Cancer is perhaps the most feared of human diseases. For a woman, the most feared cancer is cancer of the breast. The root cause of fear is a feeling of helplessness and a lack of knowledge. If the cause of breast cancer were better understood, a woman might know how to lower her risk of contracting the disease. There might be actions she could take to keep herself healthy. It is through knowledge of the cause of a disease that we lose our fear.
Despite the heavy toll breast cancer has taken on our society, little has been done to stem the tide of this menace. Virtually every American woman now has some sort of familiarity with this disease. Perhaps a friend or relative has it, has gone through treatment for it, or has died from it. Perhaps this woman herself has experienced the horror of finding a breast lump. Current estimates suggest that 90 percent of all women in the United States will experience at least a breast cancer scare by finding a breast lump at some time in their lives. Thankfully, most of these lumps will not be cancerous. Is there anything women can do to be spared from this poorly understood illness?
To answer this question, we must first understand the cause of breast cancer, which is, as yet, elusive. Why has the cause been so difficult to pin down? Have researchers been searching for clues in the right places? Might a new direction and new research approach prove fruitful in uncovering aspects of this disease that have been previously ignored, overlooked, or misunderstood?
Several risk factors have been identified in association with breast cancer, but their connections to the disease are not clear. Mechanisms through which cells become cancerous have been discovered, including the role of hormones, DNA, and other cellular molecules and structures. Radiation, certain chemicals, and some genetic factors have been identified with the development of cancer. Certain lifestyle practices have been associated with breast cancer as well, but no approach has come up with a deep enough answer regarding the cause. The difference between risk factors and a cause of breast cancer is that risk factors do not explain why women get the disease, only that certain factors are associated with women who develop the disease. Causal explanations have more asked of them. They must make sense, not just show a statistical association. Causal explanations must tell how something happens. They must provide a reason.
The key to solving the problem of breast cancer, and of other cancers, remains elusive due to the limitations of current approaches being used to find it. As such, we have decided to follow a new path toward understanding breast cancer: applied medical anthropology. Let me explain this term. Fundamentally, applied medical anthropology is a form of anthropology, which is the study of mankind. It is probably the broadest of all fields, since all activities of mankind are within its scope. This includes aspects of life that we all take for granted, such as our customs of dress and eating. It also includes economic systems; political structures; ideologies; thought processes; religions; sex roles; forms of interpersonal relationships; forms of self-expression, such as language, art, music, and dance; and every other facet of the activities that make us human beings. Of relevance to diseases such as breast cancer is anthropology’s study of lifestyle—and lifestyle, as we are learning, is responsible for most of our illnesses and deaths.
To understand how lifestyle affects human health, one needs a good understanding of how the human body works. Medical anthropology is a branch of anthropology that studies the medical and health issues of different cultures. When it comes to breast cancer, for example, medical anthropologists may study how different cultures treat the disease. The focus would be on a cultural comparison concerning breast cancer diagnosis, treatment, and perhaps the outcome of this treatment.
What we are practicing, however, is more than medical anthropology, which, like anthropology in general, is a basic science. What we are doing is an applied science. The difference is that basic science is a general search for information. It is a curiosity about the world and a desire to gain information without any concern for its practicality. In other words, basic scientists do research that has no currently known application. Applied science, on the other hand, is focused on a particular problem.
As applied medical anthropologists, then, we do more than study the cultural aspects of a disease. We study diseases and how they may be caused by cultural factors. Put differently, we try to find the biological consequences of certain cultural practices. We refer to the diseases caused by culture as culturogenic diseases. Heart disease, for example, is predominantly a culturogenic disease because it is produced by certain lifestyle factors, particularly high stress, poor diet, and minimal exercise.
How have we developed this concept of applied medical anthropology? As my own graduate training and experience in anthropology, biochemistry, and medicine took me through these various specialties, I had the opportunity to experience their strengths and weaknesses.
Biochemistry has the research strength of a precise and highly analytical method, although it suffers from considering all life processes, even human behavior, as biochemical processes. Humanity gets lost in the shuffle of beakers and test tubes.
Cultural anthropology has the advantage of studying humanity from a broad viewpoint and seeing the world from many perspectives, but it lacks the rigorousness of the “harder” sciences. As a basic science, it also lacks practical application for its research.
Medicine has the strength of understanding the body from a very technical, physical, and chemical perspective, but it has the weakness of seeing people as mere machines that function according to certain chemical reactions. The flaws found in biochemistry also plague medicine, since much of medicine is defined by biochemists. Nowhere in modern medicine, as far as I have been able to determine, is there a serious appreciation of human beings as cultural entities.
While each of these fields has its limitations, much can be gained by combining their strengths. This is exactly what we have done with applied medical anthropology. I am not alone in this approach to research. Soma Grismaijer is my coauthor, coresearcher, and spouse—and the inspiration for this breast cancer research. Through her training and experience in behavioral science, ecology, environmental health, and anthropology, Soma has brought an environmental perspective to our approach. You cannot truly understand people and their lifestyles without understanding the natural and man-made worlds in which those lifestyles are practiced.
Soma has also provided this breast cancer project with something a man could not have achieved on his own: a woman’s point of view. Breast cancer is primarily a woman’s disease. The entire success of this project rested with Soma’s ability to question women objectively about their lifestyles and illness.
Taking this applied medical anthropology approach, we have put the pieces of the breast cancer puzzle together in a new way, constructing a picture so obvious that we wonder why others have not already seen it. We have developed a new theory about breast cancer and have tested this theory by conducting original research on thousands of women. And we feel confident that we have discovered something tremendously important.
We believe we have found a trigger for breast cancer. It is a trigger that is pulled by women themselves—but the gun is loaded by society. The cause of breast cancer is complex, as you shall see. It involves biological, environmental, and cultural factors. Some of these are difficult to change. Others are easy to address. We understand that, on first blush, the wearing of bras being linked to cancer is an easy target for humor. We understand that laughter can be an excellent defense mechanism. All we ask is that you judge the facts in this book fairly.
We hope this book provides the right amount of light in the darkness that surrounds breast cancer. By actually seeing what goes on, we can better understand the root cause of the disease. And by understanding how it begins, we can put ourselves in a position to prevent it.
“Bras can cause breast cancer? You’re joking, right?” This, of course, would be the usual response. As apparel designed to enhance a woman’s bustline, bras seem the least likely candidate for a cause of breast cancer that you could imagine. They make you think about sexy models, not about mastectomy. They create cleavage, not cancer. Right? As you shall learn, bras are more than objects of fashion. They transform more than just appearance.
Many women consider their breasts to be one of the most important features of their bodies. This bias is no doubt emphasized by our society’s preoccupation with breasts. Styles of women’s clothing, from underwear to nightgowns to bathing suits to business suits, focus on breasts and the bustline. Breasts are truly an American obsession. Ironically, this obsession may be a root cause of cancer.
The search for a breast cancer cause is a frantic one. Thousands of people spend their entire professional lives working on this one problem, and typically on one small aspect of this problem. Thousands of pages of research results on breast cancer are generated annually, yet little information has provided any hope for the prevention or cure of this dreaded disease. Are all these great scientific minds barking up the wrong tree?
Breast cancer incidence is higher now than ever before in history. This disease is now spreading worldwide, with no end in sight. And despite the discovery of certain risk factors for the disease, the research community admits it is just as much in the dark regarding the causality as it was fifty years ago. Many researchers, such as breast cancer epidemiologists Dr. Jennifer Kelsey and Dr. Marilie Gammon of the Columbia University School of Public Health, are calling for a new approach to the problem, a fresh perspective.
But bras? How can they be the cause of breast cancer?
Few things are what they seem on the surface. By the time you finish this book, we hope to have changed the way you look at the usage of bras and other lifestyle choices. This book is based on hard evidence, evidence that comes from medical research performed by others in the breast cancer field. It also comes from what we have termed the Bra and Breast Cancer (BBC) Study, which we conducted to discover the attitudes, values, and behaviors of American women regarding their breasts and bras. As you will see, the way in which women feel and act toward their breasts and bras has a great deal to do with their development of breast cancer.
Of course, at the beginning of any good study there must be a theory. We arrived at our theory—that breast cancer may be triggered by the wearing of bras—by connecting previously disconnected facts. The field of cancer research is so overloaded with details and information that connecting the pieces seemed impossible at first. But, as you shall see, all the pieces have been connected, and the theory has obvious merit. When we tested it, our findings were astounding. The connection between bras and breast cancer proved greater than our original expectations. And the implications of our research go far beyond breast cancer.
Perhaps the greatest challenge facing any researcher is the need to keep an open mind. We cannot hope to unravel the mysteries of our time when confronted with the biases of our time. Indeed, mysteries exist because we have been taught ways of seeing the world that are necessarily limited by our cultural perspective. It is our own ignorance and lack of vision that create mysteries—and epidemics like breast cancer.
To put this in perspective, we will use an example from medical history. During the eighteenth century and part of the nineteenth century, countless women and their newborn children died from childbed fever throughout parts of Europe. This epidemic, which claimed the lives of nearly 50 percent of women who delivered their babies in certain hospitals, was a mystery to the great medical minds of the time. In attempts to explain the cause of these deaths, theories multiplied for over a century, many reflecting deep, complex thought and elaborate medical reasoning. However, the solution, as history has shown, was simple, not complex: Physicians were not washing their hands between patients or after handling dead, diseased bodies. As unwitting transmitters, doctors spread disease throughout the maternity wards of the newest hospitals of the time.
No different than most other people of that era, physicians were ignorant of the connection between cleanliness and health. It would seem that even the experts of the day are often limited by the biases of their culture. Simple solutions sometimes underlie seemingly complex problems and are usually related to the implicit habits and customs of the time. The challenge of any era in addressing an illness that plagues society is to examine the problem from an impartial, objective perspective. But impartiality is as elusive as truth itself.
We are all subjects—and victims—of our time and our perspective in history. Truth, or our perception of it, is a function of our limited, culture-bound understanding, and is often as fluid as a change in custom. The problems this poses for medical research are ongoing, but, as you shall see, are occasionally surmountable. The best we can hope to do is rise above our culture as much as possible to see our biases, challenge them, and willingly allow our view of the world to shatter as these biases knuckle under the blows of scrutiny.
What is it about the lifestyle or culture of certain nations today that makes breast cancer a major disease for its women? As we attempt to answer this question, we will be challenging the reader to look at the assumptions and basic behaviors that mold and define everyday life for most Americans and other first-world citizens. As the pillars of culture are shaken, there may be a tendency to reject the question as irrelevant or too simple. This is to be expected. Who wants to see the very fabric of his or her culture stretched to such a degree of examination? Yet we must all get past this denial if there is to be any meaningful advance made in the understanding of culture-caused, or culturogenic, diseases. Like a skilled surgeon, we must dissect those aspects of culture that work against our health, and which can shed light on the mystery of breast cancer.
You will learn that the cultural assumption we must question pertains to fashion—specifically, to the idea that wearing bras has no effect on health. Bras are so accepted by modern Western societies that questioning their impact on the health of breast tissue sounds ludicrous. But, as will be evident, this question makes good sense medically and is borne out by the results of a study we conducted on women in the United States, and by other studies that have followed-up on our research.
We have done our best to make the contents of this book understandable to everyone interested in the topic. We have avoided medical jargon as much as possible so that the reader need not have a medical education to understand the information presented. All that is required is an open mind and a willingness to examine the evidence.