Bodily continuities and discontinuities the evidence of danger

The 'obvious' and 'logical' danger of family history were also made apparent in a number of more bodily ways, helping to confirm and confer an anticipatory embodiment to perceptions of risk. Here the sharing of physical symptoms, build and even personality or life experiences between related individuals provided further evidence of an underlying narrative of causation that strongly suggested the involvement of genes in some way;something which others examining 'lay' or patients' perceptions of genetic risk have also discussed (Richards and Hallowell 1997;Finkler 2000).

For instance, Lucy talked about the significance of similarities in physical build between herself and related individuals:

Lucy: I expect to get it, that's how I feel. All the woman in my mum's family we're all very much the same sort of build my sisters and me, I just feel like I'm very much like them, built like them. I wouldn't be in the least bit surprised if I got it. If I've inherited similar genes like them then I would be [more susceptible] and I'm probably more like my mum than my other two sisters.

For her, these bodily connections were more than enough evidence to suggest that there was a high probability she would develop the same condition. Donna also discussed the way physical parity between family members fuelled her disquiet. At the same time, this sharing of symptoms could not be separated from a sense of anxiety and trauma that had passed through the lives of many generations that included her mother and grandmother. For her, lived experiences became caught up with the anticipated danger of genes:

Donna: What makes it worse for me is the same year that my mum had the cancer that same month I found lumps in my own bust. And then there was my Gran... I can just remember it living with my mum just as it does with me and my sister.

These bodily connections could be seen as akin to what Nahman, in a different arena of reproductive medicine, refers to as kind 'part/whole telescoping of traits' across different temporal terrains and in the configuring of persons and patients (2005). The 'telescoping' work of patients in relation to breast cancer genetics operates in pursuit of, while helping to make real, an at-risk identity.

While physical similarities between related family members were seen by some as evidence of genetic risk, others expressed an underlying fear and uncertainty about their bodies, which also informed and fed the perceived need and rationale for referral to a specialist clinic. Although a sense of connection with others' bodies might provide the background to perceptions of risk for these persons, this was less the locus of concern than a sense of detachment and feelings of pathology about their own. For example, a number of women talked about the anxiety they felt in examining their breasts. For Chloe, this was directly linked to her desire to be seen by a specialist clinic.

Chloe: That's why I asked [for an appointment at the clinic] because I have a fear of it, because I'm quite scared of it happening. It actually makes me not want to check myself more. I know it's not logical but the fear is that this will be the time that you will find something. So that's why I asked to be checked by the nurses, so at least then you know I have someone doing it thoroughly.

Like Chloe, others felt distrustful not only of their own ability to examine their breasts but, because of what had happened to their relatives, also of the utility of doing so. As Jane pointed out:

The thing is my Nan's, when her lump was big enough to get worried about it, it was too late anyway and my mum she felt a little tiny one, but she had little growths and they were deep seated. We're all quite big and you can't feel, this is the thing at the back of all of our minds really, there was no sign, no feeling or change. It wasn't detected by feel, so this is something that's a big fear.

A more explicit indication of this bodily anxiety was the way a few women I met mentioned in passing, and without any direct questioning or remarks from myself, how they would, as a 'preventative' measure, consider having their breasts surgically removed at some point in the future. Towards the end of our first meeting, Faye's comments about undertaking surgery seemed to come out of the blue, suggesting this was something that lay semi-consciously behind some of her anxiety:

Faye: if someone said to me that I could have an operation, if it was cutting something off to eliminate the risk of breast cancer, I would definitely do it... you wouldn't have to think about it then.

Another woman's discussion of undertaking this procedure also emerged in what seemed an offhand way, after I asked about her expectations of care following the appointment at the clinic:

Deborah: well I don't know, obviously there are things to consider if there is a very high risk. You could almost voluntarily have a mastectomy and I know many women who've done that, get a boob job (laughing). I mean I know someone who's done it, they actually had a mastectomy then had their boobs re-built at the same time. To them they've taken away their risk of breast cancer. It seems fairly logical way round of doing it to me. I really feel like if I need to do something about it I'll go and have it, just to get rid of the risk.

Although there was a sense of flippancy about Deborah's discussion of 'boob jobs', like Faye's of-the-cuff remark, their comments seemed to disguise a deeper set of concerns about the risk of developing breast cancer. The sense of anxiety around breast examination and the ease and readiness with which several women I met discussed prophylactic mastectomy, as a possible option that they might undertake in the future, revealed the extent to which some expressed a sense of detachment and disconnection from their bodies. This might, in part, be understood in relation to the increasing routinisation and public profile of cosmetic procedures associated with the breast (Davis 2003). But it also cannot be abstracted from the way an ethic of preventive health is embedded in a message about the need for routine and regular monitoring and vigilance. Fear and anxiety about the body were clearly linked to how and why those I met engaged in efforts to make genetic risk visible, and tangible. In this sense, the bodily parities which served to make genetic risk manifest, for some, must also be understood in relation to the articulations of disembodiment with which, for others, was an equally powerful source and manifestation of anxiety.

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