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Gender-roles in a patriarchal society are established with man in mind and female sexuality is constructed to complement male sexuality. Thus a woman's breast performs both reproductive and sexual functions; a nutrition source for infants also serves as erotic draw for men. Women's subordinate position also manifests itself in breast cancer treatment, where patients tend to be female and physicians male. In the disease's early history, women often delayed seeking medical treatment because of shame and stigma. After diagnosis women usually left the treatment decision entirely in the hands of their male physicians. This paternalistic relationship between breast cancer patient and physician persisted until major social changes transformed medical practice in the 1960s and 1970s (Casamayou 2001, Olson 2002, Young 1998).

At the macro level, post-World War II economic affluence led to significant cultural and structural changes in the United States. As suggested by political scientist Ronald Inglehart, people became more sensitive to quality of life issues such as social justice, equity, and citizen participation in the public decision-making process. Economic affluence also created more than 72 million baby boomers during the period from 1946 to 1964. Social movements in the 1960s such as civil rights, environmental, and feminist movements as well as the anti-Vietnam War movement, were products of these cultural and social changes. These macro-level changes set a new stage for patient advocates to challenge the medical establishment and demand the federal government reexamine issues related to women's health and patient's rights.

At the micro level, the federal government did not have a formal policy about cancer until public concern about the disease replaced fear of infectious diseases in the 1930s. As a result of the new public interest, the NCI was established in 1937. Funding for biomedical research emerged as the heart of federal health policy after the World War II--a triple alliance among congressional representatives, executive agency personnel, and lobbyists was formed to secure funding. Key congressional supporters included John Fogarty, chair of the Labor-Health, Education, and Welfare subcommittees of the appropriations committees of the House and Senate, and Lister Hill. Outside the government, health activist Mary Lasker formed the first lobbyist group for cancer research with her own wealth after her husband died of cancer. Backed by the triple alliance, the medical establishment basked in an unprecedented position of prestige and power over patients.

However other social forces emerged during the 1970s that changed paternalistic relationships between patients and physicians. First media coverage of prominent women's diagnoses and cancer treatments led to a societal openness toward the disease. These women included actress and diplomat Shirley Temple Black; Betty Ford, wife of President Gerald Ford; Happy Rockefeller, wife of politician Nelson Rockefeller; and writer Betty Rollin. Second the 1960s feminist movement created a new generation of educated women with professional and organizational skills. One of them was Rose Kushner whose breast cancer experience led her to become the first patient consumer advocate. She campaigned to change the one-step (biopsy and mastectomy) process to a two-step process of breast cancer diagnosis and surgery, and promoted the patients' rights to shop for the surgeon after diagnosis. Other survivors and advocates shared similar views and believed that more funding was needed to further lower breast cancer deaths and that patients should have greater involvement in treatment decision making. Many were also disturbed by the 1977 FDA policy that banned fertile women from toxicity studies and from initial safety and efficacy studies. Under the guise of protecting the fetus, this policy resulted in excluding many women from accessing major clinical trials. Angered and frustrated with unfair medical practices, breast cancer survivors formed grassroots patient advocacy organizations; eventually national breast cancer advocacy groups like the National Alliance for Breast Cancer Organizations (NABCO) in 1986, Y-ME in 1978, Susan B. Komen in 1982, National Breast Cancer Coalition in 1991, and Living Beyond Breast Cancer in 1991 were established. The grassroots breast cancer movement led to the biggest increase in federal funding for breast cancer research. For example, in 2005, the NCI alone invested $570 million in breast cancer research, while the entire public funding for breast cancer research was about $600 million in 1993 (Casamayou 2001, Oberman 1994).

References:

Casamayou, Maureen Hogan. 2001. The Politics of Breast Cancer. Washington, DC: Georgetown University Press.

Oberman, Michelle. 1994. ''Real and Perceived Legal Barriers to the Inclusion of Women in Clinical Trials.'' In Reframing Women's Health, ed. Alice J. Dan. Thousand Oaks, CA: Sage Publications.

Olson, James S. 2002. Bathsheba's Breast: Women, Cancer & History. Baltimore, MD: The Johns Hopkins University Press.

Young, Iris Marion. 1998. ''Breasted Experience: The Look and the Feeling.'' In The Politics of Women's Bodies, ed. Rose Weitz. New York: Oxford University Press.

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