Thread by @JANEMCARTHUR11

In-depth individual interviews of 25 #women #workers at the Ambassador Bridge produced #breastcancer risk understandings & agency narratives.

Kathy said: “put us all together, and pretty soon you have just got lots of stories that all have the same ending.”

A thread

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The research captures & explains layered & multifactorial influences on women’s narratives of #breastcancer risks & related agency and to see how #health and health knowledge are constructed in a #nested set of relationships.

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Multiple information sources influenced #women’s #breastcancer risk and agency narratives.

Social, cultural & experiential information were all included.

#Workplace & #environmental exposures & socio-cultural aspects of work & environment were critical to the narratives.

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Dominant ideas, discourses & narratives of #breastcancer risks were woven in along with #resistance to these dominant ideas.

Women outlined & explored relational conflicts & exposed #power #inequalities that influence breast cancer risk knowledge & agency

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Three distinct narrative typologies of #breatcancer risk & agency were identified in the research with women at the Ambassador Bridge:

They bring out dichotomies, transcendence and power in #breastcancer risk knowldge.

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1st typology Narratives of Risk: Spaces between Dichotomies

#Breastcancer risks often framed in dichotomies. At-risk characterized by lifestyle factors (modifiable/ voluntary risks); ‘not at risk’ as factors external (genetics, hereditary, non-modifiable/involuntary risks).

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Women in the study identified spaces between #breastcancer risk dichotomies, developing nuanced understandings that identify, explore, explain, and embody risk factors that fall between the dichotomies.

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While typically obscured by breast cancer risk dichotomies #environmental risks are a vital part of how the women in the study understand #breastcancer risk. Key was awareness of multiple breast cancer cases at the Bridge & identified exposures at #work.

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#Women’s knowledge of their workplace & other environments show how awareness-raising & the focus on individual-level choices is an insufficient approach to risk communications & #breastcancer risk mitigation strategies.

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Omission of #environment & #occupation in #breastcancer risk messages & inadequate protective & preventive action are #environmentaljustice issues.

Focus on prevention through lifestyle choices ignores that we don’t all share equal access to the same lifestyle.

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2nd typology: Narratives of Agency: Transcending the Implication of Individual Volition

#Women go beyond personal choice insinuation & identify a range of multi-level strategies for action, reflective of a #socioecological framework of #health.

#breastcancer

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#Women discussed personal & behavioural choices, as components of a broad range of #prevention measures
as they described environmental risks for #breastcancer, particularly those identified in their #workplace at the Ambassador Bridge.

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Solutions posed include changes in exposures & work practices at the Bridge & other #workplaces; in information reported by media, doctors, employers & #healthandsafety committees & training; compensation; regulation & policy; future practices.

#breastcancer #environment

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Changes discussed seek resolution of conflicts in health & social systems, between biomedical & social realities, through social & political change.

#Breastcancer risk mitigation strategies are moral choices made in face of injustice, reflecting values & local realities.
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3rd typology: Exposing the Paradox of Breast Cancer Control

Illustrates intersection of personal biography with illness & risk understandings as socio-cultural experiences, mediated by both internal and external factors.

#breastcancer #environment

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The paradox is that women are told they can control their risk for breast cancer. But women describe how & where they don't have power over certain risks for breast cancer - #workplace & #environmental

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The women’s narratives are powerful forms of resistance speaking to suffering & structural oppression where institutions such as biomedicine, lay claim to legitimacy, authority and objectivity over women's bodies & risks.

#breastcancer #environmental

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Inequality & socially rooted #health risk factors are presented as contradictions, tensions & resistance narratives, adding to the question of control & possibilities for agency around #breastcancer risks.

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Despite relative powerlessness compared to employers, governments, compensation board, #women's narratives, name & identify power structures & possibilities for preventive action in #workplaces, #communities & globally. This is their agency and power over #breastcancer risk.

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By describing structure, #power, #work & #environment, the #women’s narratives expose the limitations of the biomedical frame of #breastcancer. The social phenomenon that is breast cancer is crucial to understanding and addressing breast cancer as a public health problem.

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Thinking about #breastcancer risks in our #environments leads to significant questions of #feminism, #gender, #equality & #intersectionality, producing social justice imaginings through systemic changes, including transportation, trade, economies and ideology.

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Must recognize:
- Lay knowledge as critical to understanding #breastcancer risk for populations
- Barriers to agency & power relations that constrain & allow action
- Inequalities & #socialdeterminants of health in prevention strategies & #publichealth

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Need: systems levels approach to #prevention, #precautionaryprinciple as guide in all #environments; include occupational & environmental #breastcancer risks in knowledge translation & mobilization

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Need:
- Formal investigation of #breastcancer cluster at the Ambassador Bridge
- Women as collaborators in cluster investigation & future community/#workplace #health investigation
- Multi-level, just, equitable interventions for #breastcancer prevention

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Need:
- #Environmental & #workplace regulations revisited with current evidence on breast cancer risks & adoption of #precautionaryprinciple where uncertainty remains
- population-level strategies recognizing social & structural #determinants of #health

#breastcancer

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@psac_afpc @PSACOntario

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