From Stigma to Respect: A Change in Attitudes towards Women with Breast Cancer since the 19th Century

Georgia Bock is a fourth year biological chemistry major at Grinnell College. She has a long-standing interest in medicine and a recent attraction to public health. She enjoys learning about medicine through the lenses of different disciplines and hopes to find a career that will allow her to apply these various approaches.

In 1985, National Breast Cancer Awareness Month was conceived as a result of the partnership between the American Cancer Society and Imperial Chemical Industries with the aim to promote preventative screening through mammography. A short 28 years later, it is hard to imagine breast cancer as a disease of which people need to be more aware. Today, breast cancer awareness is perhaps one of the most highly commercialized campaigns with trends including the Tweeting Bra and #Mamming.

Social media and advertising are proven ways of raising awareness. And the act of raising awareness itself is far from an uphill battle when American society holds in high respect both the research efforts for a cure and the individuals who battle against the disease. Yet, victims of breast cancer haven’t always been portrayed as heroic. While the disease and procedures for diagnosis have remained relatively unchanged over the past two centuries, the cultural perceptions of breast cancer have undergone a complete transformation.

In the early 19th century, cases of breast cancer were only well documented in patients who were white, female, and upper class. Benjamin Rush, one of the most famous physicians in American history, diagnosed Abigail Adams, daughter of our second president, with breast cancer. [1] Abigail’s experience with breast cancer likely differed from most women at the time. She was well informed and able to afford the services of highly regarded physicians and surgeons. What she did share with her less affluent female counterparts was the bashfulness she felt about her life-threatening discovery. While she noticed the lump in her breast several months prior to her diagnosis, she hid her discovery until the lump was visible to the eye.

Because Abigail Adams was well respected and fit the cultural standards of an ideal woman, her experience with breast cancer was not subject to prejudice. In general, however, 19th century doctors linked their diagnoses of the disease with inherent “female” characteristics. Dr. D. Hayes Agnew believed that anxiety and worry, both feminine attributes, predisposed women to breast cancer. [2] These characteristics originated in the belief that women were passive, fragile beings whose reproductive organs made them susceptible to disease. These characteristics are evident in Thomas Eakins’ The Agnew Clinic, below, a depiction of a radical mastectomy in which the patient lies unconscious, objectified by the audience, and dependent on the expertise of Dr. Agnew.

Thomas Eakins, "The Agnew Clinic," 1889
Thomas Eakins, “The Agnew Clinic,” 1889

For most of the 19th century, female breast cancer patients were viewed through this objectifying lens. Doctors focused more on developing a successful treatment than instilling trust in the doctor-patient relationship. Breast cancer treatment in the 19th century was marked by brutal, unsuccessful surgeries that resemble nothing like the one portrayed in The Agnew Clinic. Ultimately, the development of staging and new emphasis on early detection originating with these procedures paved the way for patient advocacy. Doctors began pushing for patient responsibility in the diagnosis and treatment of breast cancer with “do not delay” campaigns focused on early detection. [3] The perception of breast cancer shifted from a disease caused by feminine characteristics to one that women could prevent and control provided that they assumed full responsibility in taking preventative measures.

Responsibility and risk assessment continue to be ever-present in how today’s women perceive breast cancer. As Nancy Wong and Tracey King state in The Cultural Construction of Risk Understandings through Illness Narratives, “The burden of personal responsibility is so ingrained that women often feel that they are to blame for not detecting the disease earlier or having failed to pursue the most aggressive treatment.” [4]

In the 1970s, activist and support groups developed in response to the anxiety and frustration women felt about their diagnosis and treatments. Similarly, illness narratives allowed them to openly discuss their experiences. Today, when an American woman makes decisions regarding her diagnosis, she is influenced, consciously or subconsciously, by the voices of thousands of other women. Breast cancer is no longer an individual disease. It has become a collective experience.

Studies have shown that many women believe that a mastectomy is more effective than a lumpectomy even in early stage breast cancer when typically only a lumpectomy is recommended. [4] My mother was diagnosed with breast cancer in 2007 and was given the option to undergo chemotherapy followed by a lumpectomy or a mastectomy followed by chemo. She chose the latter. This decision was based in part upon her own mother’s mastectomy decades prior. After her surgery, the doctor informed her that two additional tumors and lymph node metastasis had been discovered and that she had certainly made the right decision. Like my mother, Angelina Jolie also underwent a mastectomy. Her decision was preventative and highly discussed by the media. No doubt, her decision will influence future generations of women.

In the 21st century, the culture surrounding breast cancer is transparent and open. Breast cancer has been transformed from a shameful and hushed topic to one that the vast majority of women in America will be tested for by the end of their lifetime.

_____________________

[1] Olsen, James Stuart. Bathsheba’s Breast: Women, Cancer & History. Baltimore: The Johns Hopkins University Press, 2002.

[2] Goodbody, Bridget, L. “’The Present Opprobrium of Surgery’: ‘The Agnew Clinic’ and Nineteenth-Century Representations of Cancerous Female Breasts.” American Art 8, no. 1 (1994): 32-51.

[3] Aronowitz, Robert Alan. Unnatural History: Breast Cancer and American Society. NewYork: Cambridge University Press, 2007.

[4] Wong, Nancy, and Tracey King. “The Cultural Construction of Risk Understandings through Illness Narratives.” Journal of Consumer Research 34, no. 5 (2005): 579-594.