body images. More preoperative information cannot ensure an easy shift to favorable body images because body imaging resists and exceeds the scope of medicine and the patient’s cognitive anticipation. Thus, medical professionals should avoid decontextualizing or medicalizing body image and instead recognize (...) that body image construction is not simply an intellectual reframing but develops in everyday embodied living. (shrink)

The purpose of this study is to examine the importance that real patients attach to their right to withdraw from an on-going feasibility randomised trial (RCT) evaluating types and timings of breast reconstruction (two parallel trials) following mastectomy for breast cancer. Our results show that, while some respondents appreciated that exercising the right to withdraw would defeat the scientific objective of the trial, some patients with a surgical preference consented only given the knowledge they could withdraw if they were (...) not allocated to their preferred treatment. (shrink)

The purpose of this study was to assess the effectiveness of the Reach to Recovery Program of volunteers sponsored by the American Cancer Society. Effectiveness was defined as enhancing the quality of life and rehabilitation of women who had had a mastectomy, through increasing knowledge of rehabilitative procedures, post-surgery activities and level of self-esteem.The investigation was held in twelve community hospitals in Northeastern Massachusetts. Results of the investigation are reported here. It is recommended that post-operative teaching regarding proper management (...) of rehabilitation procedures should be increased and that Reach to Recovery should be available to every woman who has a mastectomy. (shrink)

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for dialogue (...) and the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies. (shrink)

Although scars never disappear completely, in time most people will basically get used to them. In this paper I explore what it means to habituate to scars against the background of the phenomenological concept of incorporation. In phenomenology the body as Leib or corps vécu functions as a transcendental condition for world disclosure. Because of this transcendental reasoning, phenomenology prioritizes a form of embodied subjectivity that is virtually dis-embodied. Endowing meaning to one’s world through getting engaged in actions and projects (...) is most successful indeed when one’s body is “absent,” “transparent,” or, at least, if it is not in the center of one’s attention. This taken-for-granted nature can be disturbed by discomfort, disability, and disfigurement. Incorporation, so I explain, aims at maintaining or restoring the body’s taken-for-grantedness. My analysis of the case of a woman who successfully habituated to her mastectomy scar demonstrates, however, that habituation to a perceptible scar can only be understood partly in terms of incorporation. Next to a decrease of explicit attention for the scar and the discomfort it produces, the scar should also stop being a sign that refers to something else than itself. This is only possible, I argue, by taking the body’s materiality seriously, rather than it being wiped out as a result of transcendental reasoning. (shrink)

The twenty‐six‐year‐old patient requested a prophylactic bilateral mastectomy with reconstruction because of an extensive family history of cancer. She reported that she had developed melanoma at twenty‐five; that her mother, sister, aunts, and a cousin all had breast cancer; that a cousin had ovarian cancer at nineteen; and that a brother was treated for esophageal cancer at fifteen. The treating team was skeptical about this history, and they could find no documentation of the patient's reported melanoma. The surgeon wrote (...) the patient's primary care physician, explaining that he had seen the patient and planned to proceed with the bilateral mastectomy and reconstruction. The primary care physician responded that he was unable to substantiate several of the patient's claims; some of his colleagues believed the family history to be fabricated. Trying to make sense of the discrepancies, the genetic counselor called a counselor colleague who had met with this patient. The colleague suggested that the in‐house genetic counselor “google” the patient. The search revealed two Facebook pages linked to the patient. In one, apparently a personal profile, the patient stated that in addition to battling stage four melanoma, she had recently been diagnosed with breast cancer. She provided a link to a site where she solicited donations to attend a summit for young cancer patients. The other Facebook page featured numerous pictures of her with a bald head, as though she has been through chemotherapy. The genetic counselor showed the Facebook pages to the surgeon, who then decided not to operate. Should health care professionals “google” their patients? (shrink)

Bioethics committees have issued guidelines that medical interventions should be permissible only in cases of clinically verifiable disease, deformity, or injury. Furthermore, once the existence of one or more of these requirements has been proven, the proposed therapeutic procedure must reasonably be expected to result in a net benefit to the patient. As an exception to this rule, some prophylactic interventions might be performed on individuals “in their best interests” or with the aim of averting an urgent and potentially calamitous (...) public health danger. In order to invoke these exceptions, a stringent set of criteria must first be satisfied. Additionally, where the proposed prophylactic intervention is intended for children, who are unlikely to be able to provide a meaningfully informed consent, a heightened scrutiny of any such measures is required. We argue that children should not be subjected to prophylactic interventions “in their best interests” or for public health reasons when there exist effective and conservative alternative interventions, such as behavioural modification, that individuals could employ as competent adolescents or adults to avoid adverse health outcomes. Applying these criteria, we consider the specific examples of prophylactic mastectomy, immunisations, cosmetic ear surgery, and circumcision. (shrink)

Philosophizing on Scars: Plea for a Material Turn in PhenomonologyIn this paper, I provide a philosophical reflection on the meaning of scars while drawing on phenomenological studies of the body. According to Husserl and Merleau-Ponty, the body as Leib or corps vécu functions as a transcendental condition for world disclosure. Because of this transcendental reasoning, phenomenological studies concerning embodiment often prioritize a form of embodied subjectivity that is virtually immaterial. Endowing meaning to one’s world by becoming engaged in actions and (...) projects is most successful when one’s body is ‘absent,’ ‘transparent,’ or, at least, if it is not in the center of one’s attention. This taken-for-granted nature can be disturbed by discomfort, disability, and disfigurement. Habituation to these kinds of disturbances aims at maintaining or restoring the body’s taken-for-grantedness. Successful restoration of this taken-for-grantedness is mostly understood in terms of incorporation. My analysis of the case of a woman who successfully habituated to her mastectomy scar demonstrates, however, that habituation to a perceptible scar can be understood only partly in terms of incorporation. Next to a decrease of explicit attention for the scar and the discomfort it produces, the scar should also stop being a sign that refers to something else than itself. This is only possible, I argue, by taking the body’s materiality seriously, rather than it being wiped out as a result of transcendental reasoning. (shrink)

Rationale Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines.Aims and objectives To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines.Methods Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of (...) breast cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression.Results The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P < 0.001) and from 31.1% to 52.2% across these periods for stage II (P < 0.001). Adjuvant radiotherapy also became more common (P < 0.001), with 20.6% of patients receiving this treatment in 1977–1990 compared with 60.7% in 1997–2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P < 0.001), from 19.6% in 1977–1990 to 36.9% in 1997–2003, and the proportion having hormone therapy also increased (P < 0.001), from 34.3% to 59.4% between these periods.Conclusions Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based. (shrink)

D.T. a 35-year-old woman, was found to have breast cancer. At the time of mastectomy axillary lymph nodes were positive and the cancer was classified as adenocarcinoma, grade 4. The patient underwent conventional chemotherapy. When it became apparent the disease was metastatic, the patient's oncologist contacted a well-known cancer center regarding the possibility of treating the patient with high dose chemotherapy and autologous bone marrow transplantation. The patient's health insurance provider informed the patient, however, that the treatment—estimated to cost (...) in the range of $150,000–200,000—was “considered experimental or research in nature” and therefore was not included in coverage. D.T. did not pursue this further. Approximately 2 years later, cancer was detected in the patient's spine. This time she applied to another well-known cancer center for HDC/ABMT. The cancer center agreed to accept her on the condition of proof of ability to pay for the treatment. Again her insurer refused coverage on the same grounds as before. D.T. found another source for the money, underwent treatment, then sued the insurance carrier. She sought a declaratory judgment that the treatment was covered under the insurance policy. The court ruled in favor of D.T. finding the contract phrase “considered experimental” ambiguous. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BreakClarice DouilleBreakWe have low expectations for M3s this early in their clerkships. I'm disappointed in you; I had higher expectations for you.""Be yourself. But …""I can see where ____ was coming from. You lack emotional intelligence.""I expected you to have constant questions because of what's going on with your mom.""Don't insert yourself into conversations.""You are a med student; you don't have a reputation yet … you can't change medicine. (...) Nobody will listen to you.""Everyone is going through something. If you knew half the stuff I'm dealing with, you'd cry. So I know what you're going through with your mom right now is tough, but you need to compartmentalize and be fully present with patients.""We know each other …"I can't get this "feedback" out of my head.________I can't quite escape my mom's breast cancer diagnosis since it is shoved in my face every day. This is exposure therapy like no other. Immediately after seeing my mom for the first time since her diagnosis—seeing her distressed and supporting her after losing 75% of her hair during the four days I was home for a visit—I was thrust into assisting with three mastectomies on my first day of the breast cancer surgery service.My third year of medical school has been more than a struggle. I've accepted going through the motions as the best I can do, for I barely have enough energy to make it through each day. Every time I start feeling relief—like I can come up for air—I'm pushed back down and feel myself drowning. I'm constantly waiting for the next shoe to drop. While I can forget about my grief momentarily, as soon as I slow down, the pain returns in unrelenting multiples, pushing me into a dark hole of self-isolation.All I've been doing is grieving. Grieving my mom's diagnosis and fearing the unknown. Grieving the idea that I'm a subpar daughter. Grieving that I'm a subpar friend. Grieving the idea of medicine I had believed in. I grieve for the medical student I was in the past, who wanted to excel in this setting. I grieve that I cannot be this student because I am frozen in fear. I'm grieving the life I thought I'd have, and the life my mom thought she'd have. I'm grieving the life we lost. Time is standing still and simultaneously going by in a blur. I want to be able to control something in my life. My heart and head are heavy with thoughts of disappointment, overwhelm, anger, guilt, and confusion. This is grief.I need a break, but I fear a break might make things worse. In medical school, we are given no time to be human, to live a life full of joy, pain, achievement, and disappointment. I feel myself cracking. I'm being pulled in a thousand different directions. I might break. I tell myself I should be able to get past this. Everyone has something going on. Why can't I be like everyone else—able to tough it out and do medicine? [End Page E1]During clerkships, we are constantly thrown into vulnerable situations where we show up every day and put our best foot forward to impress our team and attendings. We can't miss a beat. It feels like we must be Superman. Every day, we feel inadequate and have to "fake it till we make it." It's soul-crushing. It's exhausting. Every day is terrifying. We worry about getting "pimped"—if we'll be able to answer any question correctly—if we'll present the patient adequately—hopefully not too long, or not too short—so our attending doesn't become annoyed. We don't know when we're allowed to go home, and it feels like we can't even go to the bathroom or eat without asking permission. It feels like we're back in Kindergarten, except with so much more at stake.I think attendings forget that we're more than... (shrink)

A hypothetical scenario is presented in which a female patient is admitted to a private hospital to undergo a mastectomy and breast reconstruction. The surgeons and anaesthetists conducting the different procedures charge three times the medical aid rates. When the patient asks what the co-payments are likely to be, she is informed by the doctors’ accounts section that they can only provide this information after each procedure. The patient’s medical scheme also advises her that it cannot determine the likely (...) co-payments unless she completes the assessment form sent to her. The form requires her to include the costs reflected against the relevant ICD10 codes. The patient cannot complete the form because the doctors’ accounts sections have not informed her about the proposed procedures and the likely costs of each. This article builds on a previous article discussing doctors’ overarching responsibility to disclose medical treatment costs in advance. The present article outlines the legal requirements in the South African Constitution, the National Health Act and the Health Professions Act, and refers to the Promotion of Access to Information Act and Consumer Protection Act. Similar to the earlier article, this article addresses the ethical requirements of the Health Professions Council of South Africa and the internationally recognised biomedical ethical principles. Furthermore, it also refers to the National Patients Charter, the government’s policy document on health care services. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 571 Moving through Cancer: An Interview with Carol Collins Artist Carol Collins spoke with Feminist Studies editorial collective member Stephanie Gilmore about her experience of cancer, treatment, and recovery and how it gave rise to an art series that examines what nature means in the midst of unnatural treatments. SG: Carol, thank you for the opportunity to speak (...) with you about your artwork. Having just lost my sister to cancer, your work reminds me of much pain and loss, but also of love and the desire to survive. Before we discuss the work itself, I would like to hear about your journey through cancer, treatment, and recovery. CC: The breast cancer patient’s journey is complex and perilous. When I was healthy, I was ignorant about the magnitude of suffering many cancer patients undergo. And, although I am a private person, I’m now publicly sharing my cancer experience in order to be a voice for those who have suffered through similar treatments—and worse—and those who sadly are no longer with us to tell their story. Being bald and nauseated are not the most awful possible side effects of the treatments, although they are the most well known. Some women survive the cancer but can die from the treatments, or others suffer through the treatments and die anyway. Often, it seems many believe patients can overcome their 572 Carol Collins adversity solely with positive thinking and persistence. However, not discussing the array of physical and psychological damage that even those with good prognoses incur propagates ignorance about this malady. I hope that my artwork and story will promote a deeper understanding of a breast cancer patient’s plight and will encourage more support for research for individualized therapies and prevention. My cancer journey began when I received a breast cancer diagnosis in January 2014. Life just before that point was good; the future was bright. Tendon pain, caused by my flat feet and a lot of exercising, was my only known ailment. But one day a routine mammogram revealed three tumors in my right breast. The radiology oncologist said the masses were highly likely to be cancerous, so he immediately did painful core biopsies at the sites of my three tumors. The next day, it became clear that we needed to act quickly. The biopsy results revealed I had a very aggressive invasive breast cancer with estrogen, progesterone, and HER2 receptors. Breast cancer in premenopausal women grows quickly due to the high level of hormones present. The oncologists and surgeons said I would, at a minimum, need a mastectomy and possibly lymph node resection, and they warned that I would likely need chemotherapy, which would destroy my eggs and ovaries. After learning of my limited options, I approved the removal of one breast and my sterilization. I knew I needed to think rationally and face the giant raven before me head on. However, I did not realize the magnitude and multitude of physical and psychological pains, illnesses, and losses that were soon to come. The first year of cancer treatments inflicted much physical pain. I received three extremely painful injections into my right breast with a radiolabeled colloid just prior to the mastectomy. The pain came from the injected dye, not from the needle. The modified radical mastectomy was more excruciatingly painful than I anticipated, even with painkillers and overnight hospitalization. Breast reconstruction was an option that added more pain and discomfort from weekly fillings of the installed “expander” and additional surgeries. Extreme pain after the mastectomy prevented me from lying down for months. Foolishly, I did not get an injection port installed in my chest. Instead, I endured numerous deep (and often unsuccessful) needle pricks into the seemingly few veins of my left arm (which still had its lymph nodes) that were appropriate for infusions over the period of a year. Shooting pains across my chest and arm were the norm. Carol Collins 573 In addition to the surgically induced physical pain, the chemotherapy quickly caused a myriad of undesirable physical side effects. It is scary to realize that the medical community does not often fully understand... (shrink)

Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer were evaluated with different self-report questionnaires. Afterward, patients (...) were divided into two groups to analyze dependent variables according to the type of surgery. The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy. (shrink)

In parallel with the rapid rise in breast cancer incidence, there is also a noticeable rise in the number of patients who experience persistent negative body image cognition after breast cancer surgery. This study aimed to explore the differences in illness perception, social support, and body image cognition among breast cancer patients with different surgical methods, and the correlation, regression, and mediation among the three variables. The Brief Illness Perception Questionnaire, the Social Support Rating Scale and the Body Image Cognition (...) after Breast Cancer Questionnaire were used to evaluate breast cancer patients’ illness perception, social support and body image cognition. Data analyses were performed by descriptive statistics, independent samples t-test, analysis of variance, Pearson correlation, and linear regression. The mediation was explored by the PROCESS V3.3. The study found that breast cancer patients undergoing radical mastectomy and modified radical mastectomy demonstrated more negative illness perception, body image cognition, and lower social support compared with the patients receiving nipple-sparing mastectomy. The subscale cognitive representation of BIPQ was strongly positively correlated with BIBCQ. Illness perception positively predicted body image cognition, while social support negatively predicted body image cognition. Social support partially mediated illness perception and body image cognition, exhibiting a positive role in post-operative body image cognition. (shrink)

_The Tender Bud_ is the moving story of one woman's journey through breast cancer. The woman in question happens to be a senior psychiatrist of broad learning and deep clinical insight. Madeleine Meldin weathered the crisis of breast cancer without the support of an immediate family and in the context of ongoing professional burdens. This book is the journal that she wrote for herself as an aid to coping with the personal upheaval of diagnosis, mastectomy, and the aftermath of (...) treatment. It was written while these events unfolded. With arresting candor, Meldin chronicles her emotions at each stage of her odyssey - the recurrent cycles of denial, anxiety, and despair; the conflicting feelings engendered by her physicians, surgeons, and the treatment "establishment" in general; her struggle between resignation and emergent hopefulness. Unique to Meldin's account is her ongoing juxtaposition of the different dimensions of "having cancer." Simply and gracefully, she chronicles the everyday dimension of cancer, with its obligation to proceed maturely and dispassionately with medical and surgical care, to meet one's professional responsibilities, to maintain the appearances that allow one to carry on with one's life. Meldin excels at showing how even the most mundane experiences of everyday life - conversations with friends and colleagues, the selection of clothes, a trip to the hairdresser - became saturated with her illness, with her sense of herself as a cancer patient. (shrink)

An ex-voto (from the Latin for ‘from the vow’) is an image made to express the patron's gratitude for divine assistance in the face of personal difficulty. Here, we describe a late 18th century Mexican painting that shows Doña Josefa Peres Maldonado undergoing a mastectomy, and, as an ex-voto, expresses her thanks for divine aid in having survived the operation. As such, the painting manifests Doña Josefa's response to her disease, drawing on both medical and religious sources of support. (...) This brief report analyses the unusual double dedication of the ex-voto, the elaborate home altar it depicts and the surgical technique it demonstrates. (shrink)

The aim of the study was to confirm the mediation effects of the task-specific self-efficacy on the relationship between the general self-efficacy and intention and planning considering treatment. The study comprised 265 subjects, of which 165 were post-mastectomy women and 100 patients hospitalized due to acute coronary syndrome. The variables were assessed using the Generalized Self-Efficacy Scale and tools developed to examine the context of treatment. The data were analyzed using the bootstrapping procedure. The results confirmed the indirect effects (...) of task-specific self-efficacy, both in women making a decision to undergo breast reconstruction, and in patients after ACS formulating intention to change risk behaviours. As smoking was considered to be a moderator in the post-ACS group, the obtained associations were observed only among the patients declaring quitting smoking. In view of the fact that taskspecific self-efficacy is susceptible to context, it is useful to assess it in order to increase treatment effectiveness. (shrink)

ObjectivesThe breast cancer stigma affects Health-related quality of life, while general resilience resources, namely, sense of coherence, social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.MethodsIn this cross-sectional study, Stigma Scale for Chronic Illness 8-item version, SOC-13, Medical Outcome Survey- Social Support Scale, Brief COPE, and Functional Assessment of Cancer Therapy-Breast were investigated (...) in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson’s correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.ResultsAn analysis of 221 women with the mean age of 47.14 showed that stigma was negatively correlated to all HRQoL’s dimensions, SOC, social support, and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support, and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.ConclusionWhile GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Solving the Jigsaw PuzzlePeggy CadetIn my medical record, there is an enigmatic note. It was written as a consultation request from a pediatric endocrinologist to a plastic surgeon while I was hospitalized at age 13 (in the late 1960s) for mastectomy. The note reads:You have seen this unfortunate teenager with the feminizing testis [older name for androgen insensitivity] syndrome on several occasions in the past in reference to (...) the construction of a penis. Would appreciate your seeing him again to evaluate the problem. He is firmly fixed in the male gender role despite efforts on the part of his father to persuade him of the logic of a change.The surgeon’s response (also in my notes) was:The prospect of creating an acceptable penis in this patient seems to me very remote. There is nothing there except an enlarged clitoris. This could be mobilized and might project a few cm but cannot be made into a male organ of normal dimensions. The hair distribution and the perineum is also feminine which compounds the reconstruction problem.Since the decision has been made to go along with the male gender I suppose that mobilization of the penis–clitoris is reasonable. Urethral reconstruction will be possible only much later....I saw this note for the first time at age 21 but didn’t think it was particularly significant until many years later. At the time I had other, much more pressing concerns, as I had reached the conclusion by then that I had been mis–assigned as a boy and that the only way for me to have a reasonable and happy life would be for me to change to living as a girl. It was not a surprise that my doctors had been completely on the wrong track about my “gender”. I was also not about to bring this up with the endocrinologist, a person who had terrified me as a child and whom I still found a bit intimidating.I do remember the surgeon stopping by and examining me briefly without explaining who he was or why he was there. I had a somewhat longer, but equally uninformative (for me) visit from a child psychiatrist. The note requesting a consultation from the psychiatrist reads:Would you see while he is here recovering from his mastectomy? Since he began to show mammary growth 18 months ago his father has put him under considerable pressure to undergo another change in gender role. has resisted but he is quite depressed. We would appreciate any suggestions you may have.I actually have no recollection at all of anything like pressure from my father to change to living as a girl. What I actually experienced was more like 180 degrees away from that—the expectation that I should try to be more masculine. As I remember, my father was bothered by my having breasts and was the one who initiated the physician contacts that led to mastectomy. (My mother had died when I was five, leaving him to rear me as a single parent.)As my father recollected to me many years later, he had asked the pediatric endocrinologist to explain all of my treatment options and alternatives to me. I can only guess, but possibly the pediatric endocrinologist interpreted this as my father wanting me to change to living as a girl. As a young [End Page E1] adult, I got the impression that this particular doctor tended to mistake asking for information about possible treatments for requesting treatment. The idea of a patient gathering information and making informed decisions may not have figured prominently in his thinking. On the office visit when I was 21 and first mentioned to him that I might want to live as a girl, he told me that gender identity was “an unshakable conviction,” so perhaps his idea was that gender was just not something a person could make an ordinary decision about, weighing the pros and cons.My father knew—but at age 13 I didn’t—that the original decision for me to grow up as a boy had been made in a somewhat haphazard way. I had entered... (shrink)

The aim of the study was to determine the role of self-efficacy, outcome expectancies, and risk perception in formulating the intention to undergo breast reconstruction in 178 women after total mastectomy. The social-cognitive variables were measured in the context of breast reconstruction, while depression was assessed using the Beck Depression Inventory. The structural equation modeling revealed that among the predictors there were only two that accounted for the intention to undergo breast reconstruction, i.e. self-efficacy and outcome expectancies. Subsequent analyses (...) of the related moderators, i.e. depression, age, and duration of the disease indicated a good fit to the data. Nevertheless, in subgroups with poorer resources the direct effects of self-efficacy on intention were less noticeable or non-existent. The results suggest that self-efficacy may play the regulating role in making a breast reconstruction decision if individual resources are taken into account. (shrink)

Le cancer est perçu aujourd’hui comme une maladie qui affecte à peu près autant d’hommes que de femmes. C’est cependant une conception relativement récente. Jusqu’au milieu du xxe siècle, le cancer était considéré comme une pathologie principalement féminine, les tumeurs malignes produisant des symptômes typiques faciles à détecter. Au xxe siècle, les cancers féminins – du sein et de l’utérus – sont les principales cibles des campagnes publiques pour la détection précoce des tumeurs malignes. Depuis les années 1950, le développement (...) de méthodes efficaces de diagnostic et l’augmentation des cancers du poumon, plus fréquents chez les hommes, met fin à l’image du cancer comme une pathologie féminine. Dans les discours publics et les medias, les cancers des organes reproducteurs féminins continuent cependant d’être plus visibles que ceux des organes reproducteurs masculins, et les femmes à risques sont plus souvent sujettes à une chirurgie de prévention mutilante. (shrink)

The prelims comprise: Introduction Commerce, Ethics, and Science: Gene Sequencing Commercial Marketing of Genetic Tests Conclusion.