Bridging differential understanding of environmental risk of breast cancer: Why so hard?

Abstract

The incidence of breast cancer in the UK continues to increase: the lifetime risk for women is now one in nine. The reasons for this are hotly disputed by scientists (toxicologists, molecular biologists, geneticists, epidemiologists), breast cancer activists, and environmentalists, with a range of theories about breast cancer causation. There is a significant degree of disagreement between these various stakeholders, and a lack of effective dialogue among them. This paper reports on the findings of an innovative project investigating these issues. The study both explored the different standpoints taken up by the various players, and actively intervened to create opportunities for dialogue among them. Thus interviews were arranged with a range of policy makers, scientists, clinicians and health workers, breast cancer activists, environmentalists and others, in order for them to outline their understanding and theories of breast cancer causation. In addition, a series of ‘hearings’ were held where the different stakeholders had an opportunity to listen to each other and air their views, and allowed us to assess whether there could be any possibility of bridging the divide between their viewpoints. Our findings and analysis throw light on the factors that inhibit, and indeed might facilitate, effective communication of divergent ideas. We identify three epistemological positions which we call ‘traditionalist’, ‘dissident traditionalist’ and ‘dissident/challenge’, and conclude by suggesting that an appreciation of the stakeholders’ worldviews in this way, and the underlying ideological premises, provides an important indication as to why debates on breast cancer causation are so vociferous.