CASE STUDY Cultural Models of Breast Cancer
A number of researchers have investigated cultural models of breast cancer among a variety of ethnic groups in the United States. The anthropologist Holly Mathews and her (Matthews, Lannin, & Mitchell, 1994) found that among African American women in rural North Carolina, the indigenous model of breast cancer was based on both general and specific illness models in this population. The model drew on the general blood paradigm of illness etiology that is widely distributed in populations of African origin. Bad or contaminated blood was thought to contribute to the pathophysiology of breast cancer in the study population. In addition, a more specific plant metaphor was used to describe the disease, in which breast cancer was thought to originate with a “seed” that remains dormant until disturbed through biopsy, invasive , and exposure to air. It then can begin to move and grow, establish roots, take the form of “knots,” and respond to surgical “pruning” like a trimmed bush (i.e., it grows back thicker). These folk models of breast cancer were linked in some women to delayed help seeking and reluctance to undergo biopsies and lumpectomies.
Distinctive models of breast cancer have also been found among Latinas. Using cultural consensus analysis, Chavez et al. (1999) identified two models of breast cancer in the Los Angeles, California, area. The first model, which the researchers describe as the biomedical model, includes three types of causality: family history, reproductive behavior, and environmental pollution. Both Anglo women and physicians in the study subscribed to this model. A different model, labeled the Latina model, was identified among first-generation Latin American immigrants. This model attributed breast cancer to physical injury to the breast, breast-feeding, and immoral sexual behavior. Because of the moral overtones, breast cancer was stigmatized in the immigrant community, and some women felt ashamed to disclose their diagnosis. Interestingly, second- and third-generation Chicano women who had been living in the United States for many years subscribed to a bicultural model of breast cancer that integrated aspects of both the biomedical and the Latina models.
In a study of cultural models of breast cancer in the Tampa Bay area (Coreil et al., 2004), the researchers, interviewing Euro-American members of breast cancer support groups, identified five core elements of the shared model of the illness and recovery from its consequences: (1) the recovery narrative, (2) group metaphors, (3) perceived benefits, (4) group processes, and (5) contested domains. The recovery narrative refers to the ideology espoused by the group regarding what is considered a desirable illness recovery experience. In the breast cancer community, the recovery narrative is often discussed in terms of “survivorship,” that is, how survivors of breast cancer should approach the long-term challenge of living their lives as fully and successfully as possible. Recovery narratives exist for many health problems. For example, many individuals recovering from follow “12-step” programs modeled on the principles of Alcoholics Anonymous, which are grounded in the idea that addicted individuals have experienced loss of control over their lives and must give up their will to a higher power to begin recovery. The literature on breast cancer identifies recurrent themes underlying the narrative of recovery, including the cult of survivorship, the importance of maintaining a positive attitude, and the use of sports and military metaphors. In addition to underscoring the importance of optimism and positive thinking for successful recovery, the Florida study highlighted the significance of being initiated into a “sisterhood” and viewing the recovery experience as an opportunity for personal growth and fulfillment.