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Globalism and Gendering
Cancer

This book connects a rhetorical examination of medical and public health

policy documents with a humanistic investigation of cultural texts to
uncover the link between gendered representations of health and cancer.
The author argues that in Western biomedical contexts, cancer is
considered a women’s disease, and their bodies are treated as inherently
oncogenic, or cancer producing, which leads to biomedical practices that
adversely impact their bodily autonomy. She examines how these biases
traverse national boundaries by examining the transmission of biomedical
cancer practices from the US and international organizations to Kenya.
This book is suited to scholars and students working in the fields of
rhetorics of health and medicine, medical humanities, and gender studies.
It is also of interest to medical professionals and readers interested in
globalism and global health.

Miriam O’Kane Mara is Associate Professor of English at Arizona State

University. Her research interests include medical and health discourses,
Irish literature and film, and food studies. In all of these contexts, her
work examines the intersections between landscapes, bodies, texts, and
discourses. She has been published in Technical Communication Quarterly,
New Hibernia Review, Feminist Formations, and Irish Studies Review.
Routledge Focus on Communication Studies

A Relational Model of Public Discourse

The African Philosophy of Ubuntu
Leyla Tavernaro-Haidarian

Communicating Science and Technology through Online Video

Researching a New Media Phenomenon
Edited by Bienvenido León and Michael Bourk

Strategic Communication and Deformative Transparency

Persuasion in Politics, Propaganda, and Public Health
Isaac Nahon-Serfaty

Globalism and Gendering Cancer

Tracking the Trope of Oncogenic Women from the US to Kenya
Miriam O’Kane Mara
Globalism and Gendering
Cancer
Tracking the Trope of Oncogenic
Women from the US to Kenya

Miriam O’Kane Mara

First published 2020
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2020 Taylor & Francis
The right of Miriam O’Kane Mara to be identified as author of this
work has been asserted by her in accordance with sections 77 and
78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted
or reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the
publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this book has been requested
ISBN: 978-0-367-19810-7 (HB)
ISBN: 978-0-429-24338-7 (EB)
Typeset in Times New Roman
by Apex CoVantage, LLC
For Andrew

Credit: Miriam O’Kane Mara

Contents

List of Figuresviii
List of Tablesix
Acknowledgmentsx

1 Introduction: Rhetorical Checkpoints 1

2 Oncogenic Women in a Cancer Culturescape 21

3 Tracing Kenya’s Culturescape: Cancer as Gendered

Weakness in Place of Destiny45

4 Kenyan Healthscapes: Oncogenic Women in the

Nairobi Cancer Registry 62

5 Kenya’s Health Professionals Speak: Attitudes About

Cancer in the Field 88

6 Conclusion: Saratani Going Forward 108

Appendices113
Index121
Figures

2.1 Breast cancer semipostal stamp 26

4.1 Nakumatt “Let’s Fight This Battle Together” poster
inside Nakumatt supermarket 64
5.1 Hospital triage and phlebotomy room from research site 89
5.2 Who gets cancer the most: frequency bar chart 91
5.3 Who suffers the most from cancer in Kenya: frequency
bar chart 91
5.4 Who is most likely to die from cancer in Kenya:
frequency bar chart 92
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Table

2.1 News media coverage of mammography overdiagnosis

findings 31
Acknowledgments

Parts of Chapter 2 were first published as “Spreading the (Dis)ease: Gar-

dasil and the Gendering of HPV” in the Feminist Formations, 22.2 (2010),
124–143. Reprinted with permission by Johns Hopkins University Press.
Parts of Chapter 5 were first published as Mara, Miriam, and Mara,
Andrew. “Blending Humanistic and Rhetorical Analysis to Locate Gendered
Dimensions of Kenyan Medical Practitioner Attitudes About Cancer.” Tech-
nical Communication Quarterly, (2017), 1–15. Reprinted by permission of
the Association of Teachers of Technical Writing, www.attw.org.
I would like to acknowledge and thank Christi McGeorge at North
Dakota State University for her generous help with the interview instru-
ment and SPSS analysis.
I would like to acknowledge and thank the Fulbright Scholar Program
and the Council for the International Exchange of Scholars (CIES) for their
support, without which this project would not have been possible. The inter-
views were conducted during a Fulbright.
Special thanks to the researchers and health care professionals at KEMRI
and elsewhere, my colleagues at Kenyatta University, and the people of
Kenya who allowed me to share their space and answered my questions.
1 Introduction
Rhetorical Checkpoints

Introduction
In 1995, Laura Pemberton was compulsorily removed from her home and
forced to undergo a cesarean section after previously fleeing a hospital where
they planned to sedate her and conduct a cesarean section. After leaving the
hospital, she had been proceeding with a vaginal birth at home, when a con-
sulting doctor at Tallahassee Memorial Regional Center, with the hospital
itself, sued. They had decided that only a cesarean birth would be safe for the
fetus because of Pemberton’s previous C-section. The medical profession-
als argued that the fetus’s rights outweighed Pemberton’s rights to choose
or deny health care services. The sheriff’s department dispatched officers to
her home, who subsequently physically disabled her from laboring and took
her back to the hospital. Once there, she was allowed to represent herself,
while the court appointed a lawyer for her fetus, in a hearing that resulted in
overriding Pemberton’s right to bodily autonomy and mandating a surgical
procedure against the patient’s expressed wishes. Pemberton subsequently
sued and lost. In Pemberton vs Tallahassee Memorial Regional Center,
Judge Hinkle asserts that the state has an interest in protecting the fetus.1

Autonomy’s Limits
Such cases are extreme, but they demonstrate how women’s individual
well-being can be constructed as if they are in opposition to positive pub-
lic health outcomes in biomedical contexts. Feminist researchers in medi-
cal rhetoric like J. Blake Scott reinforce such constructions in the context
of routine HIV testing of pregnant women, arguing that testing “render[s]
some pregnant women and new mothers as threats to rather than members
of the national citizenry” and enables “the subjection of these women to
various forms of oppression, from compulsory testing and treatment to
criminalization” (Scott 161). Michel Foucault, who assembles medicine
2 Introduction
as a disciplinary practice, explains that “in the process of hysterization of
women, ‘sex’ . . . constitutes woman’s body, ordering it wholly in terms of
the functions of reproduction and keeping it in constant agitation through
the effects of that very function” (153). Thus even non-pregnant women’s
private medical decisions can collide with other interests within the com-
plexity of biomedical contexts, where networks of information, people,
and technologies create categories of risk. Adele Clarke and her co-editors
define biomedicalization in contrast to medicalization, suggesting that it
goes beyond medicalization’s “emphasi[s] exercising control over medi-
cal phenomena – diseases, illnesses, injuries, bodily malfunctions” toward
“transformations of such medical phenomena and of bodies” (Clarke et al.
2). Importantly, they describe one focus of biomedicalization as “the elabo-
ration of risk and surveillance at individual, niche group, and population
levels” (Clarke et al. 2). In this tradition of medicalization and biomedicali-
zation, women and women’s bodies can be held responsible for monitoring
and submitting to medical interventions to protect and transform their own
health as well as the health of the community.
Building out from biomedicine “as a shorthand expression for the interac-
tive field of science, medicine and health care” (Shildrik 6–7), public health
as a field focuses on social interventions to solve health-related problems,
such as smoking-cessation campaigns to combat lung cancer. Unlike clini-
cal medicine’s focus on one patient at a time, public health professionals
concern themselves with the health of a community as a whole, sometimes
at the behest of government organizations through policy. Public health
professionals would usually be more receptive to environmental explana-
tions and interventions rather than a strict biomedical emphasis on genetic
or personal risk. Yet, the biomedical model inflects public health structures.
As Mamo et al. explain in “Producing and Protecting Risky Girlhoods”
“this imperative [to accept biomedical interventions] is especially evident
as the role of public health is increasingly privatized” (124). Sometimes,
in public health, women are targets of education and other efforts because
they are seen as responsible for their own health and the health of families.
Mamo et al. name this phenomenon “a feminized collectivity responsible
for protecting the nation’s health through body practices” (134). In other
words, women’s bodies may be subjected to medical interventions if such
interventions are deemed necessary for the public good, and thus, women’s
bodily autonomy has potential to be undercut by both public health policy
and biomedical requirements for bodily improvement and management of
risk.
Public health practitioners articulate health concerns in terms of popula-
tions, depending upon epidemiology and statistics, but this emphasis on
populations sometimes means that certain groups are targeted for policy
 Introduction 3
intervention to benefit other groups. Many incidences of such interventions
sacrifice women’s bodily autonomy for existing or potential fetuses. Auton-
omy or self-rule represents the ability of patients to access and obtain – or
deny – screenings, treatments, or other health care products and processes,
deciding for themselves what health choices are appropriate. It is one of
four bioethics ideals that include beneficence, non-maleficence, and jus-
tice in addition to autonomy. These concepts allow bioethicists to evaluate
medical practices and technologies for moral implications, and they can
provide a conceptual frame for feminist rhetorical investigation of docu-
ments that implement biomedical movement. Clarke et al. suggests that “the
rise of bioethics and patients’ rights movements of the 1970s sustained these
critiques [of biomedicine]” (15). Bioethicist Karla Holloway maintains that
autonomy as “the first in the four principles that guide traditional bioethics”
connects deeply with identity, which becomes clear when “gender and race
are at issue” (17). While a biomedical intervention may already sidestep the
issue of individual autonomy because of its focus upon larger collections
of people, the issue of autonomy especially gets nuanced for women in
conjunction with pregnancy and childbirth. While this may seem an esoteric
distinction, the Pemberton case illustrates the very real ways that biomedi-
cal assumptions already inform medical, juridical, and police interventions;
women in the United States can be arrested and lose other rights if they do
not attend to medical care while pregnant. In some cases, pregnant women
are incarcerated for drinking alcohol or using other recreational drugs.2
In other cases, doctors have mandated bed rest for pregnant women, even
those who cannot afford to take time away from work.
Biomedical justification of autonomy-restricting medical and juridi-
cal interventions are neither new nor isolated. The mandated cesareans of
women like Pemberton may be read alongside the public health edict to vac-
cinate only women and girls against Rubella, a measles virus that can cause
congenital defects; both types of interventions attempt to protect fetuses
through medical procedures on women.3 In some cases, not just fetuses or
vague public health claims, but the status and agency of the medical field
itself gets considered more important than the autonomy of the woman.
As Foucault reminds us, “the medical examination” and other “controls . . .
function as mechanisms with a double impetus: pleasure and power. The
pleasure that comes of exercising a power that questions, monitors, watches,
spies, searches out, palpates, brings to light” (45). This power circulates
through women’s medical interactions with health care. In some interac-
tions, evidence does not favor secondary cesarean section and women may
wish to attempt natural labor, but many physicians recommend secondary
cesarean as a matter of course. Thus, women’s decisions are overridden not
just for the sake of the fetus but for the sake of the autonomy exercised by
4 Introduction
the medical field, which ironically builds its ethos on claims that are sup-
posedly evidence based.
Yet beyond protection of fetuses, women’s bodies bear the responsibil-
ity for public health in other contexts; even in non-reproduction instances,
medical interventions are often prescribed for women more easily than for
men. Of course, using a binary of women and men can erase the experiences
of non-binary and trans people in their experience of biomedical environ-
ments. Elizabeth Grosz explains that “a plural, multiple field of possible
body ‘types’ . . . must be created” (22), while primarily maintaining a two-
sex system for her framework. Yet Stefan Hirschauer reminds us that “med-
ical disciplines reconstruct, protect, and mould the life-world distinction
between men and women” (13) reinforcing a two-sex dualism and making it
salient for rhetorics of health. Within that dualism, Mamo et al. describe the
willingness to proscribe interventions for women as “the longstanding med-
ical and cultural pathologization of women’s bodies and its concomitant
production of their bodies as ripe for medical intervention” (130). Women
may be directed to therapies more often than men or pressured to accept
treatments that they would not otherwise willingly agree to. Because of the
assumptions and attendant pressures, women do not have the same control
as men when it comes to health care decisions. In order to understand these
distinctions, it helps to understand popularly accepted conceptions of the
differences between bodies gendered female and male.

Rhetorics of Health and Medicine in the Literature

Traditionally rhetoricians of health and medicine investigate documents
and contexts concerning health care, including medical documents used
in hospitals and labs, media attention to health debates, and related docu-
ments and discourses. A leading figure in the field, Judy Segal explains
that the rhetoric of medicine’s “purpose is to assist the understanding of
human action in the realm of health and medicine by describing its rhe-
torical element” (17). Scott et al. expand on Segal’s explanation suggesting
that “while rhetoricians of health and medicine may not suggest specific
corrections to a flawed system, we do, ultimately, believe our work shares
some type of ameliorative aim” (3). Within this optimism about ameliora-
tion of harm, questions of gender and oppression enter health rhetorics at
its outset; in her chapter on migraine headaches, Segal analyzes how gen-
der influences migraine rhetoric to the detriment of female patients (48).
Health rhetoric researchers have produced a number of important under-
standings of health’s interaction with gender. From Condit’s critique of
brain sex research (Condit “How”) to Hausman’s examination of medical
warrants in breastfeeding rhetorics, rhetoricians of health often build from
 Introduction 5
“feminist theorists [that] have long resisted using scientific evidence as an
argument for how women should live their lives, because historically most
instances of this kind of usage have tried to circumscribe women’s freedom
with what have come to be understood as fallacious arguments” (Hausman
339). Others approach medicine’s attitude toward the gendered body (Shil-
drik; Grosz) or menstruation (Martin), while Epstein and Owens address
pregnancy/childbirth, explaining how “the rhetorical space of the hospi-
tal, . . . and the hegemonic nature of Western medicine in the United States,
obstructs individual women’s abilities to successfully assert agency – as
– power in the moments of childbirth” (Owens 1). Owens’ attention to
removal of agency matches my own concentration on autonomy for women
in health settings. Each of these researchers attends to the ways that gender
interacts with construction of health and provision of care. As Hausman
relates “the concept of rhetorical situation helps us see medical and other
types of decision making as they are enacted by socially situated individu-
als” (332). Using rhetorical tools allow researchers to understand articu-
lated constructions of gendered bodies and illness in the laboratory and in
popular culture, and as Scott et al. assert, even hope to amend problems that
might arise from those constructions.

Popular Imagery Poses Male Injury Versus

Female Cancer
One such construction that presents women’s bodies as vulnerable to ill-
ness gets repeated in cultural texts. In the enormously popular television
show Lost the only crash survivor who brings a serious illness to the magi-
cal island is Rose Nadler, a middle-aged African-American woman with
cancer. While she survives this disease due to the island’s healing affects,
Rose represents a woman whose body has turned against her.4 The audience
gradually learns she has been diagnosed with terminal cancer in a flashback
during season two, but the writers and producers do not reveal the site of
her cancer (S.O.S). Another Lost character brought by the plane crash, who
is also healed by the island, regains use of his legs during the first episode,
although viewers are not at first aware of the significance of his ability.
John Locke’s extraordinary healing circumvents a paralysis below the waist
caused by defenestration, which becomes part of his far-fetched narrative.
The combination of Nadler’s island-cured cancer and Locke’s magically
reversed paralysis juxtaposes female sickness against male injury from vio-
lence, a trope repeated in many contexts.
The imagery of women with cancer becomes laced through much con-
temporary pop culture, including futuristic worlds where cancer might
conceivably be curable or completely eradicated. The science fiction hit
6 Introduction
Battlestar Galactica addresses mostly injury rather than illness in the sick
bay; the main exception is the breast cancer of President Lara Roslyn. Her
ongoing struggle with cancer throughout the series and the cancer’s adverse
effects on her decision making, become important ways the television show
undercuts its own commitment to strong female characters. Roslyn finally
succumbs to the disease in the final episode, leaving her male professional
counterpart and lover Admiral Adama, who has survived two bullets to the
chest, healthy and alone. Both Nadler and Roslyn have aggressive cancers
that respond to treatment only in the short term, and each of these other-
wise healthy women becomes the only long-term diseased character in their
show’s artistic universe. Fictional representations of women with cancer
are not confined to American television, and these creative narratives build
from and add to real-world beliefs about cancer and women.5 These two
award-winning shows enjoin their audiences to suspend their disbelief in
extravagantly fictional worlds at least partially because audiences are famil-
iar with women bringing cancerous bodies and men bringing injured bodies
into their respective universes.
Those real-world beliefs about potential for illness in female bodies can
stem from the laboratory and the clinic. Attitudes about women and cancer
originate in older ideas about the inherent weakness and imperfection of
women’s bodies. Nancy Tuana’s book The Less Noble Sex affirms how sci-
ence in Western contexts has long been suffused with negative assumptions
about women’s nature (biological and temperamental). Tuana traces those
ideas from Aristotle through the nineteenth century, explaining that “as
we look next at biological theories of woman’s nature, we will indeed find
that the premise of woman’s inherent imperfection has been a fundamen-
tal axiom of the biological sciences for centuries” (17). Researchers in the
natural and biological sciences historically have built ideas about the weak-
ness of female bodies into their experiments and theories, and these social
biases transfer neatly into clinical medicine and public health campaigns.
As cultural historian Sander Gilman notes: “cultural differences concerning
gender also play a major role in constructing those groups understood as
being more at risk” (4). The idea that women’s bodies are weak in a number
of ways becomes a problem for women who want to use health care services
in ways that they control. In her study of gender bias in brain sex research
Celeste Condit reminds us that “understanding the social biases we harbor
can help us to recognize linguistic biases in research and produce scientific
findings less hobbled by linguistic short-comings” (“How” 87). If health
care researchers and clinicians begin with inaccurate or only partially accu-
rate assumptions about women’s bodies, then they can direct care in inac-
curate and inappropriate ways.
 Introduction 7
These beliefs about the weakness of the female body extend to cancer
predisposition, and cancer itself gets inaccurately viewed as predominantly
a woman’s disease. Ornella Moscucci’s book Gender and Cancer in Eng-
land, 1860–1948 explains “it is not exaggeration to say that, in England
and in many other Western countries women’s cancers have played an out-
standing role in positioning cancer in the public domain” (1). Moscucci
shows that breast and cervical cancer have long received more attention
than other cancer sites. Tammy Duerden Comeau, a researcher in medical
sociology, elucidates that “in order to maintain the notion that women were
more subject to cancer and that cancer predominantly struck the female
breast, ‘true’ cancer was [originally] deemed to be a hard or scirrhous sub-
stance” (Comeau 167). Christa Teston’s study of cancer reminds us that
“evincing disease is not a solely human enterprise but a matter of rhetori-
cal attunement, in which evidences are coconstructed phenomena” (173).
According to Comeau, the need to categorize cancer in a gendered manner
convinced nineteenth-century British surgeons to define cancer by its mass
rather than using other properties or diagnostic categories as definitional.
Comeau’s article traces a shift in descriptors for cancer in nineteenth-century
British medical texts. Her work further shows how British physicians and
researchers were so invested in the gendered nature of cancer that when
one gendered representation of cancer was found inaccurate through the
advancing of cell theory, “instead of re-considering the reliance on a gen-
dered framework, British surgeons re-incorporated predominant gender
ideologies” (Comeau 176). The medical professionals were unable to see
beyond their belief that cancer struck women more than men. Beyond the
nineteenth century, Leslie Reagan maintains that “women have long been
taught that cancer is their special concern and that, indeed, to worry about
cancer is their duty” (1779). Yet her conclusion suggests that despite the
“dilemmas of targeted health measures: they may be both a necessity and a
hazard” (1785). Her work begins to identify in the United States what Mos-
cucci and Comeau have shown in the British context, although she does not
go as far as labeling the attitude to women’s bodies as oncogenic. My book
argues first that such beliefs about cancer as a woman’s disease, created
in and by female bodies often in their reproductive organs, still inhere in
the United States and that those same beliefs are transported to developing
nations, like Kenya.
Part of the insistence on cancer as feminine connects to women’s capac-
ity in reproduction. Moscucci relays how “the emergence of ‘sex’ as a cat-
egory of scientific enquiry gave a different meaning to women’s perceived
liability to cancer. The rise of gynaecology, the ‘science of woman,’ legiti-
mated the belief that women’s bodies defined their social position and their
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