Of Mansplaining and Mastectomies

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Emma PiersonCredit

The man would tell me only that he had read my essay about the BRCA1 genetic mutations and wanted to talk to me. I was nervous as I sat across from him in the coffee shop; he was an older man who had traveled a long way to meet me, so I figured he had to say something important and too sensitive for email.

It turns out he wanted to explain to me that I didn’t know what I was talking about. I should preface what happened next by saying that BRCA1 mutations, which were made famous by Angelina Jolie and confer a very high risk of breast and ovarian cancer, are a subject on which I can claim some expertise. I worked for a year as a researcher at one of the first companies to offer BRCA testing; I have two master’s degrees focusing on computational biology; I carry the mutation.

“You really need to learn the math before you start making big decisions,” the man told me, referring to a figure I had cited in the essay. “That’s what I came here to tell you. How long ago did you find out?”

“What date is it?” I asked.

“January 28,” he said.

“One year, one month, and eight days ago,” I said.

He was briefly silent. “That’s precise,” he said.

“I like numbers,” I said.

If I had hoped to persuade him that I did, in fact, spend most of my waking hours thinking about either math or BRCA, I needn’t have bothered. He proceeded to lecture me on everything from his views on breasts (he wasn’t a breast guy) to the material used to fill reconstructed breasts (the skin of human cadavers, he claimed, at $5,000 a sheet) to nipple-saving surgery (I should look into it).

“Apparently there are different kinds of breast cancer,” he said. “There’s this one kind that’s super aggressive.”

Triple negative,” I said. “Not responsive to many forms of treatment. Particularly common in BRCA mutation carriers.”

“Er. . . yeah,” he said. “Maybe.”

“My mom had it,” I said.

I wish I could tell you this was an isolated incident. It is not. There was the man who asked me what the mutation did and then told me I had gotten it wrong. The man who lectured me on loss of heterozygosity, a fundamental cause of cancer which he had just learned about, not letting me get in a word to explain that I’d learned all this years ago, and it had so delighted me that I wrote about it in my journal. I could go on.

Here is the part where I tell you, first, that women do this, too, and second, that not all men do this. I cannot honestly tell you the first bit based on personal experience, though as a statistician I believe it. But I can testify that not all men do this. There was the man who told me only that he had found my essay deeply moving and shared his own experience with cancer; the coworker who, learning that I carried the mutation, stopped offering his own views and asked me about mine; the founder of a cancer genetics company who wrote down my questions and asked some of his own.

My claim is not that the mansplainers are a majority. The trouble is, like cancer cells, they seem to do unexpectedly well in certain environments: politics, for instance. I used to struggle to understand how male politicians ( Marco Rubio, Scott Walker, Mike Huckabee, Todd Akin, Vito Barbieri) could combine such certainty with such ignorance about women’s bodies. But having had my breasts and broken DNA explained to me by men who possess neither, I no longer wonder. (The dominance of men’s voices on women’s health issues also goes deeper than politics: a 2016 Women’s Media Center study found that most women’s health stories are written by men, who in turn quote mostly men.)

It would be too easy, though, to pretend that only Todd Akins mansplain. The men who lectured me all meant well; they were not misogynists. And many studies point to the general nature of their behavior. People are often overconfident about how much they know, and men are on average more confident than women. Worse, our world rewards overconfidence, especially in men: one study found that groups tended to choose overconfident narcissists as leaders. (Judging by Donald Trump, the American electorate is no exception to this rule.) In light of this, the behavior of my mansplainers seems not pathological but utterly predictable.

In contrast, I find that the people who are qualified to lecture me on my medical condition refrain from doing so. At my annual appointment at the Stanford Women’s Cancer Center, I was familiar with the research of the doctor doing my exam, so I asked her about it. When she learned I was a computational biologist, she ignored the fact that I was a patient on her table and spoke to me as a fellow academic. A few months later, I called the Center to fact check an essay; I wanted to know the age at which they would recommend a prophylactic mastectomy. But they would tell me only that it was a deeply personal decision. These people had literally done the studies on how likely you were to die if you got a mastectomy at each age, but they refused to make the leap from percentages to prescriptions.

I can understand why those with deep experience of BRCA might be less likely to offer strong prescriptions. The more I learn, the more intimidated I am by the complexity both of the underlying biology and the personal choices it raises, and the less willing I am to make categorical statements. David Dunning, a psychologist who studies overconfidence, notes that part of good judgment is the ability to recognize the limits of your knowledge — and that achieving this ideal is extremely difficult. So when I seek someone whose opinion I can trust, I look for two things. The easy part is expertise: can they teach me something I don’t know? The harder part is humility: can they recognize and admit when they don’t know?

Emma Pierson is a Rhodes Scholar and computer science PhD student at Stanford who writes about statistics at Obsession with Regression.