Making the connections: women talk about breast self examination

Kearney, Anne Judith (2004) Making the connections: women talk about breast self examination. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Breast cancer is a serious health concern for women. Early detection has been hailed as key to reducing the morbidity and mortality associated with this disease. Largely as a result of three large trials that failed to demonstrate a mortality reduction with breast self-examination (BSE), the usefulness of this screening method has been seriously questioned. In 2001, the Canadian Task Force for Preventive Health Care concluded there was fair evidence to recommend physicians no longer routinely teach BSE to women. Through reports in the academic and lay literature, women have been advised that BSE may not only be ineffective, but harmful to them. The research problem is that there is a poor understanding of the meaning of BSE to women within a society that does not value it. Previous research on BSE was chiefly concerned with measuring women's knowledge, attitudes and beliefs related to BSE with the primary aim of increasing compliance. Yet, little was known about how women really felt about BSE. To investigate this phenomenon, women were engaged over time in a cycle of collective self-reflective inquiry to explore personal and social factors influencing their practice of BSE. This was achieved through a series of group discussions with two groups of women as they examined their everyday experiences related to BSE. Consistent with a participatory action approach, the women were considered co-researchers and were actively involved in the framing and analysis of the research problem. Thematic analysis allowed for the collaborative identification of the temporal map components that described the context of BSE for these women. These components were later organized by the women into a concept map, which provided a meaningful schematic representation of the meaning of BSE to them. Consistent with a feminist experiential approach, the standpoint of women was considered a valuable source of knowledge. Through this collective inquiry, the women developed a critical consciousness of the commonality of their personal experiences in relation to BSE, and their relationship to the larger social environment. In this way, the women were able to more fully understand the complexity of personal and social factors influencing the meaning of BSE to them, which was empowering. At the beginning of the research process, the women's subject position was characterized by their feelings of vulnerability in relation to their perceptions of breast cancer as a lethal disease and their inferior status in the world in relation to men. BSE is an intensely personal issue for women. It brings to the fore a complex web of interrelated meanings and experiences such as those related to cancer (breast cancer in particular), being a woman (and having breasts), and the health care system (including their treatment by physicians). By situating BSE at the juncture between these phenomena, a greater understanding of its meaning to women can be achieved. Three dominant discourses are relevant to women's practice of BSE: (a) femininity, (b) medical and technological dominance, and (c) lifestyle and responsibility for breast cancer. To the extent that breast cancer is seen as a threat to a woman's self-worth, she will be reluctant to do it. To the extent that a woman is ambivalent about her relationship with her physician and medical technology, BSE may be seen as a threat to her ability to care for herself. To the extent that the prevention, diagnosis and treatment of breast cancer is not well understood, BSE brings to the foreground the uncertainties of the disease and the reluctance of women to be held accountable for its trajectory. This research study has shown that experiential knowledge held by women is important and should not be subjugated by increasing medical and technological dominance. Relying solely on scientific evidence to evaluate BSE provides an incomplete measure of its value. Future research into BSE and other issues affecting women's health should be carried out collaboratively with women so that their voices are heard.

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