Abstract
In Sexualizing Cancer: HPV and the Politics of Cancer Prevention, Laura Mamo confronts readers with details of how medical researchers and pharmaceutical companies shaped knowledge about HPV-associated types of cancer. She delves into vaccine development and marketing, as well as screening tools and treatment protocol. Mamo also clarifies consequences of HPV-related medical technology developments intersecting with social constructions of gender, sexuality, and sexual health. Her work adds to scholarship on HPV infections and HPV-associated cancers as gendered, stigmatized, and (de)sexualized. A science studies scholar, Mamo draws on data collected from key conferences and interviews, in addition to analyzing pharmaceutical and medical research. Methodological strengths include access to high-level researchers and decision-makers, including participant-observation at influential health/medical conferences and detailed content-analysis of HPV marketing materials.
Mamo analyzes pharmaceutical decisions to desexualize the Gardasil vaccine: for example, the consequences of not clarifying HPV as a STI/STD and delaying access to boys/men by gendering HPV and the vaccine. She reminds readers that the initial rollout of “cervical cancer” vaccines intentionally obscured HPV as a sexually transmitted infection and analyzes the causes and consequences of this marketing strategy. Sex-based vaccination development decisions, including the use (and misuse) of herd immunity to justify initial HPV vaccination rollout only for girls/women, aligned with Merck’s marketing a “cervical cancer vaccine” to sell it as a cancer-prevention tool. Mamo’s compelling case would be strengthened by expanding on why standard practices in boys’/men’s health care do not consistently include annual sexual health exams, even in the current era of increased knowledge about HPV-related cancers in male bodies. Readers unfamiliar with HPV’s “skin-to-skin” transmission infecting not only cervices but also other “epithelial zones” will benefit from Mamo’s explanation of the etiology in chapter five (p. 144) which further justifies her call for the need to “queer” HPV-related cancers.
While the Introduction promises, “The book examines how viral causal association with disease establishes certain ways of talking about sex in relation to health, risk and disease” (p. 10), the book lacks data about sexual health education policies/practices. It is not clear on which research she bases her assertion that FDA approval of medications to treat herpes and HIV meant that these infections were “certainly no longer a source of moral shame or social stigma” (p. 186). To its credit, this book presents compelling arguments which complement prior research on HPV patients’ experiences and the ways in which gendered double standards of sexual morality reinforce STI stigma, negatively impacting those living with and working to prevent HPV-related cancers.
Mamo features a few quotes from HPV-cancer patients whose illness experiences have inspired their activism/advocacy work. She spotlights how medical researchers/clinicians determine best practices: including HPV prevention, HPV-related cancer detection, and cancer treatments. In this, the author illustrates tensions between optimal patient care and “precision” public health goals. However, Mamo’s analysis could be strengthened by addressing patients in the “unlucky” 10 percent (whose immune systems fail to clear the virus), including women fearing negative impacts on pregnancy and childbearing which may result from cervical cancer/treatments.
Chapter nine’s summary of unmet needs notes the lack of “low-tech” products which could protect sexual and reproductive health, but Mamo does not point to U.S. failures to fund/support sexual health education. In the final pages, she claims, “When it comes to HPV cancer prevention, young people are well versed in the links between HPV and various cancers, and many will likely be asking their dentists to check them for early signs of HPV-associated oropharyngeal cancers” (p. 257). Without citing sources, this optimistic assessment of American youth contrasts with Mamo’s reminder that U.S. HPV vaccination rates for adolescents remain significantly lower than the CDC target of 80 percent (p. 259).
With a level of scientific, medical, and pharmacological detail that will resonate with readers who have expertise, this book will also be useful to graduate-level scholars and faculty in medical sociology and public health. Mamo’s skillful writing is exemplified in chapter seven, where she walks readers through the processes by which HPV detection/diagnostics have shaped prevention via cancer-screening guidelines. She includes how/why tests originally focused on diagnosing pathology have become tests to “diagnose” risk. The practice of co-testing may be new to some readers, and Mamo presents a comprehensive overview and critique of screening tools and diagnostics (including the Pap test), as well as how they have evolved throughout decades of HPV-related cancer research.
Overall, Mamo’s insightful contribution to studies of biomedicalization highlights how gender and sexuality studies remain key to medical sociological understandings of HPV and HPV-related cancers. She makes a strong case for why we should not only question the medical research and heath care norms of HPV-related cancers but also consider the likely benefits of destigmatizing STIs/STDs and of implementing sex/gender inclusive approaches to reproductive and sexual health care as well as HPV-related oncology.