What is a breast worth?
Olivia Munn, cancer, capitalism, and the danger of having low-value boobs
“If we are to translate the silence surrounding breast cancer into language and action against this scourge, then the first step is that women with mastectomies must become visible to each other.” Audre Lorde, The Cancer Diaries
Olivia Munn’s recent disclosure of her breast cancer caused some ripples among the community of breast cancer patients I’ve become a part of. But aside from the sighs of familiarity at her stories of the trauma and numbness of diagnosis and treatment, many of us experienced an unexpected emotional response: rage.
Munn, a wealthy and beautiful Hollywood celebrity, had an OBGYN who spent enough time with her to suspect that when Munn’s mammogram and genetic testing turned up normal, something might still be amiss. So, according to Munn, her doctor ran a breast cancer risk assessment test, which led to Munn’s cancer being discovered.
Zero people I know who’ve had cancer were offered this risk assessment test. Most of us see a gynecologist once a year or so, and we’re lucky to get ten minutes with the doctor during those appointments. Our gynecologists juggle hundreds and sometimes thousands of patients, and with mammograms still being the standard diagnostic tool, a normal mammogram result is usually the end of any conversation about cancer.
That’s what happened to me – congrats, normal mammogram, come back in two years. If I hadn’t felt something physically amiss, my stage 3 cancer would likely have kept growing. I have a good job with good benefits thanks to my union, but good benefits for a lecturer in the public university system look different than good benefits do for a Hollywood celebrity. I don’t blame the radiologist for missing my cancer on the mammogram because it really was impossible to see – my surgical oncologist showed me the images and it was a wall of white snow. You could have hidden a garden gnome or Waldo in there.
I do, however, blame capitalism for the fact that neither I nor any person I’ve met with breast cancer got the same treatment as Olivia Munn. Some of these people have much rarer and more aggressive forms of breast cancer, some have immediate family members with breast cancer, and still, no doctor sat down with them and said “we should probably run this test.”
Mammograms are cheap and easy; ultrasounds, MRIs, and genetic testing are not. The “mammograms save lives” messaging we get bombarded with is true to a certain extent, and many people’s early stage cancers are indeed found in this way. But for the 50% of people with breasts whose breasts are dense, mammograms have deep flaws.
If you have an HMO, and your doctor visits are basically drive through, you’ll get a mammogram, and that’s about it. If you have a PPO, and you go to the kind of medical center that has valet parking and a fountain in the lobby (I’ve been to LA and some of the hospitals look like spas), you’re more likely to get the kind of doctor Olivia Munn has. That can be the difference between stage 1 cancer, like she had, where you can avoid chemo and sometimes even radiation, and what’s called de novo cancer, which is cancer so advanced that it’s stage 4 at diagnosis.
Saint Agatha of Sicily, whose breasts were cut off by the Romans in the 3rd century. She’s the patron saint of breast cancer patients. Painting by Francisco de Zurbarán.
Olivia Munn’s breasts are part of her job, so Olivia Munn’s breasts are worth money. In the Instagram post where she revealed her diagnosis, she mentioned that her double mastectomy surgery took ten hours, which likely means that like many people, she had a reconstructive surgery at the same time as the mastectomy. I’m not judging that choice. If she’d had a flat closure, it would likely have implications for her career. But it’s likely she had top plastic surgeons working on her reconstruction, and it’s likely her post-mastectomy breasts will be nearly identical to her pre-mastectomy ones.
How much is a breast worth, anyway? In May, I’ll start a medication I have to take for two years that should hopefully help prevent my cancer from returning. This medication, without insurance, costs $10,000 a month. This is a criminal amount of money for pills I need to stay alive. If I lose my job and can’t afford it, what happens then? I started to add up some of the bills I got for surgery, chemo, radiation and pharmaceuticals, and the last eight months of treatment added up to more than the cost of four years of Stanford tuition1. If it wasn’t for the union, I’d be on GoFundMe begging for donations like so many other people smothered under medical debt.
But my breasts were never worth as much as Olivia Munn’s. In a society where beauty is privilege and money can determine a cancer patient’s survival, my breasts and those of most people whose diagnoses were missed, delayed or incorrect were worth nothing. Our low-value breasts meant low-value diagnosis. They were disposable, and that’s a grim reckoning in a time when science and medicine are advancing at light speed. But the first people on the medical rocket ship will always be the ones who can afford the ticket.
Of course I empathize with Olivia Munn to a certain degree. We’re in the same shitty situation, after all. But for me and many other breast cancer patients, there’s a degree of bitterness in hearing about how some people essentially get the Tesla of diagnosis and treatment while the rest of us are dealing with a dented old Subaru at best. Until poor people and middle class people are all offered the same diagnostic tools, more of us with low-value breasts will continue to die in greater numbers. And I’m no law enforcement officer, but I’m pretty sure that’s a crime.
Here’s a video of Stanford’s mascot beating up UC Berkeley’s mascot. This is a metaphor for class struggle.