A discursive analysis of accounts of breast cancer screening, risk and prevention

Abstract

This thesis presents a discursive analysis of accounts of breast cancer screening, risk and prevention. Breast cancer is currently the largest form of cancer death for women in Australia ( and many other Western nations ), but the causes are unknown. Consequently, health promotion has tended to focus on the early detection of the disease. Despite this focus, the currently available techniques for early detection of breast cancer continue to be subject to research and debate. For women at high risk of the disease due to a family history and, in some cases, a genetic predisposition, there is also discussion regarding the best course of preventative action. One option, prophylactic surgery ( or the removal of healthy breasts ), continues to be the topic of both medical and psychological research. In addition to the ongoing medical research and debate around the topics of breast cancer screening, risk and prevention, there has been extensive sociological theorising around the increased societal emphasis on risk more generally. This emphasis on risk has been argued to be one feature of governance in modern liberal democratic societies. Particularly with respect to health - care in such societies, there has been argued to be a shift towards increasing individual responsibility for health and the management of potential illness. A focus on individual responsibility is not necessarily a key feature of contemporary public health approaches. Nevertheless, it has been suggested that the emphasis on risk management, in combination with the prevalence of ' lifestyle ' diseases, has widened the gaze of public health, such that all aspects of individuals ' lives are open to scrutiny and regulation. An inevitable consequence of such shifts is the placing of increased responsibility for health on to individuals. The analysis in this thesis draws on a synthetic discursive approach to examine talk and text around the issues of breast cancer screening, risk and prevention, in light of these shifts in conceptualisations of health and health - care, and the medical debate surrounding detection and prevention techniques. In particular, three analytic chapters are concerned with three sets of data : media accounts of prophylactic mastectomy ; pamphlets promoting breast cancer screening ; and women ' s focus group talk. The analysis focuses on the discursive themes, ideological dilemmas, and subject positions deployed in the data. The following analytic findings are discussed : - the repeated positioning of individuals as ' patients without symptoms ', who are required to engage in risk management in order to prevent their ( inevitable ) future illness ; - the positioning of women in terms of traditional notions of femininity and mothering ; - the construction of a dilemmatic relationship between individuals and medical experts, whereby individuals are positioned as responsible for their own health and illness prevention, while simultaneously being reliant on medical experts who are sometimes wrong ; - the negotiation and flexible management of notions of responsibility, emotion and health behaviours in women ' s talk. The final chapter in the thesis considers implications of the analysis for public health and health promotion, and for a critical ( public ) health psychology.