Download Press Release - Journal of Consumer Research

For Immediate Release: January 8, 2008
Contact: Suzanne Wu / 773-834-0386 / [email protected]
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American women are more likely to choose overly aggressive treatments for
breast cancer
Study explores understanding of risk in illness narratives
Despite a 1990 consensus recommendation from the National Institute of Health (NIH)
that lumpectomy plus radiation was the treatment of choice for early stage breast cancer,
the United States continues to have the highest rate of mastectomy surgery among
industrialized countries. Why would a person knowingly undertake a far more severe
form of treatment when a lesser one would suffice? A recent survey shows that only 74
percent of women diagnosed with early stage breast cancer (ductal carcinoma in situ or
DCIS) chose breast-conserving surgery – even though 82 percent of their physicians had
recommended the procedure.
“To answer this question, we investigate the framing of individual risk understandings
by the broader cultural discourses surrounding the disease,” explain Nancy Wong and
Tracey King (both Georgia Institute of Technology). “In-depth interviews . . . suggest that
screening and treatment decisions are influenced by the predilection toward restitution
narratives that exists in the United States and other Anglo-western societies. Reflecting
culturally structured values toward illness, the dominant narrative of restitution is
reinforced by the long-established biomedical model through its emphasis on personal
agency, control, and survival.”
Due to increases in the availability and sophistication of mammographic screening, DCIS
now accounts for approximately 20 percent of all breast cancer cases. The researchers
find that women’s individual understandings of breast cancer and the risks associated
with detection, treatment, and reconstructive surgery are heavily influenced by the ideas
of vigilant detection, aggressive treatment, and conformity in maintaining appearances.
“The burden of personal responsibility is so ingrained that women often feel that they
are to blame for not detecting the disease earlier or for having failed to pursue the most
aggressive treatment,” the researchers explain. “Furthermore, despite widespread
information dissemination and requirements for physicians to discuss breast cancer
treatments, women still do not translate this information into accurate risk assessments
regarding their treatment options. Instead, they rely on stories of survivorship and
restitution in constructing their risk understandings.”
They continue: “The impact of individual beliefs in restitution through aggressive
detection and treatment is reflected in a broader sense by statistics on overall healthcare
consumption in this country. From breast cancer and heart surgery to diabetes,
numerous reports from general interest, business, and public health publications have
raised concerns about the over-consumption of and runaway spending on medical
treatments.”
The researchers suggest that increased efforts in education and intervention alone will
not be enough to offset these implicit cultural biases. In order to understand why
patients often choose difficult and expensive treatments that may not necessarily yield
improvements in their quality of life or odds of survival, they reveal that we must also
consider the deeply entrenched illness narratives that frame patient’s interpretations of
medical and risk information.
“Illness narratives allow us to convey, express, and formulate our experiences of illness
and suffering, thus providing a platform for shared cultural experiences,” Wong and
King write. “We hope that this research will direct more attention to the recognition and
conceptualization of these alternative discourses within an expanded composition of
illness narratives.”
Nancy Wong and Tracey King, “The Cultural Construction of Risk Understandings
through Illness Narratives.” Journal of Consumer Research: February 2008.