Pink Ribbons, Inc. Breast Cancer and the Politics if Philanthropy ‐ by King, S., Breast Cancer Genes and the Gendering of Knowledge. Science and Citizenship in the Cultural Context of the ‘New’ Genetics ‐ by Gibbon, S., Building Genetic Medicine. Breast Cancer Technology and the Comparative Politics of Health Care ‐ by Parthasarathy, S. and Breast Cancer and the Post‐Surgical Body. Recovering the Self ‐ by Crompvoets, S

King, S. Pink Ribbons, Inc. Breast Cancer and the Politics if Philanthropy . 2006 Minneapolis : University of Minnesota Press xxxii +157pp . $24.95 ISBN 0 8166 4898 0 (hbk) Gibbon, S. Breast Cancer Genes and the Gendering of Knowledge. Science and Citizenship in the Cultural Context of the ‘New’ Genetics . 2006 Basingstoke : Palgrave McMillan ix+221pp . £45 ISBN 978 1 4039 9901 6 (hbk) Parthasarathy, S. Building Genetic Medicine. Breast Cancer Technology and the Comparative Politics of Health Care . 2007 London : The MIT Press x +271pp . £21.95 ISBN 978 0 262 16242 5 (hbk) Crompvoets, S. Breast Cancer and the Post-Surgical Body. Recovering the Self . 2006 London : Palgrave xii +177pp . £45.00 ISBN 1403999007 (hbk) Each of these texts seeks to examine and problematise the contemporary dominant discourses of breast cancer, in order to reveal, through ethnographic studies, the lived realities of the disease, its treatment and detection. Each too, is a fine example of ‘passionate scholarship’, to use a nice phrase borrowed from Orla O'Donovan. The pre-eminent context for this body of work, however, has to be the recognition that breast cancer is now the most studied and the most written about disease; the books’ bibliographies certainly suggest, too, that there is now an authoritative literature, with the same sources being exhaustively referenced. These texts add to that literature, building critically on what has gone before, and drawing particularly on feminist critiques in the social sciences; arguably, it is these ideological perspectives which have shaped most recent scholarship in the field of breast cancer and, indeed, each of the authors explicitly locates her book as a feminist study. While it has been well demonstrated how ‘breaking the silence’ about breast cancer was a feminist project inspired by the women's health movement and informed by what may now seem a naïve rhetoric of empowerment through knowledge and shared stories, the authors of these four texts write in a different political climate of neo-liberalism, in which empowerment has been translated into an ideology of self-care and individual responsibility for lifestyle and treatment choices. In each of the books considered here, the shifts in governance and policy-ordering of breast cancer detection and treatment is the significant frame of reference: the focus of Parthasarathy's work makes these wider political processes explicit in her comparison of the US and UK institutional contexts of ‘building genetic medicine’; Gibbon and King consider how those processes are enacted in the practices taken up by charities and advocacy groups, and by the breast cancer industry more widely; Crompvoets’ ethnographic study of women after surgery reveals the ways in which current beliefs and attitudes are embodied by the women she listens to. Reading the texts together, in succession and then reflexively in relation one to the other, one is struck by the shifting gaze: looking in and looking out; the continuing relevance of breast cancer subjectivities within the context of biological citizenship and media-managed identities. Together they reveal much of the contemporary world of breast cancer and each is richer for that collective reading; individually the picture is more fragmented, less clear. For instance, the broad range of settings these four texts examine is illustrative of the now very public status of breast cancer in the imagination, and of its pervasive reach into the regimes and practices of everyday life. Crompvoets, King and Gibbon study a variety of breast cancer charities, support groups and advocacy organizations; Parthasarathy and Gibbon take the reader inside the clinic and the research laboratory; King and Crompvoets consider how the industrial complex and global corporations are involved in breast cancer – and profit from it. Personal narratives of breast cancer have been an important focus of study in the last decade, and have had a particular role in the changing understanding of the experience of the disease; all four of these books construct their arguments from the received narratives of women with breast cancer, ensuring that still more voices are heard in the grand project of making breast cancer audible. The foci of these books reflect the main themes established by prior research: the relatively new work on risk and genetic aspects of breast cancer, since the ‘discovery’ of BRCA1 and BRCA2; the sexualised and feminised representation of the disease; and the importance of the breast cancer movement – in its various manifestations – in changing policies and practices. But there is perhaps another and more significant contribution made by these studies: their nuanced and sophisticated analyses of contemporary breast cancer help tear down the pink veil which – apparently soft, safe, feminised and benign – hangs over the material realities of a life threatening disease in much of popular cultural discourse. It is, as ever, redoubtable activists like Breast Cancer Action and the Breast Cancer Fund (both based in San Francisco) who have exposed the egregiousness of such a paradigm, with campaigns such as Think Before You Pink and Follow the Money; these books acknowledge a relationship to the extensive advocacy and activist movements, which has been strongly forged in much of the prior breast cancer literature, and has marked a shift to a politically more cogent understanding of contemporary experience of the disease. Evidence of the commodification of the disease runs thematically through the books; as Gibbon claims, breast cancer has moved from the original silence to discourses of heroic survivorship, to being a successful market brand. As King tells, breast cancer has been labelled ‘a dream cause’ by marketing experts claiming that ‘cancer sells’. The range of artifacts is vast: from the pink ribbon itself and the pink plethora of domestic products and clothing, and the runs and races, which King discusses, to the dedicated research laboratory supported by the fundraisers Gibbon studied. In making public these particular private troubles, all women are now constructed as, on the one hand, brand consumers within corporate marketing strategies using breast cancer to sell products, and on the other as good citizens practising self-responsibility for our health, charitable giving and purchasing. This quartet of books also illustrates another broad theme: that of the range of breast cancer careers (to which one should, perhaps, reflexively add the research academic). Compvoets's study contributes to our further understanding of patienthood, rehearsing again the familiar discourses of illness experience (the military metaphors, victimhood and survivorship), and usefully identifying how breast cancer becomes a new framing of identity for the women in her empirical study – where biography has become a list of treatments, ‘neatly packaged into a breast cancer CV’ at the Bosom Buddies fashion parade, for instance (p. 80). The new breast cancer self acts as a qualification to participate in volunteering for various related activities, revealing a ‘social ladder’‘based on the extent of surgery, availability of time and energy and willingness to conform to dominant attitudes and belief systems’ (p. 67). These emerging identities are clearly feminised and hetero-normative, with women's role as nurturers and carers duly emphasised; they may also be figured as response to the neo-liberal imperative to be a virtuous citizen (King); as ‘the work of memorialisation’ (Gibbon p. 134); and as an ethical practice of reciprocity, of giving something back (Crompvoets). More complicated and ambiguous are the framings of identity provoked by genetic medicine, which are considered by Parthasarathy and Gibbon. The technology both demands and shapes new subjectivities and new practices, giving new dimensions to the uncertainty inhering to any disease state, and, crucially, constructing risk within the body rather than in the lived environment as cause of disease. Both books help to unravel some of the strands of these shifts, which should serve to illuminate how genetic medicine is played out in relation to other conditions too. Gibbon adopts the notion of ‘anticipatory patienthood’ or ‘patients in waiting’, in which women struggle to have warning signs, from their family histories, recognised as medically defined risks, and thus to have access to investigation and treatment. She locates this as an ‘active process that is embedded in a moral code of awareness and vigilance’ (p. 190), in the context of ‘a hope and hype filled science’ (p. 191). Parthasarathy usefully shows how the construction of identities and technologies are shaped by particular social and political environments, and by nationally specific ideas about practitioners and users of health care. In comparing the US and UK, she shows how, in the former, DNA analysis has emerged as a consumer product in a commercial context and market environment, while in the UK, the NHS ethos demanded that questions of equity of access be addressed, investigation supported by counselling, and women positioned as patients or citizens, rather than consumers. The analysis based on the relationship to ideologies of governance is valuable in this context, but could usefully inform a broader understanding of the power cultural specificities have in relation to other aspects of breast cancer too. Thus subsuming all these books and the diligent research they represent, is the shift over the last twenty years from its status as private and personal to one that is public and political – for good and ill. The pre-eminence of breast cancer in the public imagination has recently been much discussed, in academic, medical and popular discourse – raising questions as to whether it has obscured the needs of other cancer patients and other research priorities, overshadowing with its ‘sexy’ connotations the messier and grimmer sites – notwithstanding the just attention to breast cancer as one of the most commonly experienced. The historical context is acknowledged by all the authors, though as taken for granted fact rather than focus of enquiry; perhaps what is needed now is examination of how a disease condition has shaped wider thinking about health and illness, how it has contributed to some crucially important reforms of research protocols and how it has influenced treatment and care paradigms across clinical specialty. Finally, then, the connections between these texts begin implicitly to reveal a larger theme, one that is perhaps particularly evident through the kind of interplay of reading required for a shared book review. The emergent idea of global citizenship, and of the varied roles that ‘risky’ women variously have in relation to the disease, begins to suggest a different poised solidarity from that which started the movement for greater visibility for breast cancer, and has informed much of the subsequent advocacy examined in these books. This could be understood as a bio-politically shaped identity, through which to make better sense of the causes of the escalating incidence of breast cancer worldwide, and of the efforts to establish policies for primary prevention that protect citizens from harm

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