Invisible Risk in a City of Medical Excellence: Gender, Stigma, and BRCA Testing Among Menin Boston
- Zoe Simonte
- Mar 19
- 9 min read
Introduction
BRCA gene mutations are most commonly discussed in relation to women’s health,
particularly breast and ovarian cancer. Therefore, women are frequently framed as the main
subjects of risk and responsibility in BRCA testing-related public awareness campaigns, clinical
messaging, and genetic counseling pathways. Men are much less likely to seek BRCA testing,
despite the fact that mutations carry significant health implications for men as well, including
increased risks of prostate, breast, and pancreatic cancers. This disparity suggests that gender
norms, stigma, and the social construction of genetic risk influence health behavior and cannot
be solely attributed to medical relevance.
When analyzing gender-based disparities in BRCA testing, Boston provides a particularly
illuminating context. The city is home to some of the most cutting-edge medical facilities in the
world, including Massachusetts General Hospital, Brigham and Women’s Hospital, and
Dana-Farber Cancer Institute. Together, these institutions form a global hub of elite medicine and
genetic research. In this setting, genetic testing is widely available and increasingly normalized.
Given this, it is not possible to attribute ongoing disparities in BRCA testing to a lack of access
or technological limitations alone. Instead, the persistence of these disparities in a city defined by
medical abundance emphasizes the impact of social and cultural factors on men’s engagement in
preventive healthcare.
BRCA1 and BRCA2 are genes that help repair damaged DNA and protect the body from
developing certain cancers. Mutations in these genes are inherited by some people, and they
greatly raise the risk of cancers such as pancreatic, ovarian, prostate, and breast cancer in both
men and women. BRCA testing is typically considered when a relative has previously tested
positive for a mutation or when there is a significant family history of cancer. Instead of being
used in response to symptoms, testing is frequently used as a form of preventive care because it
can identify risk before illness even develops (National Cancer Institute 2023).
This paper examines BRCA testing among men in Boston as a case study of the
relationship between gender and health. Drawing on course concepts, including gender as a
social determinant of health, fundamental social causes, and social constructionism, I argue that
men’s lower uptake of BRCA testing reflects gendered expectations that frame genetic risk as
feminine and discourage men from engaging in preventive care. By focusing on preventive care
rather than illness outcomes alone, this analysis demonstrates how gender structures health
behaviors long before disease manifests.
Theoretical Framework
Sociological approaches to health emphasize that health behaviors and outcomes are
shaped not by biology alone, but by social structures, norms, and institutions. This paper draws
primarily on social constructionist approaches to health, while also incorporating insights from
gender as a social determinant of health and the theory of fundamental social causes.
First, by influencing how individuals perceive risk, accountability, and appropriate health
behavior, gender serves as a social determinant of health. It has been demonstrated that men are
deterred from participating in preventive healthcare by gendered norms surrounding masculinity,
2such as strength, emotional restraint, and self-reliance. Because genetic risk for BRCA mutations
has been culturally linked to women’s health, BRCA testing may be viewed within this
framework as being at odds with masculine expectations. According to Kempner, “legitimacy
also refers to the ways in which institutional attention and other resources are allocated to the
treatment of various diagnoses” (2014:12). Gender influences which bodies and risks are viewed
as legitimate targets of medical attention when it comes to BRCA testing.
Second, the reason why medical advancements do not always result in the elimination of
health inequality is explained by the theory of fundamental social causes (Link and Phelan
1996). Link and Phelan contend that access to and utilization of what they term “flexible
resources”—including knowledge, social connections, and institutional authority used to prevent
health risks or mitigate disease—are shaped by social factors such as status and power. Social
conditions determine who recognizes and uses new technologies, like genetic testing, so
disparities continue even after they become widely accessible. Despite the high institutional
availability of preventive genetic care, gender operates as one of the structural factors that shapes
men’s access to and engagement with these flexible resources.
Finally, social constructionist perspectives emphasize that health risks are shaped by
cultural meanings and institutional practices rather than by biomedical mechanisms alone. As
Conrad and Barker (2010) point out, professional authority, media representation, and discourse
all play a role in socially defining illness and risk. Through public messaging, clinical pathways,
and awareness campaigns, BRCA mutations have been socially constructed as a problem that
affects women. Because of this framing, patterns of recognition and preventive behavior are
shaped, making men’s genetic risk less obvious.
Together, these frameworks shift attention away from individual choice and toward the
social structures and meanings that shape men’s engagement with BRCA testing.
Literature Review: Gender and Preventive Health Behavior
Scholarship on gender and health consistently demonstrates that men are less likely than
women to engage in preventive care. Research finds that norms of masculinity such as
self-reliance, emotional restraint, and risk tolerance shape men’s help-seeking behaviors and
discourage engagement with medical services, especially in the absence of symptoms.
Particularly vulnerable to these gendered expectations are preventive health practices, which call
on individuals to take action on potential future risk (Bird and Rieker 2008; Wharton 2009).
Additionally, genetic testing research indicates that BRCA mutations have historically
been framed within women’s health discourse. The idea that BRCA mutations are mainly
relevant to women has been strengthened by clinical guidelines, advocacy campaigns, and public
awareness initiatives that have focused on breast and ovarian cancer. Men with BRCA mutations
are less commonly targeted in genetic counseling outreach and public health messaging, despite
the fact that they have significantly increased risks of breast, prostate, and pancreatic cancer.
Access by itself does not ensure utilization, according to studies on health inequality.
Social meanings and institutional structures influence who perceives risk and takes action, even
in the case of widely accessible medical technologies (Link and Phelan 1996). BRCA testing and
other preventive measures are part of larger cultural narratives about legitimacy, vulnerability,
and responsibility. Men may be less inclined to view genetic risk as relevant to their own health
when it is culturally encoded as feminine.
Thus, existing literature identifies three recurring themes: the persistence of inequality in
the face of technological advancement, the feminization of BRCA-related discourse, and men’s
lower participation in preventive care. Less focus has been placed on how these dynamics are
reinforced in resource-rich settings by institutional messaging and local healthcare environments.
By examining BRCA testing among men in Boston, a city known for its abundance of medical
services, this paper investigates how gendered meanings shape preventive health behavior even
where structural access barriers are minimal.
Analysis: Gender, Institutional Messaging, and BRCA Testing in Boston
Despite Boston’s position as a leader in genetic medicine, BRCA testing remains institutionally framed as a women’s health issue. This analysis uses online informational graphics created by Boston-based medical institutions and research projects, social media posts, and hospital websites to investigate how genetic risk is publicly communicated. These resources serve as media texts that reveal how institutions implicitly signal who is expected to engage in preventive genetic care and visually and linguistically construct BRCA risk.
Across institutional graphics and online resources, BRCA testing is consistently depicted using feminized language and imagery in both institutional graphics and online materials. In order to reinforce the connection between BRCA mutations and women’s bodies, visual materials often use pink color schemes, breast cancer ribbons, and images of women. Campaigns urge people to evaluate their risk or see a physician, yet these messages are visually anchored in symbols that have been historically tied to women’s health. Men are rarely portrayed as primary subjects of risk, even when male-specific cancers like prostate cancer are discussed.
As shown in Figure 1, BRCA testing is framed within a pink color palette and explicitly
tied to Breast Cancer Awareness Month, visually reinforcing the association between BRCA
mutations and women’s health. Although prostate cancer is mentioned in the text, the imagery
and symbolic cues center breast cancer iconography, subtly indicating who is imagined as the
main subject of risk.
Figure 2 further illustrates this pattern. The promotional language explicitly frames BRCA testing as central to “women’s health,” accompanied by pink coloring once again, and an image of a woman positioned as the visual focal point. The headline, “Why BRCA Testing is a Must for Women’s Health,” reinforces the idea that BRCA mutations are primarily a female concern by directly linking genetic risk to female identity. Men are not specifically mentioned or portrayed as pertinent subjects of risk. The content shapes who is invited to consider themselves as suitable candidates for preventive care by limiting the imagined audience for genetic testing through both visual and textual cues.
This argument does not question the importance of BRCA testing for women or minimize
the risk they face; rather, it examines how focusing almost entirely on women can lead to men’s
risk being overlooked.
This gendered framing is further reinforced by language. In order to place BRCA testing
within women-centered narratives of familial responsibility, informational prompts frequently
inquire about a person’s family history of breast or ovarian cancer. Testing is rarely presented as
a component of men’s preventive health, and men are hardly ever specifically identified as
at-risk subjects. This absence is striking considering clinical evidence that BRCA mutations
dramatically raise men’s risk of breast, pancreatic, and prostate cancer. Through both imagery
and wording, institutional messaging renders men’s genetic vulnerability less visible.
This effect is also amplified by institutional placement. Assumptions regarding who
should manage genetic risk are reinforced by the frequent inclusion of BRCA information in
women’s health clinics, breast cancer centers, and awareness campaigns. Even in areas with
widespread access to genetic services, men may be given the impression that testing is not for
them if they encounter it primarily in feminized medical settings. Institutional structures give
legitimacy to men and women unevenly in this way.
These trends show how institutional discourse and visual representation are used to
socially construct health risk. As Link and Phelan (1996:472) argue, “social conditions expose
people to risk factors, and those risk factors cause disease, thereby producing patterns of disease
in populations.” Institutional messaging operates as one such social condition, shaping who is
recognized as at risk and who is encouraged to act. When BRCA risk is culturally coded as
feminine, men’s engagement with preventive testing is filtered through gendered meanings rather
than determined solely by clinical relevance.
Masculinity norms further intensify these dynamics. Expectations of strength and
independence may clash with the need for individuals to recognize their own vulnerability and
7take action on uncertain future risk in order to receive preventive care. When BRCA testing is
visually and institutionally framed as feminine, men may perceive testing as socially illegitimate
or unnecessary. Gender thus operates not only as a determinant of access, but as a determinant of
recognition, structuring who sees themselves as an appropriate subject of preventive care.
Together, this analysis demonstrates that disparities persist not because of insufficient
medical knowledge or technological limitations, but because gendered meanings are embedded
in institutional communication and broader public health messaging. In a city defined by medical
abundance, it is these social meanings—not access alone—that shape men’s engagement with
preventive genetic medicine.
Conclusion
Examining BRCA testing among men in Boston shows how, even in situations where
access to healthcare is exceptional, gender still influences health-related behavior. Men’s lower
uptake of BRCA testing demonstrates that availability alone does not determine utilization, even
though Boston’s top medical institutions offer cutting-edge genetic services. Rather, how
preventive care is understood and implemented is shaped by institutional messaging, ingrained
gender norms, and the social construction of genetic risk.
This case emphasizes how crucial it is to view gender as a structural determinant of
health as opposed to merely an individual trait. Gender influences not only who seeks care but
also who believes they should be the focus of preventive intervention through institutional
framing, cultural expectations of masculinity, and the unequal assignment of legitimacy to
various bodies and risks. Genetic testing is one practice that shows how inequality shapes whose
vulnerability is recognized and whose is hidden long before illness manifests.
In a city defined by genetic possibility, BRCA risk remains unevenly imaginable: genetic
risk may be universal, but its recognition is not. Until risk itself is reframed, preventive medicine
will continue to protect some bodies more fully than others.
Works Cited
Bird, Chloe E., and Patricia P. Rieker. 2008. Gender and Health: The Effects of Constrained
Choices and Social Policies. Cambridge: Cambridge University Press.
BRCA Gene Changes: Cancer Risk and Genetic Testing Fact Sheet. 2024.
Boston College BRCA [@BRCAStudyBC]. 2022. “October Is Breast Cancer Awareness Month!
Know Your Risks!” X (formerly Twitter), October 4.
Conrad, Peter, and Kristin K. Barker. 2010. “The Social Construction of Illness: Key Insights and
Policy Implications.” Journal of Health and Social Behavior 51:S67–79.
Kempner, Joanna. 2014. Not Tonight: Migraine and the Politics of Gender and Health. Chicago,
IL: University of Chicago Press.
Link, B. G., and J. C. Phelan. 1996. “Understanding Sociodemographic Differences in
Health–the Role of Fundamental Social Causes.” American Journal of Public Health
86(4):471–73. doi:10.2105/AJPH.86.4.471.
Progenics Labs. 2024. “Behind the Genes: Why BRCA Testing Is a Must for Women’s Health.”
Wharton, Amy S. 2009. “The Sociology of Emotional Labor.” Annual Review of Sociology
35(1):147–65. doi:10.1146/annurev-soc-070308-115944.
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