Breast Cancer: Legacy of Shared Misery

The “politics of meaning” met breast cancer the other day when Hillary Rodham Clinton came to town.

The event was a glittering luncheon fund-raiser for UCLA’s Iris Cantor Center for Breast Imaging. The First Lady addressed a sea of mostly female faces, gathered in the ballroom of one of the city’s fanciest hotels. How many in that room would be facing the trauma of breast cancer, I wondered. How many already have?

Although her call for higher political truths and deeper human connections is often demeaned as New Age mumbo jumbo, Clinton spoke a simple, but often overlooked truth about women’s health: Breast cancer may strike one in nine women, but its effects are felt by everyone.

Women, said Clinton, are so often the care givers of the community. And a woman’s well-being, she added, is inextricable from the well-being of her family.

She told the story of a friend, a Virginia woman who lost her battle against breast cancer last week. The friend, whom Clinton identified only as Sherry, wanted her child to meet the President. Sherry sat in a wheelchair, said Clinton, as the little boy clutched his mother’s leg. When the family left, Sherry made a plea to the Clintons: “Don’t ever let anyone forget what this disease does to those who are left behind.”

As Clinton spoke, I noticed a rather well-known woman at the table next to me, a woman who has recently conquered breast cancer. The woman had tears in her eyes, and the arm of a friend around her shoulder.

Every three minutes, the First Lady was saying, a woman will be diagnosed with breast cancer. Every 12 minutes, a woman will die of it.

Whose life, really, has not been touched in some way by breast cancer?

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It has been only recently--in the last three years--that breast cancer, indeed women’s health issues as a whole, have been given the research emphasis they deserve. Most people date the sea change to June, 1990, when the General Accounting Office reported that the subjects of medical research are mostly males and males are usually the beneficiaries.

Clinton ticked off the insults: Heart disease is the leading cause of death for American women as well as American men, yet one of the most important clinical trials of the last decade--the study that found an aspirin every other day may reduce the risk of heart disease--involved more than 22,000 men and no women.

Women live longer than men, Clinton said, yet the presumption that they are so much healthier is wrong. “Too often, those benefits we can look forward to because of our gender are, sadly, no bonus at all.”

She could have also mentioned that a 1990 Harvard study, which concluded coffee did not promote heart disease, was based on the histories of more than 45,000 men and no women.

Or that hormone replacement therapy has been used for years to treat symptoms of menopause, yet it’s only been recently that large-scale clinical trials to assess the long-term benefits and risks of such treatment have gotten underway.

Or that even though women live longer than men, a National Institute on Aging study begun in 1958 only got around to including women two decades later.

The good news is that, as Clinton put it: “The national research agenda is finally recognizing women’s special needs.”

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These days, no speech by Hillary Clinton is complete without a call for health care reform, and this was no exception. The estimated 40 million Americans who have no coverage is a hard fact to grasp, so she told a simple, graphic story about a woman she recently met in New Orleans, a woman who happened to be a 15-year employee of a company that adoes not offer health insurance. The woman’s doctor found a suspicious lump in her breast and referred her to a surgeon. Normally, the surgeon told her, he’d biopsy the lump, but since she didn’t have health insurance, he’d just watch it.

“She fell into a crack,” said Clinton, “in which there are 40 million of our fellow citizens, most of them women and children.”

This is not a crack. This is a gaping chasm.

Millions of people are forced to make an unpleasant and unfair choice: rent or health insurance; food or health insurance.

Thank God, you might be thinking, at least I have health insurance. But as Clinton pointed out, will you have it next year? How do you know your job won’t evaporate? What will you do then?

The same week that Clinton’s friend died of breast cancer, a comprehensive survey on women’s health found that only 44% of women older than 50 ever get mammograms. The reason: they can’t afford to or their health insurance doesn’t pay for mammography. (Why insurance companies would rather pay for surgery than preventive care is always a boggling issue.)

The First Lady made it clear on Monday: The woman who misses the mammogram, whose breast cancer goes undetected, who dies of the disease, is not an individual tragedy.

She is the tragedy of a family, a community, a profession.

If we start to see women’s health issues in this larger context, we can start to understand why serving them serves everyone.